Psychopharmacologic Treatment: Middle-Aged Caucasian Man With Anxiety

Week 5: Psychopharmacologic Treatment of Psychopathology
Examine Case Study: A Middle-Aged Caucasian Man with Anxiety
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Background -A Middle-Aged Caucasian Man with Anxiety
This is a case of Generalized Anxiety Disorder for a middle-aged white male with Anxiety, and there is focus on psychopharmacologic treatment to improve outcomes. The patient experiences chest tightness and shortness of breath as well as feeling of impending doom. The client is using ETOH to combat worries and takes 3-4 beers/night and considering his behavior factors is useful to understand how this impacts the client’s pharmacokinetic and pharmacodynamic processes. The Hamilton Anxiety Rating Scale (HAM-A) score for the client was 26, and for the severity score ≥ 24 indicates severe GAD. Zoloft is first prescribed at 50 mg and then increased to 100 mg.
Decision Point One- Begin zoloft 50mg oral daily
In decision point one, the PMHNP ought to select begin zoloft 50mg oral daily, and the other two options are: Imipramine 25mg oral BID and Buspirone 10mg oral BID. Zoloft (sertraline) is a Neuroscience-based Nomenclature: serotonin reuptake inhibitor (S-RI) and selective serotonin reuptake inhibitor) (SSRI), which is commonly prescribed for Generalized anxiety disorder (GAD) (Stahl, 2014). I hoped that Zoloft will have therapeutic effects for the patient with GAD. Zoloft boosts neurotransmitter serotonin and blocks serotonin reuptake pump (serotonin transporter) (Stahl, 2014). There were improvements as expected since there was n chest tightness, and shortness of breath, and the HAM-A score decreased to 18. However, I expected that the HAM-A would be lower and a score rating of 18 indicates partial response.
The genes involved in serotonin release and reuptake, which influence the effect of selective serotonin reuptake inhibitors (SSRI) Zoloft may block the dopamine transporter to increase and Zoloft binds at sigma 1 receptors (Sthal, 2014). When the therapeutic actions begin they may be delayed for 2-4 weeks and when no working after 6-8 weeks an increase in dose is required (Stahl, 2014).
The other two options were begin Imipramine 25 mg po BID and begin Buspirone 10 mg po BID. Imipramine (Tofranil) is a tricyclic agent (TCA) and there is high interaction potential when using the medication. While imipramine is commonly prescribed for anxiety, it is FDA approved for depression and I did not choose the medication as it is sedating antidepressants (Stahl, 2014). Buspirone (BuSpar) inhibits the uptake of serotonin, dopamine and norepinephrine. Buspirone is often an augmenting agent to SSRIs/SNRIs, and I did not choose the option as the reduction symptoms is likely to be lower than Zoloft, and this makes it less effective and less preferred than Zoloft.
Alcohol affects some of number of neurotransmitter receptors, and while three has improvement in symptoms alcohol will likely affect health outcomes. When using the mood-altering drug there is rapid absorption in the gastrointestinal tract when there is alcohol ingestion. Thus, considering how the drugs interact with alcohol and whether alcohol worsens the health outcomes. The major pathway for alcohol metabolism is class I alcohol dehydrogenases...