NURS 6521 COMPARING AND CONTRASTING PHARMACOLOGIC OPTIONS FOR THE TREATMENT OF GENERALIZED ANXIETY DISORDER 

Walden University NURS 6521 COMPARING AND CONTRASTING PHARMACOLOGIC OPTIONS FOR THE TREATMENT OF GENERALIZED ANXIETY DISORDER – Step-By-Step Guide

This guide will demonstrate how to complete the Walden University NURS 6521 COMPARING AND CONTRASTING PHARMACOLOGIC OPTIONS FOR THE TREATMENT OF GENERALIZED ANXIETY DISORDER  assignment based on general principles of academic writing. Here, we will show you the A, B, Cs of completing an academic paper, irrespective of the instructions. After guiding you through what to do, the guide will leave one or two sample essays at the end to highlight the various sections discussed below.

How to Research and Prepare for NURS 6521 COMPARING AND CONTRASTING PHARMACOLOGIC OPTIONS FOR THE TREATMENT OF GENERALIZED ANXIETY DISORDER 

Whether one passes or fails an academic assignment such as the Walden University NURS 6521 COMPARING AND CONTRASTING PHARMACOLOGIC OPTIONS FOR THE TREATMENT OF GENERALIZED ANXIETY DISORDER  depends on the preparation done beforehand. The first thing to do once you receive an assignment is to quickly skim through the requirements. Once that is done, start going through the instructions one by one to clearly understand what the instructor wants. The most important thing here is to understand the required format—whether it is APA, MLA, Chicago, etc.

After understanding the requirements of the paper, the next phase is to gather relevant materials. The first place to start the research process is the weekly resources. Go through the resources provided in the instructions to determine which ones fit the assignment. After reviewing the provided resources, use the university library to search for additional resources. After gathering sufficient and necessary resources, you are now ready to start drafting your paper.

How to Write the Introduction for NURS 6521 COMPARING AND CONTRASTING PHARMACOLOGIC OPTIONS FOR THE TREATMENT OF GENERALIZED ANXIETY DISORDER 

The introduction for the Walden University NURS 6521 COMPARING AND CONTRASTING PHARMACOLOGIC OPTIONS FOR THE TREATMENT OF GENERALIZED ANXIETY DISORDER  is where you tell the instructor what your paper will encompass. In three to four statements, highlight the important points that will form the basis of your paper. Here, you can include statistics to show the importance of the topic you will be discussing. At the end of the introduction, write a clear purpose statement outlining what exactly will be contained in the paper. This statement will start with “The purpose of this paper…” and then proceed to outline the various sections of the instructions.

How to Write the Body for NURS 6521 COMPARING AND CONTRASTING PHARMACOLOGIC OPTIONS FOR THE TREATMENT OF GENERALIZED ANXIETY DISORDER 

After the introduction, move into the main part of the NURS 6521 COMPARING AND CONTRASTING PHARMACOLOGIC OPTIONS FOR THE TREATMENT OF GENERALIZED ANXIETY DISORDER  assignment, which is the body. Given that the paper you will be writing is not experimental, the way you organize the headings and subheadings of your paper is critically important. In some cases, you might have to use more subheadings to properly organize the assignment. The organization will depend on the rubric provided. Carefully examine the rubric, as it will contain all the detailed requirements of the assignment. Sometimes, the rubric will have information that the normal instructions lack.

Another important factor to consider at this point is how to do citations. In-text citations are fundamental as they support the arguments and points you make in the paper. At this point, the resources gathered at the beginning will come in handy. Integrating the ideas of the authors with your own will ensure that you produce a comprehensive paper. Also, follow the given citation format. In most cases, APA 7 is the preferred format for nursing assignments.

How to Write the Conclusion for NURS 6521 COMPARING AND CONTRASTING PHARMACOLOGIC OPTIONS FOR THE TREATMENT OF GENERALIZED ANXIETY DISORDER 

After completing the main sections, write the conclusion of your paper. The conclusion is a summary of the main points you made in your paper. However, you need to rewrite the points and not simply copy and paste them. By restating the points from each subheading, you will provide a nuanced overview of the assignment to the reader.

How to Format the References List for NURS 6521 COMPARING AND CONTRASTING PHARMACOLOGIC OPTIONS FOR THE TREATMENT OF GENERALIZED ANXIETY DISORDER 

The very last part of your paper involves listing the sources used in your paper. These sources should be listed in alphabetical order and double-spaced. Additionally, use a hanging indent for each source that appears in this list. Lastly, only the sources cited within the body of the paper should appear here.

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Sample Answer for NURS 6521 COMPARING AND CONTRASTING PHARMACOLOGIC OPTIONS FOR THE TREATMENT OF GENERALIZED ANXIETY DISORDER 

Generalized anxiety disorder (GAD), a chronic condition, frequently starts in adolescence or the early stages of adulthood and lasts the rest of one’s life (Strawn et al., 2018). The medications include selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). These are Antianxiolytics, which typically affect the brain’s neurotransmitters inhabiting reuptakes in terms of their pharmacokinetics and pharmacodynamics.  

