Introduction
Generalized anxiety disorder (GAD) is a highly debilitating mental health condition. It has cognitive and physical manifestations, with patients exhibiting extreme nervousness and apprehension and experiencing dizziness, muscle tension, chest pain, respiratory disturbances, and increased heart rate (Jafarnia et al., 2017). As GAD can cause extreme discomfort and adversely impact the patient’s well-being and quality of life, it is imperative to address it with a comprehensive plan of care. This case study aims to compare and contrast different pharmacological options for the treatment of GAD.
Main body
The case study client is a middle-aged white male experiencing cognitive and physical symptoms of GAD. The 46-year-old patient went to the emergency room believing he was having a heart attack as he was suffering from “chest tightness, shortness of breath, and feeling of impending doom” (Laureate Education, 2019). The case scenario offered the choice of three drugs to offer the client. The first drug was Zoloft, also known as sertraline, 50 mg administered daily. A substantial decrease in cognitive symptoms was noted during the first follow-up session, with the noted seizure of all physical manifestations. The next step was to recommend the increase of dosage to 75 mg to facilitate further symptom reduction. As symptoms decreased by the next follow-up session, the client was advised to maintain the 75 mg dose. Notably, the patient experienced no significant symptom reduction when administered Tofranil (imipramine) 25 mg twice a day and reacted adversely to the 50 mg dosage. Similarly, Buspirone 10 mg twice a day had no change in the patient’s feelings of anxiety, with the increase to 10 mg thrice a day having no substantial effect.
It can be argued that the pharmacokinetics and pharmacodynamics of Zoloft, Tofranil, and Buspirone affected how the patient in the scenario reacted to each of the drugs. Considering the pharmacodynamics of Zoloft, the drug does not have a substantial impact on blood pressure or heartbeat interval and slightly decreases the heart rate (Saiz-RodrĂguez et al., 2018). The drug also “exhibits linear pharmacokinetics, and peak plasma concentrations occur around 4–8 hours after a single oral dose” (Saiz-RodrĂguez et al., 2018, p. 501). In addition, there are no significant sex differences in the pharmacodynamics and pharmacokinetics of the drug, translating into it being the optimal medication for GAD.
The pharmacodynamics and pharmacokinetics of Tofranil and Buspirone vary from those of Zoloft. Thus, Tofranil takes 2-6 hours to absorb, with adverse reactions including dizziness, confusion, and loss of consciousness, as experienced by the client in the scenario (“Imipramine,” 2020). Meanwhile, Buspirone is absorbed immediately after oral administration, with a 2-4 hours half-life (“busPIRone,” 2021). Side effects of Buspirone include dizziness, confusion, drowsiness, musculoskeletal pain, and numbness in extreme cases (Wilson & Tripp, 2021). Thus, when prescribed Tofranil and Buspirone, the patient was more likely to experience adverse side effects in the case scenario.
It should also be noted that specific characteristics of the patient may have influenced his adverse reaction to Tofranil and Buspirone. According to the case study (Laureate Education, 2019), the client consumes 3-4 beers a night. Alcohol use considerably increases clearance and decreases the half-life of Tofranil, which may have affected the patient and led to an adverse reaction to the drug (“Imipramine,” 2020). Similarly, the absorption of Buspirone is exceptionally volatile and depends on food consumption and the metabolism of the client (Wilson & Tripp, 2021). Thus, the client’s habits and behavior might have impacted the reaction to Tofranil and Buspirone. In addition, experience shows that the client’s job, welder, should be considered as it is physically demanding, affecting the pharmacokinetics of medications.
Summary
In summary, in the case study, the patient was offered Zoloft, Tofranil, and Buspirone to address his GAD, presenting with cognitive and physical symptoms. Due to the pharmacokinetics and pharmacodynamics of Tofranil and Buspirone and the client’s lifestyle and profession, these drugs were ineffective and had an adverse effect on the health and well-being of the patients. The personalized plan of care for the patient should prescribe Zoloft, with a 50 mg dose taken daily and increased to 75 mg if needed.
References
busPIRone. (2021). Drugs.com.
Imipramine. (2020). Drugs.com.
Jafarnia, N., Ghorbani, Z., Nokhostin, M., Manayi, A., Nourimajd, S., & Razeghi Jahromi, S. (2017). Effect of Saffron (Crocus Satious L.) as an add-on therapy to Sertraline in mild to moderate generalized anxiety disorder: A double blind randomized controlled trial.Archives of Neuroscience, 4(4), 1–7.
Laureate Education. (2019). Generalized anxiety disorder [Interactive media file]. Web.
Saiz-RodrĂguez, M., Belmonte, C., Román, M., Ochoa, D., Koller, D., TalegĂłn, M., Ovejero-Benito, M. C., LĂłpez-RodrĂguez, R., Cabaleiro, T., & Abad-Santos, F. (2018). Effect of polymorphisms on the pharmacokinetics, pharmacodynamics and safety of Sertraline in healthy volunteers. Basic & Clinical Pharmacology & Toxicology, 122(5), 501–511.
Wilson, T. K., & Tripp, J. (2021). Buspirone. In StatPearls. StatPearls Publishing.