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11 hours ago
Stefannie Sanchez-Flores
Week 8 Initial Discussion on GAD
COLLAPSE
Week 8 Initial Discussion
The interacted media presents a middle age white male that comes in with complaints of anxiety
attacks. He has a history of hypertension, obesity, and occasional ETOH use due to work and
private life-related stress. The patient scored 26 on the Hamilton Anxiety Rating Scale (HAMA), which measures the severity of anxiety symptoms (University of Florida Health, 2007). The
patient is diagnosed with generalized anxiety disorder and has no history of psychotropic
medication usage.
Generalized anxiety disorder (GAD) is a chronic disorder of unrealistic or excessive worrying
that causes anxiety; most patients with GAD also have a secondary psychiatric disorder such as
depression (Rosenthal & Burchum, 2021). Drugs and psychotherapy are the treatments of choice
for GAD.
In this case, the patient can begin psychotherapy and Buspirone 10mg PO BID. Since the patient
admits to drinking alcohol daily, Buspirone, an anxiolytic, has no potential abuse as it does not
depress the central nervous system therefore safe to use in this case. Also, Buspirone is known
not to cause physical or psychological dependence or medication tolerance (Rosenthal &
Burchum, 2021). The only negative is that positive effects develop slowly, and proper response
to the drug may take weeks.
If the patient does not respond to Buspirone or has adverse effects, stop the intake, and start a
Selective serotonin reuptake inhibitor (SSRI) or a Serotonin-Norepinephrine reuptake inhibitor
(SNRI) instead. Treatment with SSRI or SNRI is usually safe in older adults and effective in
GAD care whether depression is present or not (Salimi Kordasiabi et al., 2020). These
antidepressants also take time for anxiolytic effects to develop. Therefore, with both
medications, educate patients on taking medicines as directed without stopping for a month or
more to see the results.
The last choice for GAD treatment would be the older antidepressants such as Tricyclic
Antidepressant (TCAs) or Monoamine Oxidase Inhibitor (MAOIs), as they are less tolerated and
have more negative side effects and are usually only used if the patient does not respond to the
first-choice drugs such as the SSRI, SNRI, or Buspirone (Rosenthal & Burchum, 2021).
References
Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice
nurses and physician assistants (2nd ed.). St. Louis, MO: Elsevier.
Salimi Kordasiabi, A., Daneshzad, T., & Aminpour, A. (2020). Comparative study of the
efficacy of cognitive-behavioral therapy and sertraline in generalized anxiety disorder. Tabari
Biomedical Student Research Journal. https://doi.org/10.18502/tbsrj.v2i1.2580
The University of Florida Health. (2007). Hamiltonanxiety [PDF]. https://dcf.psychiatry.ufl.edu/files/2011/05/HAMILTON-ANXIETY.pdf
Student 2
14 hours ago
Edwin Pineda
Initial Post Week 8
COLLAPSE
Week 8 post
Introduction
Generalized anxiety disorder (GAD) is prevalent in approximately 4.1 to 6. 6 % and is a
bit higher in women than in men (McCance & Huether, 2018). GAD can manifest in childhood
but is more commonly known to emerge in young adulthood. Symptoms may include irritability,
fatigue, difficulty concentrating, sleeplessness, and restlessness. Symptoms tend to decrease with
age. Patients with GAD may abuse drugs to self-medicate (McCance & Huether, 2018). GAD
may occur as a comorbidity to various disorders, further complicating treatment.
Pharmacokinetic and Pharmacodynamics in Treatment of GAD
GAD must be diagnosed before beginning pharmacotherapeutic treatment. Therefore the
patient must display at least six significant symptoms for six months. 5-HT/norepinephrine
reuptake inhibitors, like venlafaxine or the SSRIs paroxetine and escitalopram, are the first line
of defense when beginning pharmacological treatment of GAD (Thom et al., 2019). The patient
may exhibit signs of improvement within one week of treatment initiation; however, clinical
efficacy may take up to 2 weeks (Rosenthal DNP ACNP, Laura et al., 2020). Venlafaxine
(Effexor XR) is the first SNRI approved for GAD and other disorders. The drug inhibits NE and
5-HT reuptake and dopamine. Venlafaxine can be taken on a full or empty stomach. It is
metabolized in the liver. It is contraindicated to be used with MAOIs because it can be
fatal(Rosenthal DNP ACNP, Laura et al., 2020).
Conclusion
The treatment for GAD should also be combined with psychotherapeutic interventions to
help decrease some symptoms. Venlafaxine should not be discontinued abruptly, and the dose
should be tapered over a few weeks to reduce physical withdrawal symptoms.
References
McCance, K. L., & Huether, S. E. (2018). Pathophysiology: The biologic basis for disease in
adults and children (8th ed.). Mosby.
Rosenthal DNP ACNP, Laura, Burchum DNSc APRN BC, Jacqueline, & Burchum DNSc APRN
BC, Jacqueline. (2020). Lehne’s pharmacotherapeutics for advanced practice nurses
and physician assistants (2nd ed.). Saunders.
Thom, R. P., Keary, C. J., Waxler, J. L., Pober, B. R., & McDougle, C. J. (2019). Buspirone for
the treatment of generalized anxiety disorder in williams syndrome: A case
series. Journal of Autism and Developmental Disorders, 50(2), 676–682. Retrieved July
20, 2022, from https://doi.org/10.1007/s10803-019-04301-9

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