Selective Serotonin Reuptake Inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are considered the first line of drugs to treat generalized anxiety disorder. The main mechanism of action of SSRIs is to prevent presynaptic serotonin reuptake at the serotonin transporter, which raises serotonin levels at the postsynaptic membrane in the serotonergic synapse (Edinoff et al., 2021). These medications include fluoxetine, Citalopram, escitalopram, paroxetine, sertraline, and fluvoxamine. These medications treat generalized anxiety disorder using the same mechanism. However, each of them has unique pharmacokinetics and pharmacodynamics. The half-life of each drug varies, for instance, fluoxetine’s half-life is 1 to 4 days, whereas Citalopram’s half-life is 26 hours. SSRIs tend to be metabolized by cytochrome P450 in the liver. SSRIs tend to have better specificity than MAOIs and TCAs, which makes them the drug of choice for treating depression as well. The side effects of these medications include weight gain, sleepiness, and dry mouth. 

Different Treatment Options:  

Antihistamines, such as Hydroxyzine are one of the most common FDA-approved medications that could be used for anxiety as well. Antihistamines, such as hydroxyzine, are histamine-1 receptor (H1) blockers that are frequently used as an alternative to benzodiazepines for anxiety, panic attacks, and sleeplessness (Garakani et al., 2020). Though antihistamines are used for allergy symptoms, Hydroxyzine and Diphenhydramine (Benadryl) may be safer for adolescents and in pregnancy for anxiety symptoms as well. Aside from side effects including dry mouth, constipation, and sedation, antihistamines are generally well tolerated. 

Cannabis may have potential therapeutic effects in treating anxiety. Cannabis is known for its pleasurable and calming effects. Additionally, preclinical studies show that CBD has antidepressant effects after both acute and long-term dosing (Martin et al., 2021). The use of cannabis and other cannabinoids is accepted as a safe means of promoting relaxation and reducing anxiety, however there is not much literature or evidence that supports that.  

Benzodiazepines are one the treatment for anxiety and remain one of the most commonly used classes of psychiatric drugs worldwide. Benzodiazepines, which function as GABA-A agonists, are very adaptable drugs that can be administered for a variety of disorders. They can be used for mania, insomnia, anxiety, agitation, and seizures. However, antidepressant effectiveness may be decreased by long-term usage of benzodiazepines to treat anxiety and co-morbid depression (Garakani et al., 2020).  

 Edinoff, A. N., Akuly, H. A., Hanna, T. A., Ochoa, C. O., Patti, S. J., Ghaffar, Y. A., Kaye, A. D., Viswanath, O., Urits, I., Boyer, A. G., Cornett, E. M., & Kaye, A. M. (2021, August 5). Selective serotonin reuptake inhibitors and adverse effects: A narrative review. Neurology international. Retrieved January 14, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8395812/ 

Garakani, A., Murrough, J. W., Freire, R. C., Thom, R. P., Larkin, K., Buono, F. D., &Iosifescu, D. V. (2020, December 23). Pharmacotherapy of anxiety disorders: Current and emerging treatment options. Frontiers in psychiatry. Retrieved January 15, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7786299/#:~:text=in%20anxiety%20disorders.-,Antihistamines,approved%20for%20use%20in%20anxiety. 

Martin, E. L., Strickland, J. C., Schlienz, N. J., Munson, J., Jackson, H., Bonn-Miller, M. O., &Vandrey, R. (2021, September 9). Antidepressant and anxiolytic effects of medicinal cannabis use in an observational trial. Frontiers in psychiatry. Retrieved January 15, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8458732/ 

Strawn, J. R., Geracioti, L., Rajdev, N., Clemenza, K., & Levine, A. (2018, July). Pharmacotherapy for generalized anxiety disorder in adult and pediatric patients: An evidence-based treatment review. Expert opinion on pharmacotherapy. Retrieved January 14, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6340395 

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Sample Answer 2 for NURS 6521 COMPARING AND CONTRASTING PHARMACOLOGIC OPTIONS FOR THE TREATMENT OF GENERALIZED ANXIETY DISORDER 

GAD is a chronic condition characterized by uncontrollable worrying. (Rosenthal 2018, p.243). Most patients with GAD also have another psychiatric disorder, depression.  It usually involves a persistent feeling of anxiety or dread that interferes with how you live your life. “It is not the same as occasionally worrying about things or experiencing anxiety due to stressful life events. People living with GAD experience frequent anxiety for months, if not years. GAD develops slowly. It often starts around age 30, although it can occur in childhood. The disorder is more common in women than in men.” (NIH of Mental Health). Good news, it’s treatable. SSRIs and SNRIs are the first line treatment for GAD.  

Of the 13 benzodiazepines available, 6 are approved for anxiety. Benzodiazepines are second-line drugs for anxiety called central nervous system depressants. “They raise levels of an amino acid in your brain called gamma-aminobutyric acid (GABA). blocks other activity in your brain, which helps you feel calm and can make you sleepy. Anxiolytic effects develop slowly with first initial responses to show within a week.They are distinguished by their pharmacokinetics and their metabolism to a large extent; condition their use [3]. These are weak acids of variable constant dissociation with a high lipophilicity, which allows rapid passage through the membranes (blood-brain and placental barriers, and passage in breast milk). ” (Bourin, 2018). 

