Examine Case Study: A Middle-Aged Caucasian Man With Anxiety. You will be asked to make three decisions concerning the medication to prescribe to this patient. Be sure to consider factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes. Generalized Anxiety Disorder Treatment Generalized Anxiety Disorder Treatment At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature. Introduction to the case (1 page) Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision-making when prescribing medication for this patient. Decision #1 (1 page) Which decision did you select? Why did you select this decision? Be specific and sup
Generalized Anxiety Disorder Treatment
Summary of the Case
The client is a white 46-year-old male who works as a welder at a local steel fabrication factory. He was referred by his PCP after visiting the ER in suspicion of having a heart attack. He noted that he experienced chest tightness, shortness of breath, and a feeling of impending doom. He has mild hypertension managed with a low-sodium diet and is slightly overweight. The patient had his tonsils removed when he was 8, and his medical history since then has been unremarkable. In the ER, myocardial infarction was ruled out, his EKG was normal, and the remainder of the physical exam was WNL. However, the patient continues to experience chest tightness and shortness of breath, which he now terms “anxiety attacks,” and occasional feelings of impending doom, leading him to want to “run” or “escape” wherever he is. The patient admits to drinking 3-4 beers a night to deal with work-related worries. He also gives care to his aging parents. The client is well-dressed, alert, and oriented to person, place, time, and event, and his mood is “blah.” He feels nervous with a somewhat blunted affect. He brightens up a couple of times during the interview with a broad effect. He has no visual or auditory hallucinations and denies having overt delusional or paranoid thought processes readily apparent. From observation, his judgment is grossly intact. He denies suicidal or homicidal ideation. He is single and takes care of his aging parents at home. He reports that his workplace is harsh and fears for his job. A Hamilton Anxiety Rating Scale (HAM-A) was administered and yielded a score of 26. This led to the client being diagnosed with generalized anxiety disorder.
Decision #1
The best decision is to use Paxil 10mg PO daily. Paxil is the decision #1 because it is a selective serotonin reuptake inhibitor (SSRI). As an SSRI, Paxil works by blocking serotonin reabsorption in the brain, increasing its levels in the brain and its availability to neurotransmitters (Kowalska et al., 2021). This has a relaxing effect, therefore helping regulate the patient’s moods and other functions of the body (Lochmann & Richardson, 2019). It can also improve the patient’s appetite and sleep. Paxil has fewer side effects than the other available options, Imipramine and Buspirone.
I did not select Imipramine and Buspirone for a number of reasons. Imipramine is a tricyclic antidepressant (TCA), while Buspirone is an anxiolytic. TCAs have an improved action against generalized anxiety disorders. However, they have a higher risk for side effects than SRRIs (Klein et al., 2019). On the other hand, Buspirone as an anxiolytic has the lowest efficiency and could not be considered a first-line treatment for the diagnosed generalized disorder. The use of Paxil as the first-line treatment for the client’s diagnosed generalized anxiety disorder manages the symptoms manifested and improves the client’s quality of life and daily functioning. SSRIs also have the potential to reduce the frequency of the symptoms manifested (Bui et al., 2016).
Ethical considerations significantly impact the treatment plan and communication with the 46-year-old client. For instance, informing the patient on the benefits, side effects, and costs of using Paxil 10mg PO and the available treatments such as Imipramine and Buspirone can help them make an informed decision on the medications to use. Assuring their privacy and, confidentiality, autonomy and that the treatment will be beneficial to their well-being can improve how openly they explain their symptoms and adhere to treatment.
Examine Case Study: A Middle-Aged Caucasian Man With Anxiety. You will be asked to make three decisions concerning the medication to prescribe to this patient. Be sure to consider factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes. Generalized Anxiety Disorder Treatment Generalized Anxiety Disorder Treatment At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature. Introduction to the case (1 page) Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision-making when prescribing medication for this patient. Decision #1 (1 page) Which decision did you select? Why did you select this decision? Be specific and sup
Summary of Recommendations on the Use of Paxil to Manage Generalized Anxiety Disorder
The recommendations for the treatment of the client with Paxil will include starting the Paxil treatment with a low dose and then increasing gradually based on how the symptoms respond to the treatment. Starting with a low dose will minimize the risk of side effects of the medication. Gradually increasing the dosage will, on the other hand, improve the medication’s efficiency in improving the client’s symptoms.
The patient will also be monitored throughout the use of Paxil with a focus on the development of side effects. Although common side effects such as nausea, dizziness, and headaches are expected, all side effects will be monitored to provide a basis for decisions to either adjust the dosage or find an alternative for Paxil. This will help ensure that the medication does not add to the client’s suffering, risk the progression of generalized anxiety disorders, and reduce the risk of developing other complications.
Besides monitoring the side effects related to Paxil, it is also important to continuously monitor the client’s suicidal ideation. Although the client denied having any instances of suicidal ideation, the use of Paxil, as with other SSRIs, can risk the development of suicidal ideation, especially when used for a prolonged period. The patient will, therefore, need to be continuously assessed for suicidal ideation throughout and after the treatment period. Additionally, it is also recommended to consider other non-pharmacological methods of managing generalized anxiety disorder, such as psychotherapy. The use of psychotherapy can reduce the risk of side effects. Combining Paxil with psychotherapy can help manage the symptoms as well as identify and resolve the underlying factors leading to the experiences the client has.
References
Bui, E., Pollack, M. H., Kinrys, G., Delong, H., Vasconcelos e Sá, D., & Simon, N. M. (2016). The pharmacotherapy of anxiety disorders. In T. A. Stern, M. Favo, T. E. Wilens, & J. F. Rosenbaum. (Eds.), Massachusetts General Hospital psychopharmacology and neurotherapeutics (pp. 61–71). Elsevier.).
Klein, D. F., Rabkin, J. G., & Gorman, J. M. (2019). Etiological and pathophysiological inferences from the pharmacological treatment of anxiety. In Anxiety and the anxiety disorders (pp. 501-532). Routledge.