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Pharmacokinetics and Pharmacodynamics(GET HELP)
Generalized anxiety disorder (GAD) is excessive worrying about several events that lasts longer than 6 months (Rosenthal & Burchum, 2021). Symptoms include vigilance, tension, apprehension, poor concentration, difficulty falling or staying asleep, trembling, muscle tension, restlessness, palpitations, tachycardia, and sweating (Rosenthal & Burchum, 2021). Patients with GAD typically have an accompanying psychiatric disorder such as depression. Additionally, compared to the other anxiety disorders, GAD is least likely to be cured.
Treatment Options
GAD treatment is dependent on the severity of the symptoms and falls into two categories nondrug and drug therapy (Rosenthal & Burchum, 2021). Nondrug treatment includes relaxation therapy, biofeedback, cognitive behavioral therapy, and supportive therapy. Drug options include serotonergic reuptake inhibitors (SRI’s), nonbenzodiazepine-nonbarbiturate, and benzodiazepine. First line drug therapy is the SRIs including selective serotonin uptake inhibitor (SSRI) and serotonin-norepinephrine reuptake inhibitors (SNRI), and buspirone. Onset is delayed with these medications, but they are better for long term use. Second choice is the benzodiazepines. One major benefit of Benzodiazepines is the rapid onset of relief of symptoms. However, they have a huge potential for abuse, and should not be used long term (Rosenthal & Burchum, 2021).
Case Study
The patient is a 46 y.o. white male employed as a welder at a steel factory (Laureate Education, 2019). He was in the ER because he thought he was having a heart attack, symptoms included chest tightness, shortness of breath, and feeling of impending doom. He has history of hypertension, that is treated with a low sodium diet, he is overweight, other medical history is unremarkable. Myocardial infarction was ruled out, physical exam was WNL. Patient reports continued “anxiety attacks” of chest tightness and shortness of breath. He reports ETOH use of 3-4 beers/night. He was diagnosed with GAD. The treatment options include starting the patient on Zoloft 50 mg PO daily, Burpirone 10 PO BID, or Imipramine 25 mg BID.
Based on the patient presented in the case study, I elected to begin treatment with Burspirone 10 BID, because it is considered first line treatment for GAD, and the other options are not, even though Zoloft is an SSRI, it is not under the recommended treatment plan (Rosenthal & Burchum, 2021).
Upon return to the clinic the patient reported a slight decrease in symptoms, but he still feels very anxious. His HAMA score decreased from 26 to 23. My options were to then increase Buspirone to 10 mg TID, Buspirone 20 mg TID or discontinue Buspirone and start Lexapro 10 mg PO daily. I elected to increase Buspirone to 10 mg TID.
At his next check up in four weeks, the patient reports no change in anxiety. I elected to discontinue buspirone and begin Zoloft 50 mg orally daily. In this scenario, buspirone meets criteria for treatment failure, so it is appropriate to discontinue it and begin another first line option (Laureate Education, 2019). Sertaline is a SSRI that has been shown to reduce anxiety symptoms and may prove an effective treatment for GAD (Brawman-Mintzer et al., 2006).
Pharmacokinetics and Pharmacodynamics
I do not think pharmacokinetics or pharmacodynamics would have a large impact on this patient, primarily because he is younger, and not taking any other medications. The main problem I could foresee is due to the patients history of ETOH use and the use of a benzodiazepine. This is due to the potential to abuse benzodiazepines, and it should be used cautiously in patients that abuse ETOH (Rosenthal & Burchum, 2021). Additionally, if the patient does need medication for his hypertension there could potentially be an interaction depending on the medication chosen.
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