Pregabalin can be used for epilepsy and neuropathy pain, as well as GAD. Pregabalin exerts its anxiolytic effects by potently binding to the alpha2-delta subunit of the voltage-gated N-and P/Q-type calcium channels in central nervous system (CNS) tissue. This causes a decrease in presynaptic calcium currents which modulates the release of neurotransmitters, including glutamate, substance P, and calcitonin gene-related peptide from excited neurons. A decrease in scores on the Hamilton Anxiety Rating Scale was noted with pregabalin within a week and was effective on both somatic and psychic symptoms; shown to be effective in patients over 65 years of age.  

  References 

Bourin, M. (2018, February 12). Clinical Pharmacology of anxiolytics. Archives of Depression and Anxiety. Retrieved January 16, 2023, from https://www.peertechzpublications.com/articles/ADA-4-129.phpLinks to an external site. 

Rosenthal, L. D., &Burchum, J. R. (2021). Lehne’spharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier. 

Sample Answer 3 for NURS 6521 COMPARING AND CONTRASTING PHARMACOLOGIC OPTIONS FOR THE TREATMENT OF GENERALIZED ANXIETY DISORDER 

Anxiety is a type of medical condition whereby the person feels worried, uneasy, nervous, or stressed. According to the American Psychiatric Association, anxiety is defined as an emotion characterized by feelings of tension, worried thoughts, and physical changes like increased blood pressure. The Diagnostic and Statistical Manual of Mental Health Disorders (DSM-V) classifies anxiety disorders into several main types such as generalized anxiety disorder, panic anxiety, and selective mutism. 

Generalized anxiety disorder (GAD) is a type of anxiety that makes a person feel constantly worried. These worrying feelings are about anything and they can last for more than six months. Other symptoms of GAD include nausea, fatigue, trembling, urinating often, sweating hot flashes, irritability, and trouble breathing (Andrews et al., 2010). People diagnosed with GAD are subjected to psychotherapy and medical treatment. The medications used to treat GAD are classified as anxiolytic medications which are a group of drugs used to prevent or treat anxiety symptoms or disorders. They are sometimes called anti-anxiety medications or minor tranquilizers. Anxiolytic medications are habit-forming and can lead to dependency or a substance use disorder. For this reason, they’re often only prescribed for a short amount of time. Some of the anxiolytic medications include SSRIs (sertraline, fluoxetine, paroxetine, and citalopram). Selective serotonin-norepinephrine reuptake inhibitors (SNRI) such as Venlafaxine and Duloxetine have been approved by FDA as a treatment for GAD. Benzodiazepines (alprazolam) and other types of anxiolytic medications such as Second-generation antipsychotics (SGAs). 

    Before prescribing these drugs to any patient, it is important to understand their pharmacokinetics and pharmacodynamics. For example, the pharmacokinetics and pharmacodynamics of benzodiazepines involve the increase of g-aminobutyric acid (GABA) inhibitory impulses in the central nervous system mediated via benzodiazepine receptors. GABA blocks other activity in your brain, which helps you feel calm and can make you sleepy.  

 The structure of benzodiazepines is made up of a benzene ring fused to a seven-membered 1,4 diazepine ring. Alprazolam is administered orally and is directly metabolized by hepatic microsomal oxidation (Jahn et al., 2016). They have a peak plasma concentration which occurs after 1 to 2 hours of being taken. Another drug is chlordiazepoxide which although itself has an intermediate half-life (6 — 28 h), its active metabolite desmethyldiazepam has a very long half-life; oral chlordiazepoxide is rapidly and completely absorbed and its volume of distribution varies from 0.25 to 0.50 l/kg. The drug seems to block electroencephalogram arousal from stimulation in the brain stem reticular formation. 

            Another type of anxiolytic drug that has been approved to treat GAD is the Selective serotonin reuptake inhibitor (SSRI) drug that works by inhibiting serotonin reuptake transporter and this inhibition of the 5-HT increases the concentration of synaptic hence increasing the extra-synaptic diffusion. An example of SSRIs is fluoxetine which is metabolized through the CYP2D6 system, inhibits CYP2D6 activity, and exhibits considerable intra-individual variability in tolerability and response (Strawn et al., 2018). It also has noradrenergic and dopaminergic effects which putatively underlie its therapeutic efficacy. SNRI is another type of anxiolytic drug used for treating GAD. An example of SNRI such as venlafaxine has been approved by Food Drug Administration to treat GAD. The pharmacokinetics and pharmacodynamics of venlafaxine work through active metabolite, o-desmethylvenlafaxine by inhibiting the serotonin and norepinephrine reuptake transporters albeit with greater potency at the norepinephrine transporter (Gravelle, 2016). Duloxetine has been approved by the FDA to treat GAD. Its pharmacodynamics and pharmacokinetics include the reuptake inhibition of serotonin and norepinephrine at the presynaptic neuron in Onuf’s nucleus of the sacral spinal cord ( ). 

            Another group of anxiolytic medications used is Non-benzodiazepine Sedative-Hypnotics such as eszopiclone which works by interaction with GABA receptor complexes at binding domains located close to or allosterically coupled to benzodiazepine receptors. Other types of anxiolytic medications are Second-generation antipsychotics (SGAs), Antihistamines, GABA-related interventions, and Tricyclic Antidepressants. 

