response on discussion post 200 words + 2 sourses
Read a selection of your colleagues’ and respond to your colleagues 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 to treat a patient with the topic of discussion.
Main post:
General Anxiety Disorder (GAD) is a mental health disorder that affects approximately 20% of adults each year. General anxiety disorder is characterized by constant fear, worry, and feelings over being overwhelmed. These feelings lead to unrealistic, uncontrollable and possibly debilitating worry. GAD can also cause physical symptoms in conjunction with mental symptoms. Physical symptoms that may present on a patient with GAD include muscle tension, fatigue, restlessness, insomnia, and irritability. (Munir, 2017)
Management of GAD can consist of non-pharmacological or pharmacological interventions. When symptoms are deemed as uncontrollable and debilitating drug therapy is recommended. The first line of treatment is selective serotonergic reuptake inhibitors (SRIs). This group of medications include two subgroups called selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) (Rosenthal & Burchum, 2021). SRIs has a response rate of 30-50% (Munir, 2017). There are four medications most commonly prescribed for GAD. Venalfaxine and Duloxetine are both SNRIs and Paroxetine and Escitalopram are both SSRIs. (Rosenthal & Burchum, 2021).
Venlafaxine is a SNRI that serves as a “blockade of norepinephrine and 5-HT reuptake and weak blockade for dopamine reuptake. This drug does not block cholinergic, histaminergic or adrenergic receptors”. The liver converts oral doses to desvenlafaxine, an active metabolite that has a half-life of 11 hours. When compared to SSRIs the drugs were equally effective. (Rosenthal &Burchum, 2021).
Duloxetine is a SNRI has a similar mechanism of action to Venlafaxine as it inhibits 5-HT and norepinephrine. Duloxetine has a balances affinity for both serotonin and norepinephrine transporters whereas Venlafaxine has a higher affinity (Ye et al., 2011).
Paroxetine and Escitalopram are both very similar to Fluoxetine. Paroxetine is associated with cholinergic muscarinic antagonism and potent inhibition of CYP2D6. Escitalopram has allosteric properties increasing the activity of the serotonin in the brain. Escitalopram can be considered a safer choice than Paroxetine due to its less tolerability (Sanchez et al. 2014).