A Middle-Aged Caucasian Man With Anxiety. 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.
Introduction to the case (1 page)
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 (1 page)
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.
Full Answer Section
You perform a physical examination and review the patient's laboratory results, which are all within normal limits. You conclude that the patient has generalized anxiety disorder (GAD).
Decision #1
Which medication would you prescribe to this patient?
Options:
- Escitalopram (Lexapro)
- Sertraline (Zoloft)
- Buspirone (Buspar)
Decision:
I would prescribe escitalopram (Lexapro) to this patient.
Rationale:
Escitalopram is a selective serotonin reuptake inhibitor (SSRI) that is approved for the treatment of GAD. SSRIs are generally well-tolerated and have a low risk of side effects. Escitalopram is also one of the most effective SSRIs for the treatment of GAD.
Factors to consider:
The patient's age, sex, medical history, and other medications are all factors to consider when choosing an anxiety medication.
- Age: SSRIs are generally safe and effective for older adults. However, older adults may be more sensitive to the side effects of SSRIs, such as drowsiness and dizziness.
- Sex: SSRIs are equally effective for men and women.
- Medical history: The patient's history of hypertension and high cholesterol should not affect his response to SSRIs. However, it is important to monitor the patient's blood pressure and cholesterol levels while he is taking an SSRI.
- Other medications: The patient's current medications, lisinopril and atorvastatin, are not known to interact with SSRIs. However, it is always important to check for potential drug interactions before prescribing any new medication.
Why I did not select the other two options:
Sertraline (Zoloft) is another SSRI that is approved for the treatment of GAD. However, escitalopram is more selective for the serotonin transporter, which may make it less likely to cause side effects such as sexual dysfunction and weight gain.
Buspirone (Buspar) is a nonbenzodiazepine anxiolytic that is also approved for the treatment of GAD. However, buspirone can take several weeks to start working, and it is not as effective as SSRIs for the treatment of moderate to severe GAD.
What I hope to achieve by making this decision:
I hope that by prescribing escitalopram, the patient will experience a significant reduction in his anxiety symptoms. I also hope that the medication will improve his quality of life and allow him to function better at work and in his personal life.
Ethical considerations:
It is important to inform the patient about the potential risks and benefits of escitalopram before prescribing it. The patient should be aware that SSRIs can cause side effects such as nausea, insomnia, and sexual dysfunction. The patient should also be aware that SSRIs can take several weeks to start working, and that it is important to take the medication as prescribed.
It is also important to monitor the patient's progress and make adjustments to the medication as needed. If the patient is not responding to escitalopram, or if he is experiencing intolerable side effects, the medication should be discontinued.
Communication with patients:
It is important to communicate with patients in a clear and concise manner. When prescribing an anxiety medication, it is important to explain the following:
- The name of the medication and its dosage
- How to take the medication
- The potential risks and benefits of the medication
- How long the medication will take to start working
- What to do if the patient experiences side effects
- The importance of taking the medication as prescribed
It is also important to answer any questions that the patient may have about the medication or their anxiety disorder.
Conclusion
Escitalopram is a safe and effective medication for the treatment of generalized anxiety disorder (GAD). It is important to consider the patient's age, sex, medical history, and other medications when choosing an anxiety medication. It is also important to inform the patient about the potential risks and benefits of the medication before prescribing it.
Sample Answer
Introduction to the case
A middle-aged Caucasian man presents to your clinic with anxiety. He is 55 years old, has a history of hypertension and high cholesterol, and is currently taking lisinopril and atorvastatin. He has no known allergies to medications.
The patient reports that he has been experiencing anxiety for several months. He describes his anxiety as a feeling of worry and nervousness, and he often has difficulty sleeping. He has also noticed that his anxiety is getting worse, and it is starting to interfere with his work and social life.