   In conclusion, the choice of anxiolytic drug to be prescribed is dependent on the pharmacokinetics and pharmacodynamics factors that might affect the efficacy of the drug. It has been observed that SSRIs and SNRIs are considered the most effective while benzodiazepine and other types of drugs come second. An expert opinion argues that there is a need for healthcare providers to take an optimal pharmacological approach towards integrative pharmacokinetic and pharmacodynamics optimization strategy that would ensure better treatment and personalization of anxiety disorders. According to Almatura et al. (2013), this approach would help in the development of new anxiolytic drugs that are more effective and have limited side, especially benzodiazepines drugs.   

 References 

Altamura, A. C., Moliterno, D., Paletta, S., Maffini, M., Mauri, M. C., &Bareggi, S. (2013). Understanding the pharmacokinetics of anxiolytic drugs. Expert opinion on drug metabolism & toxicology, 9(4), 423-440. 

Gravielle, M. C. (2016). Activation-induced regulation of GABAA receptors: is there a link with the molecular basis of benzodiazepine tolerance?. Pharmacological Research, 109, 92-100. 

Strawn, J. R., Geracioti, L., Rajdev, N., Clemenza, K., & Levine, A. (2018). Pharmacotherapy for generalized anxiety disorder in adult and pediatric patients: an evidence-based treatment review. Expert opinion on pharmacotherapy, 19(10), 1057-1070. 

Andrews, G., Hobbs, M. J., Borkovec, T. D., Beesdo, K., Craske, M. G., Heimberg, R. G., … & Stanley, M. A. (2010). Generalized worry disorder: a review of DSM‐IV generalized anxiety disorder and options for DSM‐V. Depression and anxiety, 27(2), 134-147. 

Jann, Michael W.; Penzak, Scott R.; Cohen, Lawrence J. (2016). Applied Clinical Pharmacokinetics and Pharmacodynamics of Psychopharmacological Agents || Clinical Pharmacokinetics and Pharmacodynamics of Anxiolytics and Sedative/Hypnotics. , 10.1007/978-3-319-27883-4(Chapter 10), 247–266. doi:10.1007/978-3-319-27883-4_10 

Sample Answer 4 for NURS 6521 COMPARING AND CONTRASTING PHARMACOLOGIC OPTIONS FOR THE TREATMENT OF GENERALIZED ANXIETY DISORDER 

Hello Ruth! This is an in-depth discussion post. Indeed, the treatment of GAD entails both psychotherapy and pharmacotherapy. Essentially, multimodal approaches involving psychotherapy and pharmacotherapy in the management of GAD may distinctively focus on specific symptoms and the inclusion of psychotherapy enhances compliance with treatment and reduces reported adverse effects of pharmacotherapy. Understanding the principles of pharmacokinetics and Pharmacodynamics in the management of GAD is critical in the helping healthcare professionals to make informed decisions about medication formulation and dosage needs (Abuhelwa et al., 2022). It also crucial in building treatment plans entailing medications. The other potential treatment option in this case is psychotherapy. This options involves psychological counseling or talk therapy (Lamb et al., 2019). Here, a patient is expected to work with a therapist to minimize the anxiety symptoms. The popular form of psychotherapy for GAD is cognitive behavioral therapy (CBT). Psychotherapy is CBT aims at teaching particular skills to directly control the patent’s worries and help the patient to slowly return to that had been previously avoided due to anxiety.  

References 

Abuhelwa, A. Y., Somogyi, A. A., Loo, C. K., Glue, P., Barratt, D. T., & Foster, D. J. (2022). Population pharmacokinetics and pharmacodynamics of the therapeutic and adverse effects of ketamine in patients with treatment‐refractory depression. Clinical Pharmacology & Therapeutics. https://doi.org/10.1002/cpt.2640 

Lamb, T., Pachana, N. A., & Dissanayaka, N. (2019). Update of recent literature on remotely delivered psychotherapy interventions for anxiety and depression. Telemedicine and e-Health, 25(8), 671-677. https://doi.org/10.1089/tmj.2018.0079 

Sample Answer 5 for NURS 6521 COMPARING AND CONTRASTING PHARMACOLOGIC OPTIONS FOR THE TREATMENT OF GENERALIZED ANXIETY DISORDER

Summary of Patient Case Study 

A 71-year-old Asian man with a history of GAD, which was caused by diabetes and hypertension, was presented to our inpatient psychiatric clinic. He was mainly brought for stabilization and long-term medication. The information gathered from the family stated that the patient had refused oral food intake for about thirty hours, was isolative in his room, and had increased confusion. The diagnosis also showed a history of GAD in the patient’s family, especially among aged people. After admitting him to our clinic, the clinical presentation of the patient depicted a transformed level of consciousness. I took three imperative decisions I thought could help him. They include: stabilizing him, performing psychotherapy, and administering relevant medication. 

