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. Consider factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes

Assessing and Treating Patients with Anxiety Disorders

A 46-year-old white male presented to the office after a referral from his primary care provider (PCP). He had visited the PCP’s emergency room with fears of a heart attack, as per the PCP’s report. In the ER, presented symptoms included chest tightness, shortness of breath, and feelings of impending doom. The client has some mild hypertension, which was treated with a low-sodium diet. He was also found to be a bit overweight. Although his medical history is unremarkable, it shows that the client’s tonsils were removed when he was eight years old. Myocardial infarction was ruled out, his EKG was expected, and the rest of his physical exam was WNL.

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In the office, the client has noted that he still experiences tightness in the chest and incidents of shortness of breath, self-diagnosed as anxiety attacks. He also feels like he needs to run or escape from wherever he is and occasionally experiences feelings of impending doom. He sometimes uses EtOH to manage work-related worries and consumes about three to four beers a night. However, he has never used any psychotropic medication. On his social status, the client is single and takes care of his aging parents in his house. The client noted that his workplace is harsh and has fears for his job.

Examining the client’s mental status indicated that the client was alert and well-oriented to person, time, place, and occasion. He is well-dressed and has clear, coherent, and goal-oriented speech. He is monotonous and feels nervous. He is mainly blunted but brightens sometimes and has no visual or auditory hallucinations or delusions. He has no suicidal or homicidal ideation. He scores 26 on the Hamilton Anxiety Rating Scale (HAM-A) and is therefore diagnosed with generalized anxiety disorder.

Decision #1

The first decision is to prescribe Paxil 10 mg to be taken orally daily. Unlike the other two options, Imipramine 25 mg and Buspirone 10 mg, Paxil is a selective serotonin reuptake inhibitor (SSRI). SSRIs and antidepressants have been shown to have better tolerability and higher efficacy in the treatment of anxiety and comorbid disorders such as depression (Melaragno et al., 2020). Therefore, SSRIs are selected as first-line pharmacological agents for generalized anxiety disorders. SSRIs’ mechanism of action includes inhibiting the presynaptic reuptake of serotonin, increasing serotonin levels in the brain, and impacting neurotransmission (Edinoff et al., 2021). This enables the patient to have improved moods, reduced feelings of fear, and a better sense of well-being.

The other options, Imipramine 25 mg and Buspirone 10 mg were not selected based on efficacy and safety. For instance, Buspirone 10 mg as an anxiolytic, though effective in improving anxiety symptoms, has been shown to have short-term relief of the symptoms (Wilson & Tripp, 2022). Imipramine is a tricyclic antidepressant (TCA). Drug tests comparing TCAs to SSRIs and other SNRIs have shown TCAs to have reduced efficacy, while SNRIs and SSRIs had superior efficacy (Williams, 2022). Therefore, Imipramine 25 mg and Buspirone 10 mg can only be considered second-line treatments. The decision to use Paxil was based on the need to improve the anxiety symptoms effectively and efficiently with fewer safety concerns.

Ethical considerations such as safety and confidentiality impact the treatment plan and communication with the patient. For example, as the client has concerns and stress at their workplace, anxiety is confused with depression, leading to the wrong diagnosis and medication plan. This will require a careful diagnosis to avoid therapeutic misconceptions, therefore developing safe treatment plans. Confidentiality will enable the patient to be more open and provide precise details to improve the diagnosis of presented symptoms.

Decision #2

The second decision point includes increasing the Paxil dose to 20mg to be taken orally daily. After four weeks of using Paxil 10 mg po daily, the client has observed a reduction in symptoms, such as reduced worries related to their work, in about the last five days. The client scored 18 on the HAM-A score. A HAM-A score of 18 still presents mild anxiety and a partial response to Paxil 10 mg daily. An increase of Paxil dose by 10 mg is recommended for adults to improve the symptoms associated with generalized anxiety disorder in adults (Petty & Maul, 2018).

Increasing the Paxil dose to 40 mg po daily and not changing the drug or dosage was not selected. Although the Paxil dosage can be increased to 40 mg per day, there is an increased risk of the patient exp