NURS 6521 Week 8 Discussion: Pharmacokinetics and pharmacodynamics of anxiolytic medications used to treat generalized anxiety disorder (GAD)
NURS 6521 Week 8 Discussion: Pharmacokinetics and pharmacodynamics of anxiolytic medications used to treat generalized anxiety disorder (GAD)
NURS 6521 Week 8 Discussion: Pharmacokinetics and pharmacodynamics of anxiolytic medications used to treat generalized anxiety disorder (GAD)
Q. Pharmacokinetics and pharmacodynamics of anxiolytic medications used to treat generalized anxiety disorder (GAD).
Generalized anxiety disorder (GAD) is a common and onerous mental disorder that manifests through various symptoms, including a persistent feeling of fear, worry, and restlessness. According to Munir & Takov (2022), the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) diagnostic criteria for GAD include the constant feeling of worry and anxiety that persist for at least six months, concentration issues, irritability, sleep disturbances, and fatigue. Further, anxiety should result in significant distress and impair the patient’s social and occupational wellness to confirm a diagnosis of a generalized anxiety disorder (Munir & Takov, 2022). A factor contributing to a high prevalence of GAD is an individual’s susceptibility to genetic and environmental risks. In this sense, the etiology of generalized anxiety disorder entails a wide range of risk factors, including genetics (family history), substance abuse disorder, stress, underlying comorbidities like diabetes and depression, and past traumatic events. Healthcare professionals should conduct comprehensive mental health status and assess patients’ susceptibility to these triggers when planning care for patients grappling with generalized anxiety disorder.
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Treatment Options for GAD
As a healthcare professional, I have had experiences with patients grappling with a generalized anxiety disorder (GAD). Often, I participated in interdisciplinary team approaches for developing collaborative care plans for different clients, where we embarked on pharmacological and non-pharmacologic interventions. According to Rosenthal & Burchum (2021), non-pharmacologic interventions for treating generalized anxiety disorder include supportive therapy, relaxation training, cognitive behavioral therapy, and biofeedback. The primary objective of treating mild symptoms of GAD by enhancing individual resilience and improving patients’ cognitive functioning. However, patients with severe symptoms of generalized anxiety disorder require urgent and timely care interventions that majorly entail pharmacological interventions. Rosenthal & Burchum (2021) present benzodiazepines and buspirone as FDA-approved anxiolytics for treating GAD. These classes of medication have different mechanisms of action and effectiveness. As a result, healthcare professionals should understand their pharmacokinetics and pharmacodynamics before administering them as first-line or long-term choices for generalized anxiety disorder treatment.
Comparing and Contrasting Pharmacokinetics and Pharmacodynamics of Benzodiazepines and Buspirone
Benzodiazepines
Drug pharmacokinetics entails absorption, distribution, metabolism, and excretion, while pharmacodynamics underpins the drug’s mechanism of action to achieve optimal outcomes. Benzodiazepines are anxiolytics medications with different brand names, including alprazolam, chlordiazepoxide, clobazam, diazepam, oxazepam, and triazolam (Bounds & Nelson, 2022). The mechanism of action for these medications entails enhancing responses to an inhibitory neurotransmitter, gamma-aminobutyric acid (GABA), and acting upon benzodiazepine receptors in the central nervous system to cause conformational change to a central pore which facilitates the entrance of chloride ions into the neuron.
Pharmacokinetics
Healthcare professionals can administer benzodiazepines orally, intramuscularly, and intravenously depending on the administration route that would guarantee quick absorption. After administration and absorption, benzodiazepines and their active metabolites bind to plasma proteins, facilitating distribution in plasma and cerebrospinal fluid (CSF) (Bounds & Nelson, 2022). Hepatic CYP3A4 and CYP2C19 metabolize most benzodiazepines. Other phases of metabolism for benzodiazepines include the formation of active N-desalkylated metabolites and hydroxylation. The kidney excretes benzodiazepines and their metabolites as urine and sweat.