Evaluation of My Decisions 

I believe the decisions I provided were supported by evidence-based literature. According to Watts et al. (2020), psychotherapy involves working with therapists to reduce the level of GAD. For example, in our case, I recommended the therapist to use behavioral therapy because it was the most effective psychotherapy for GAD. On the other hand, stabilizing the patient is imperative because it ensures the conditions of the patient are within the healthy range (Savioli et al., 2020). For example, in our case, I recommended calming the patient to regain his level of consciousness.  Lastly, I recommended the patient’s medication because it could ease symptoms and prevent or halt hypertension and diabetic conditions (Wilhelmsen& Eriksson, 2019). Medication was the heart of everything because the patient’s issues were beyond anxiety disorders. 

Objectives of My Decisions 

First, I hoped behavioral therapy could help the patient manage various GAD-related symptoms, such as anxiety and stress. I also expected this treatment option could help the patient cope with negative emotions. Second, I hoped the medication decisions I recommended, such as Crestor 20mg daily, Lantus insulin 10 units daily, Metformin 70mg daily, Lithium 300mg daily, and hydrochlorothiazide 25mg daily, could help the patient improve his hypertension and diabetic conditions. Lastly, I hoped the patient would be stable after recommending a stabilization program in the emergency room. I also expected his pressure to normalize after calming him by providing personal attention. 

 Differences between Expectations and Results 

In psychotherapy, the expected results were attained. For example, the patient coped with adverse emotions and managed his anxiety and stress. He calmed down and started conversing with me. On the other hand, the prescribed medication also responded positively as planned. For example, in this decision, I aimed to improve the patient’s diabetic condition, which came down to manageable levels. Therefore, there was no difference between the anticipated and results. Lastly, the objectives of my decision to stabilize the patient aligned with the outcomes. For example, the patient’s hypertension was very high, but I managed to bring it to normal levels. 

Pharmacokinetics and Pharmacodynamics Processes 

In the pharmacokinetics process, the medication I recommended, especially oral medication, undergoes three stages. Absorption is the first stage, where the medicine is ingested and passed through the stomach into the intestine linings. The second stage is distribution, where the drugs pass through the liver and intestines into the bloodstream. The third stage is metabolism, where the drug undergoes glucuronidation and oxidation. The last stage is the excretion of the medicine, mainly through the functioning of the kidney. The pharmacodynamics commences when the drug reaches the target organ or tissue. The drug may involve enzyme inhibition or cause presynaptic or postsynaptic effects on the patient. The final part of pharmacodynamics involves cellular response and signal transduction.   

References 

Savioli, G., Ceresa, I. F., Manzoni, F., Ricevuti, G., Bressan, M. A., &Oddone, E. (2020). Role of a brief intensive observation area with a dedicated team of doctors in the management of acute heart failure patients: a retrospective observational study. Medicina, 56(5), 251. 

Watts, S., Marchand, A., Bouchard, S., Gosselin, P., Langlois, F., Belleville, G., &Dugas, M. J. (2020). Telepsychotherapy for generalized anxiety disorder: Impact on the working alliance. Journal of Psychotherapy Integration, 30(2), 208. 

Wilhelmsen, N. C., & Eriksson, T. (2019). Medication adherence interventions and outcomes: an overview of systematic reviews. European Journal of Hospital Pharmacy, 26(4), 187-192. 

Sample Answer 6 for NURS 6521 COMPARING AND CONTRASTING PHARMACOLOGIC OPTIONS FOR THE TREATMENT OF GENERALIZED ANXIETY DISORDER 

Hello Brandy! This is an outstanding discussion post. Indeed, psychotherapy therapy is essential in helping the patient manage various GAD-related symptoms, such as anxiety and stress and also help the patient cope with negative emotions (Lamb et al., 2019). Understanding the pharmacokinetics and Pharmacodynamics in the management of GAD in this case is important. When prescribing medications to this patient, the ultimate goal is to achieve a therapeutic outcome and while reducing adverse effects. A proper understanding of critical pharmacokinetic and pharmacodynamic properties of the medications is critical in formulating treatment plans entailing medications and also optimizing its utility in patients and supporting the medication development initiative (Abuhelwa et al., 2022). It is important to involve interprofessional team to ensure the safety and efficacy of pharmacokinetic and pharmacotherapy. The patient should be educated on correct self-administration and storage of medications. This education can be conducted by the nurse, pharmacist, or physician.  

References 

Abuhelwa, A. Y., Somogyi, A. A., Loo, C. K., Glue, P., Barratt, D. T., & Foster, D. J. (2022). Population pharmacokinetics and pharmacodynamics of the therapeutic and adverse effects of ketamine in patients with treatment‐refractory depression. Clinical Pharmacology & Therapeutics. https://doi.org/10.1002/cpt.2640 

Lamb, T., Pachana, N. A., & Dissanayaka, N. (2019). Update of recent literature on remotely delivered psychotherapy interventions for anxiety and depression. Telemedicine and e-Health, 25(8), 671-677. https://doi.org/10.1089/tmj.2018.0079 

Sample Answer 7 for NURS 6521 COMPARING AND CONTRASTING PHARMACOLOGIC OPTIONS FOR THE TREATMENT OF GENERALIZED ANXIETY DISORDER 

Thank you for a great post on Generalized Anxiety Disorder (GAD) and its treatment options, including the mention of cannabis as a potential treatment. The use of cannabis as a possible treatment for GAD is a subject of interest, but its effectiveness and safety are complex. Cannabis comprises compounds, such as THC, that can induce anxiolytic and anxiogenic effects, varying outcomes among individuals based on strain, dosage, and personal tolerance (de Manincor et al., 2020). Individuals with GAD must exercise caution when considering cannabis as a treatment, as its effects can differ widely and have the potential for abuse. While some may experience temporary relief, others may witness heightened anxiety or even panic attacks (Stoner, 2017). Moreover, prolonged or excessive cannabis use can exacerbate anxiety and lead to other mental health issues.  

