Assignment: Generalized Anxiety Disorder

Assignment: Generalized Anxiety Disorder

Assignment: Generalized Anxiety Disorder

Pharmacokinetic (PK) factors that may affect the patient’s response to anxiolytics include absorption, bioavailability, distribution, metabolism, and excretion. A drug’s physicochemical properties, formulation, and route of administration determine its absorption. For the oral anxiolytic to survive, it must encounter low pH and numerous GI secretions (Glassman & Muzykantov, 2019). Besides, a drug’s bioavailability is significantly influenced by the properties of the dosage form. Insufficient absorption time in the GI tract can lead to low bioavailability of the anxiolytic. Furthermore, drug metabolism may also affect the patient’s response since the patient can metabolize a drug so fast that therapeutically effective blood and tissue concentrations are not attained (Glassman & Muzykantov, 2019). Pharmacodynamic (PD) factors like the drug’s concentration at the receptor site establish the intensity of the anxiolytic drug’s effect, which may affect the patient’s response.

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The patient’s gender may have influenced the patient’s PD and PK processes. Males produce more gastric acid and have a faster GI transit time than women. Besides, drug distribution is affected by BMI, body composition, plasma volume, and plasma protein-binding capacity. Men are generally heavier, have a higher BMI and larger organs than women, and thus have a higher drug distribution (Mauvais-Jarvis et al., 2021). Furthermore, males respond better to tricyclic antidepressants (TCAs) and women better to Selective serotonin reuptake inhibitors (SSRIs). Therefore, the patient’s gender may have influenced the absorption, availability, and metabolism of the anxiety drug. The patient may fail to respond as expected if administered an SSRI.

Treatment options for this patient include SSRIs and TCAs. SSRIs are typically used as first-line agents, followed by TCAs. SRIs are first-line medications for the long-term management of GAD and achieve gradual control over 2- 4 weeks (Ströhle et al., 2018). On the other hand, TCAs are used as second-line agents. However, caution is needed because of their higher toxicity and likely lethality in overdose. Their use is limited to cases in which SSRIs are ineffective.

References

Glassman, P. M., & Muzykantov, V. R. (2019). Pharmacokinetic and Pharmacodynamic Properties of Drug Delivery Systems. The Journal of pharmacology and experimental therapeutics, 370(3), 570–580. https://doi.org/10.1124/jpet.119.257113

Mauvais-Jarvis, F., Berthold, H. K., Campesi, I., Carrero, J. J., Dhakal, S., Franconi, F., … & Rubin, J. B. (2021). Sex-and gender-based pharmacological response to drugs. Pharmacological reviews, 73(2), 730-762. https://doi.org/10.1124/pharmrev.120.000206

Ströhle, A., Gensichen, J., & Domschke, K. (2018). The Diagnosis and Treatment of Anxiety Disorders. Deutsches Arzteblatt international, 155(37), 611–620. https://doi.org/10.3238/arztebl.2018.0611