Week 8 Discussion: Pharm 

Week 8 Discussion: Pharm 

Week 8 Discussion: Pharm 

Generalized anxiety disorder (GAD) presents with excessive and uncontrollable anxiety. This is an unpleasant state of tension, apprehension, or uneasiness and fear that seems to arise from a sometimes unknown source. Anxiolytic drugs should produce drowsiness and encourage the onset and maintenance of a state of sleep. They produce dose-dependent CNS depressant effects (Strawn et al., 2018). Anxiolytics reduce inhibitions, suppress anxiety, and produce relaxation. Although the primary actions of anxiolytics involve the facilitation of the effects of GABA and antagonism at ACh-N receptors, the drugs also enhance brain dopaminergic pathways. Anxiolytics are CNS depressants. Their depressant effects are enhanced by the concomitant use of opioid analgesics, antipsychotic agents, marijuana, and other drugs with sedative properties.

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Regarding pharmacokinetics, most anxiolytic drugs are absorbed orally and are lipid-soluble. They have good distribution to the brain. Those with the highest lipid solubility enter the CNS rapidly and can be used as induction agents in anesthesia (Ströhle et al., 2018). In addition, anxiolytics are metabolized by hepatic enzymes, and few are excreted unchanged. The elimination half-life depends mainly on the rate of metabolic transformation.

Various treatment interventions can be used to treat GAD, including Selective serotonin reuptake inhibitors (SSRIs), Selective-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), Benzodiazepines, and Buspirone. SSRIs and SNRIs are first-line therapies for GAD and are efficacious for treating anxiety disorders (Garakani et al., 2020). TCAs are less frequently used due to their side effects of weight gain, sedation, dry mouth, urinary hesitancy, arrhythmias, and risk of death with overdose. Benzodiazepines effectively reduce anxiety but are associated with dose-dependent sedation, confusion, tolerance, and increased mortality (Garakani et al., 2020). Buspirone is FDA-approved for use in GAD and is mainly used as adjunctive therapy with SSRIs or SNRIs.

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

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

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