A notable concern is the limited research on the long-term effects and safety of cannabis as a GAD treatment (Legare et al., 2022). Healthcare providers typically prefer evidence-based treatments, and the current body of research is insufficient to firmly support cannabis as a primary GAD treatment. In contrast, the mental health field offers a range of evidence-based therapies, such as Cognitive Behavioral Therapy (CBT), which have demonstrated effectiveness in GAD treatment (Cameron et al., 2022). These therapies equip individuals with valuable skills and strategies to manage anxiety without the potential risks associated with cannabis.  

Individuals experiencing GAD are strongly advised to seek consultation with healthcare professionals to determine the most suitable treatment for their specific condition (National Institute for Health and Care Excellence, 2019). Healthcare providers can advise on available treatment options, potential side effects, and which treatments align best with individual needs. Given that anxiety disorders, including GAD, can manifest differently from person to person, a personalized approach to treatment is crucial. What works for one individual may not be effective for another. Thus, close collaboration with a healthcare provider is essential to identify the most effective and safe treatment plan. In summary, the use of cannabis for GAD is a multifaceted issue that necessitates caution and professional guidance. Evidence-based treatments, like psychotherapy and medications, remain the primary and more established approaches for managing GAD, with a proven track record in effectively addressing this condition. 

References 

Cameron, D. H., Elcock, A., McCabe, R. E., Ouellette, M. J., Pawluk, E. J., Rowa, K., & Soreni, N. (2022). Does cannabis use impact cognitive behavioural therapy outcomes for anxiety and related disorders? A preliminary examination. Journal of Psychiatric Research, 156, 690–697. Retrieved October 19, 2023, from https://doi.org/10.1016/j.jpsychires.2022.10.054Links to an external site. 

de Manincor, M., Kramer, A., Sarris, J., Sharpe, L., & Sinclair, J. (2020). Cannabis, a cause for anxiety? A critical appraisal of the anxiogenic and anxiolytic properties. Journal of Translational Medicine, 18(1), 374. Retrieved October 19, 2023, from https://doi.org/10.1186/s12967-020-02518-2Links to an external site. 

Legare, C. A., Raup-Konsavage, W. M., & Vrana, K. E. (2022). Therapeutic potential of cannabis, cannabidiol, and cannabinoid-based pharmaceuticals. Pharmacology, 107(3-4), 131–149. Retrieved October 18, 2023, from https://doi.org/10.1159/000521683Links to an external site. 

National Institute for Health and Care Excellence. (2019, July). Generalised anxiety disorder and panic disorder in adults: Management. National Library of Medicine. Retrieved October 19, 2023, from http://europepmc.org/books/NBK552847Links to an external site. 

Stoner, S. A. (2017, June). Effects of marijuana on mental health: Anxiety disorders [PDF]. Addictions, Drug & Alcohol Institute. Retrieved October 19, 2023, from https://adai.uw.edu/pubs/pdf/2017mjanxiety.pdfLinks to an external site.

General anxiety disorder is a chronic disorder characterized by uncontrolled worrying, it is the most likely to remit and it is usually accompanied with an underlying psychiatric condition (Rosenthal, 2017). This disorder is considered a mental health disorder and two of the main characteristics of a person experiencing this disorder are worry and fear that lasts approximately 6 months or more. There are several types of anxiety disorders, and some of those disorders are normal feelings for humans to experience. GAD is more severe and of a negative nature. GAD can be treated with very effective medications. There are three types of drug treatments. SSRI, SNRI’s and benzodiazapines.

   Most common anxiolytics are approved to treat anxiety, they are alprazolam, lorazepam, diazepam, and clonazepam. BZDs are classified in terms of their elimination half-life. Short-acting BZDs have a median elimination half-life of 1-12 hours, intermediate-acting BZDs have an average elimination half-life of 12-40 hours, and long-acting BZDs have an average elimination half-life of 40-250 hours (Griffin, 2013).It is important to recognize that benzodiazepines increase the frequency of opening of the GABA-A receptor Cl– channel in the presence of GABA. In the absence of GABA, benzodiazepines have no effects on GABA-A receptor function (Bounds, 2023). The GABA receptor opening helps release a chemical in the brain to sort out feelings and remain calm.

   The benzodiazepines are absorbed in the GI tract. Distribution happens through plasma protein and is reabsorbed. Metabolism happens in three phases, the first phase of metabolism involves the formation of N-desalkylated metabolites that are biologically active. Exceptions are triazolam, alprazolam and midazolam. The second phase of metabolism involves hydroxylation and usually yields an active derivative. The third phase of metabolism is the conjugation with glucuronic acid. Most benzodiazepines are metabolized extensively by hepatic CYP3A4 and CYP2C19 (Griffin, 2013). The excretion of these medications is mainly via the kidneys.

