Assignment: Assessing and Treating Patients with Anxiety Disorders

Assignment: Assessing and Treating Patients with Anxiety Disorders

Assignment: Assessing and Treating Patients with Anxiety Disorders

Examine Case Study: A Middle-Aged Caucasian Man With Anxiety.

https://cdn-media.waldenu.edu/2dett4d/Walden/NURS/6630/DT/week_05/index.html

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.

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.

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Introduction to the case

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

Which decision did you select?

Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).

Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Decision #2
Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).

Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Decision #3

Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).

Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Conclusion
Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.

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Assessing and Treating Patients with Anxiety Disorders

The case depicts a 46-year-old white male referred by his PCP after he visited the ER because he felt the symptoms of a heart attack like chest tightness, dyspnea, and a feeling of impending doom. He has a history of mild hypertension managed with a low-sodium diet and is currently overweight. When in the ER, his EKG was normal and myocardial infarction was ruled out. The patient reports experiencing anxiety attacks with chest tightness and shortness of breath as well as occasional feelings of impending doom and a need to escape. He scored 26 in the HAM-A and was diagnosed with Generalized anxiety disorder (GAD). The patient factors that can influence treatment decisions for this patient include his history of hypertension and being overweight. Thus, the medications prescribed should have no side effects of elevating BP or weight gain. 

Decision 1

Begin Paxil 10 mg PO daily.

Why I selected this decision?

Paxil is a Selective serotonin reuptake inhibitor (SSRI) FDA-approved to treat GAD in adults. It is recommended as a first-line drug for GAD due to its therapeutic efficacy (Kowalska et al., 2021).

Why I did not select the other two options provided

Imipramine was not ideal due to its distressing side effects like sedation, dry mouth, and constipation, which affect compliance (Strawn et al., 2018). Buspirone was not ideal since it lacks anti-panic activity and thus is less effective in managing the patient’s anxiety attacks.

What I was hoping to achieve by making this decision

I hoped that Paxil would alleviate the client’s GAD symptoms by at least half within four weeks. According to Strawn et al. (2018), Paxil is associated with marked improvement in anxiety symptoms.

 How ethical considerations may impact your treatment plan and communication with patients

            Ethical principles of beneficence and autonomy may impact treatment and communication.  The practitioner has to select a treatment associated with the best outcomes for GAD patients as well as respect the patient’s treatment decisions to uphold autonomy.

Decision 2

Increase the dose to 20 mg PO daily.

Why I selected this decision?

The dose was increased to 20 mg since the patient showed a partial response from the initial dose. Increasing the dose was ideal to further improve the response and attain the desired outcome (Kowalska et al., 2021).

Why I did not select the other two options provided

            Increasing Paxil to 40 mg was not ideal since higher doses have a greater risk of side effects and limit the prescriber from effectively monitoring a client’s treatment response (Garakani et al., 2020).  Maintaining the dose was not also ideal since the client demonstrated a partial response with the initial dose and thus needed a higher dose to improve the response.  

What I was hoping to achieve by making this decision

            I hoped that increasing the dose would improve the client’s symptoms and he would achieve a full response with the higher dose. Mangolini et al. (2019) explain that increasing SSRIs dose lead to a better clinical response in patients with GAD.

How ethical considerations may impact your treatment plan and communication with patients

            Nonmaleficence can impact the treatment plan since the practitioner has to weigh the potential benefits and side effects of medication. The practitioner has to also seek consent from the patient to implement the treatment plan, which can impact communication.

Decision 3

Maintain current dose.

Why I selected this decision?

            The 20 mg dose was maintained because it led to a further improvement in the patient’s symptoms with a 61% reduction in symptoms and the HAM-A score had decreased to 10. The current dose is adequate to attain full remission of the anxiety symptoms (Mangolini et al., 2019).  

Why I did not select the other two options provided

            Increasing Paxil to 30 mg was not ideal since the 20 mg dose had attained an adequate positive response. Increasing the dose increases the risk of adverse effects, which can lower compliance (Garakani et al., 2020).  Besides, adding an augmentation agent like Buspar was not ideal since it is recommended in cases where the patient fails to attain an adequate clinical response despite increasing the initial dose (Strawn et al., 2018).

What I was hoping to achieve by making this decision

I hoped that maintaining the current Paxil 20 mg dose would help attain a full remission of GAD symptoms without compromising the patient’s safety (Garakani et al., 2020).

How ethical considerations may impact your treatment plan and communication with patients

Ethical considerations related to nonmaleficence can impact the treatment plan since the practitioner has to take into account the benefits and harms associated with a drug. In this case, the dose was maintained to avoid adverse effects. Confidentiality may impact communication since the practitioner has to assure the client that the information will be kept private.

Conclusion

The patient’s hypertension and overweight status may impact treatment decisions since the medications prescribed should not raise BP or cause weight gain. The patient was initiated on Paxil 10 mg since it is recommended as a first-line treatment due to its treatment efficacy (Kowalska et al., 2021). The dose led to a partial response, which led to the decision to increase the dose to 20 mg. The increased dose led to an adequate response with further improvement in symptoms. Consequently, the dose was maintained to further alleviate symptoms to full remission (Garakani et al., 2020).

References

Garakani, A., Murrough, J. W., Freire, R. C., Thom, R. P., Larkin, K., Buono, F. D., & Iosifescu, D. V. (2020). Pharmacotherapy of Anxiety Disorders: Current and Emerging Treatment Options. Frontiers in psychiatry, 11, 595584. https://doi.org/10.3389/fpsyt.2020.595584

Kowalska, M., Nowaczyk, J., Fijałkowski, Ł., & Nowaczyk, A. (2021). Paroxetine-Overview of the Molecular Mechanisms of Action. International journal of molecular sciences, 22(4), 1662. https://doi.org/10.3390/ijms22041662

Mangolini, V. I., Andrade, L. H., Lotufo-Neto, F., & Wang, Y. P. (2019). Treatment of anxiety disorders in clinical practice: a critical overview of recent systematic evidence. Clinics (Sao Paulo, Brazil), 74, e1316. https://doi.org/10.6061/clinics/2019/e1316

Strawn, J. R., Geracioti, L., Rajdev, N., Clemenza, K., & Levine, A. (2018). Pharmacotherapy for generalized anxiety disorder in adult and pediatric patients: an evidence-based treatment review. Expert opinion on pharmacotherapy, 19(10), 1057-1070.https://doi.org/10.1080/14656566.2018.1491966