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Buspirone
Unlike benzodiazepines, buspirone is an anxiolytic drug with a mechanism of action that entails a strong affinity to serotonin 5HT1a receptors. The drug acts as a partial agonist with a weak affinity for serotonin and dopamine D2 receptors. According to Wilson & Tripp (2022), buspirone increases serotonergic activities in the amygdala and other vital parts of the brain’s anxiety circuitry. Rosenthal & Burchum (2021) argue that buspirone differs from benzodiazepines because its anxiolytic effects develop slowly and has no abuse potential. These advantages render buspirone an appropriate treatment intervention for patients who abuse alcohol and other drugs.
Buspirone shares some pharmacokinetic aspects with benzodiazepines, including plasma absorption and excretion. Wilson & Tripp (2022) argue that the drug undergoes extensive first-pass metabolism and has about 86% plasma protein binding. Buspirone’s metabolism entails the oxidation of CYP3A4 and its subsequent conversion to hydroxylated derivatives and 1-pyrimidinylpiperazine (1-PP). Often, buspirone’s metabolism occurs in the liver, while the kidney excretes the drug in the urine as metabolites. Fecal excretion accounts for about 18% to 38% of buspirone dosage.
Healthcare professionals should understand individual factors that affect drug pharmacokinetics and pharmacodynamics before administering benzodiazepines and buspirone. These factors include age, nutritional status of the patient, competition and contradictions between drugs, and blood flow (Rosenthal & Burchum, 2021). Also, it is crucial to understand medications’ potential side effects and toxicity. For example, persistent use of benzodiazepines in treating GAD can lead to a high risk of physical dependence, panic, delirium, and paranoia. On the other hand, buspirone can result in dizziness, blurred vision, chest pain, nasal congestion, diarrhea, nausea, and musculoskeletal pain.
References
Bounds, C. G., & Nelson, V. L. (2022). Benzodiazepines. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK470159/
Munir, S., & Takov, V. (2022). Generalized anxiety disorder (GAD). StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK441870/
Rosenthal, L., & Burchum, J. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.). Saunders.
Wilson, T. K., & Tripp, J. (2022). Buspirone. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK531477/
Instructions
Psychological disorders, such as depression, bipolar, and anxiety disorders can present several complications for patients of all ages. These disorders affect patients physically and emotionally, potentially impacting judgment, school and/or job performance, and relationships with family and friends. Since these disorders have many drastic effects on patients’ lives, it is important for advanced practice nurses to effectively manage patient care. With patient factors and medical history in mind, it is the advanced practice nurse’s responsibility to ensure the safe and effective diagnosis, treatment, and education of patients with psychological disorders.
Generalized Anxiety Disorder is a psychological condition that affects 6.1 million Americans, or 3.1% of the US Population. Despite several treatment options, only 43.2% of those suffering from GAD receive treatment. This week you will review several different classes of medication used in the treatment of Generalized Anxiety Disorder. You will examine potential impacts of pharmacotherapeutics used in the treatment of GAD. Please focus your assignment on FDA approved indications when referring to different medication classes used in the treatment of GAD.
To Prepare:
• Review the Resources for this module and consider the principles of pharmacokinetics and pharmacodynamics.
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• Reflect on your experiences, observations, and/or clinical practices from the last 5 years and think about how pharmacokinetic and pharmacodynamic factors altered his or her anticipated response to a drug.
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• Consider factors that might have influenced the patient’s pharmacokinetic and pharmacodynamic processes, such as genetics (including pharmacogenetics), gender, ethnicity, age, behavior, and/or possible pathophysiological changes due to disease.
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• Think about a personalized plan of care based on these influencing factors and patient history with GAD.
Post a discussion of pharmacokinetics and pharmacodynamics related to anxiolytic medications used to treat GAD. In your discussion, utilizing the discussion highlights, compare and contrast different treatment options that can be used.
Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days by suggesting additional factors that might have interfered with the pharmacokinetic and pharmacodynamic processes of the patients diagnosed with GAD. In addition, suggest different treatment options you would suggest treating a patient with the topic of discussion.