   Alprazolam is the most commonly prescribed. It is prescribed between 0.25-005mg and can not be taken up to 3 times a day, up to 4 mg for anxiety. If Alprazolam is disrupted suddenly there can be a potential of rebound anxiety. Lorazepam doses can start up to 2-3mg given up to 3 times a day for anxiety. The maximum dose should not exceed 10mg daily. Clonazepam does not cause rebound anxiety, daily doses should not exceed 1-4mg. The dosage should start at 0.25mg and increase gradually it can be given twice a day up to 3 times a day, the maximum daily dose should not exceed 20mg daily. Diazepam is one of the most commonly used medications for anxiety, it can start use at low doses and go to high doses. Medicine can be given 2-10mg daily for up to 2-4 times daily. However, at higher doses of diazepam, sedation, and amnesia are side effects. All of these are good medications for anxiety. There are many things to consider when prescribing the doses. Always remember age, gender, and underlying conditions should always be reviewed when considering the type and dosage of a patient.

References

Bounds CG, Nelson VL. Benzodiazepines. [Updated 2023 Jan 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470159/

Griffin CE 3rd, Kaye AM, Bueno FR, Kaye AD. Benzodiazepine pharmacology and central nervous system-mediated effects. Ochsner J. 2013 Summer;13(2):214-23. PMID: 23789008; PMCID: PMC3684331.

NURS 6521 Week 8: Infections 

The amount of people living with AIDS globally reaches almost thirty-eight million with 5000 new infections daily in 2017; more than one million of them living in the United States (HIV.gov, n.d.). Just over half have achieved viral suppression using highly active antiretroviral therapy (HAART) (HIV.gov, n.d.). The following presents the pharmacology of the six classes of drugs used in HIV/AIDS treatment, and treatment as prevention (TasP). 

     Because each drug class used to treat HIV interrupts a different part of the viral replication cycle, the key to understanding how these medications work is by understanding the steps of the replication and invasion process. Arcangelo, Peterson, Wilbur, and Reinhold (2017) break this down into nine steps starting with the interaction of the viral envelope of HIV RNA with the CD4 receptor on the T lymphocyte to the last phase which consists of the formation of a capsid which shields viral RNA.  Treatment choices must be individualized, and initial treatment consists of two nucleoside/nucleotide reverse transcriptase inhibitors plus a protease inhibitor or an integrase strand transfer inhibitor (Arcangelo, Peterson, Wilbur, & Reinhold, 2017). A short description of each class and an example of each follows. 

Nucleoside/Nucleotide Reverse Transcriptase Inhibitors (NRTIs) 

     NRTIs interfere with the transcription of viral RNA to DNA after the HIV RNA enters the cell (Arcangelo, Peterson, Wilbur, & Reinhold, 2017). These nucleoside and nucleotides analogs enter cells and are incorporated into the DNA chain by reverse  (RI) and terminating any further replication of viral RNA (Whalen, Finkel, & Panavelil, 2015) the chain is incomplete, and no further transcription is possible (Animated HIV Science, n.d.). Tenofovir and emtricitabine, also active against the hepatitis B virus, is one of the NRTI combinations used for beginning treatment (Arcangelo et al., 2017) 

     The bioavailability of tenofovir increases when taken with a high-fat meal, and is minimally bound to protein (DrugBank, n.d.b). Rises in serum creatinine may indicate the need for a dose reduction, and gastrointestinal symptoms are a common adverse effect (Arcangelo et al., 2017). Emtricitabine is well absorbed orally (Whalen et al., 2015). Both drugs are excreted by the kidneys primary unchanged and have long half-lives which allow for once-daily administration (Whalen et al., 2015), and discontinuation of either drug may result in rebound of symptoms in those coinfected with hepatitis B (Arcangelo et al., 2017). 

Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs) 

     NNRTIs also block the transcription of viral DNA but this is accomplished by interacting directly with reverse transcriptase (RT) enzyme before the transcription process begins (Mechanisms in Medicine, n.d.). Efavirenz is a preferred over other NNRTI, and is well absorbed orally taken on an empty stomach (Whalen et al., 2015). Efavirenz, along with the other medications in this drug class, is metabolized by the cytochrome P-450 enzyme and is a consideration when concomitantly with other drugs that are metabolized by this pathway (Arcangelo et al., 2017).  It is administered once daily and should be taken on an empty stomach; common adverse side effects include dizziness, confusion, hallucinations, rash, nausea, and fatigue (RxList, n.d. b). Efavirenz can lengthen the QT interval, use is associated with elevated liver function tests (LFTs), false positives on drug screening tests, and should not be used during pregnancy (Arcangelo et al., 2017). 

Protease Inhibitors (PIs) 

     PIs interfere with the protease-mediated cleavage of polyprotein chains and decreases HIV RNA duplication (Arcangelo et al., 2017). All PIs are CYP3A4 substrates and CYP450 enzyme inhibitors, so drug interactions are common (Whalen et al., 2015). Drugs metabolized by CYP450 enzymes, or CYP450 isoenzyme inducers can all cause a change in serum levels of the PI or concurrent drug (Whalen et al., 2015). Common adverse effects in include nausea, vomiting, and diarrhea; patients taking PIs can experience elevated liver enzymes, hyperlipidemia, hyperglycemia, and lipodystrophy (Arcangelo et al., 2017) The recommended PI combination for treatment naïve patients is darunavir/ritonavir (Arcangelo et al., 2017). The sulfa component of darunavir may cause a rash in some patients (Arcangelo et al., 2017). 

Integrase Inhibitors 

     Integrase strand inhibitors (INSTIs) prevent entry of viral DNA into a host’s cells genome by binding to the active site of the integrase enzyme (Whalen et al., 2015).  Elvitegravir, available by itself or in a combination tablet with other medications, belongs to this drug class (Arcangelo et al., 2017). It is highly protein bound, metabolized in the liver, and excreted primarily in the stool (Gilead Sciences, 2014). Elvitegravir must be taken with food and is metabolized by cytochrome CYP3A (Gilead Sciences, 2014). Common side effects are nausea and vomiting; more serious and less frequent side effects include depression, suicidal ideation or attempt (Gilead Sciences, 2014). 

Entry Inhibitors (CCR5 Antagonist) 

     Entry inhibitors block the CCR5 coreceptor which prevents HIV from entering a healthy cell (Arcangelo et al., 2017). Maraviroc is the only drug in this class and prevents the HIV virus from attaching to the T lymphocyte (Whalen et al., 2015). It is not indicated for use as first treatment for HIV, and a tropism assay must be completed before use to ensure that the patient’s strain uses the CCR5 receptor for attachment.  Just over one-fifth to one-third of maraviroc is bioavailable, is significantly protein bound in the serum, and metabolized via the CYP3A pathway (DrugBank, n.d. a).  Marked drug interactions can occur with use of maraviroc and severe systemic reaction followed by hepatotoxicity have resulted in a black box warning for this medication (Arcangelo et al., 2017).     

Fusion Inhibitors 

     After HIV has attached to CD4 T cell, fusion inhibitors prevent fusion of the virus to the cell (Arcangelo et al., 2017). Enfuvirtide is the only dug in this class, is available only in injectable form, and is indicated for use in patients who have highly resistant forms of the HIV (Arcangelo et al., 2017). Localized site injections are the most common side effect, occurring in over ninety percent of patients and absorption is similar whether injected into the abdomen, thigh, or arm (RxList, n.d.a). It is highly protein bound, does not appear to cross into cerebrospinal fluid, and route of excretion has not been determined in humans (RxList, n.d. a). 

Treatment as Prevention (TasP) 

     Achieving viral suppression also reduces the amount of HIV in genital secretions and results in decreased transmission rates (Arcangelo et al., 2017). Though fifty percent of HIV infected individuals have achieved viral suppression, TasP is the most effective when all HIV patients receive testing, labs, and HAART are available to all infected (Montaner et al., 2014). 

References 

Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (Eds.). (2017). Pharmacotherapeutics for advanced practice a practical approach (4th ed.) Philadelphia, PA: Wolters Kluwer 

DrugBank. (n.d. a). Miraviroc. Retrieved January 18, 2019, from https://www.drugbank.ca/drugs/DB04835 

DrugBank. (n.d. b). Tenofovir disoproxil. Retrieved January 16, 2019, from https://www.drugbank.ca/drugs/DB00300 

Gilead Sciences. (2014). Vitekta (elvitegravir) [Highlights of prescribing information]. Retrieved from   https://www.accessdata.fda.gov/drugsatfda_docs/label/2014/203093s000lbl.pdf 

HIV.gov. (n.d.). U.S. Statistics. Retrieved January 16,2019, from https://www.hiv.gov/hiv-basics/overview/data-and-trends/statistics 

Mechanisms in Medicine. (n.d. a). Animation: Mechanisms of action of non-nucleoside reverse transcriptase inhibitors (NNRTIs) [Video file].  Retrieved from http://www.animatedhivscience.com/site/antiviral-animations-mechanisms-of-action-of-non-nucleoside-reverse- transcriptase-inhibitors-nnrtis.html 

Mechanisms in Medicine. (n.d. b). Mechanisms of Action of Nucleoside Reverse Transcriptase Inhibitors (NRTIs). [Video file]. Retrieved from http://www.animatedhivscience.com/site/animation.aspx?file=animations/antiviral 

Montaner, J. S., Lima, V. D., Harrigan, P. R., Lourenco, L., Yip, B., Nosyk, B., … Kendall, P. (2014). Expansion of HAART coverage is associated with sustained decreases in HIV/AIDS morbidity, mortality and HIV transmission: The “HIV treatment as prevention” experience in a Canadian setting []. PLos ONE, 9(2). https://doi.org/10.1372/journal.pone.0087872 

RxList. (n.d. a). Fuzeon. Retrieved January 17, 2019, from https://www.rxlist.com/fuzeon-drug.htm#description 

RxList. (n.d. b). Sustiva. Retrieved January 16, 2019, from https://www.rxlist.com/sustiva-drug.htm#indications 

Whalen, K., Finkel, R., & Panavelil, T. A. (2015). Lippincott illustrated reviews: Pharmacology (6th ed.). Philadelphia, PA: Wolters Kluwer.