Examine Case Study: A Middle-Aged Caucasian Man With Anxiety.

Sample Solution

Case Study: A Middle-Aged Caucasian Man With Anxiety

A middle-aged Caucasian man presents to the clinic with complaints of anxiety. He has been experiencing symptoms of anxiety for several months, including difficulty sleeping, restlessness, and irritability. He has also been having difficulty concentrating at work and socializing with friends.

The patient's medical history is significant for hypertension and hyperlipidemia. He is currently taking lisinopril for his hypertension and atorvastatin for his hyperlipidemia. He denies any alcohol or drug use.

Full Answer Section

Patient factors that may impact medication selection

The patient's age, race, and medical history are all factors that may impact medication selection. For example, older adults are more likely to experience side effects from certain medications, so it is important to choose a medication with a favorable side effect profile for this patient population. Additionally, the patient's hypertension and hyperlipidemia may limit the choice of medications available to him. Some medications can interact with lisinopril and atorvastatin, so it is important to choose a medication that is safe to use in combination with these medications.

Decision #1: Which medication to prescribe

There are a number of different medications that can be used to treat anxiety. Some of the most commonly prescribed medications include:

• Serotonin selective reuptake inhibitors (SSRIs): SSRIs are a class of antidepressants that work by increasing the levels of serotonin in the brain. SSRIs are generally safe and well-tolerated, and they are the first-line treatment for anxiety disorders.
• Serotonin-norepinephrine reuptake inhibitors (SNRIs): SNRIs are similar to SSRIs, but they also increase the levels of norepinephrine in the brain. SNRIs may be more effective than SSRIs for certain types of anxiety disorders, such as social anxiety disorder and panic disorder.
• Benzodiazepines: Benzodiazepines are a class of anti-anxiety medications that work by quickly calming the central nervous system. Benzodiazepines are effective for relieving anxiety symptoms, but they can also be addictive and have other side effects, such as sedation and drowsiness.

Decision

I would prescribe an SSRI, such as sertraline (Zoloft) or escitalopram (Lexapro), as the first-line treatment for this patient. SSRIs are safe and well-tolerated, and they are effective for treating a variety of anxiety disorders.

Rationale

SSRIs are the first-line treatment for anxiety disorders because they are safe and effective. They are also relatively well-tolerated, with common side effects being mild and transient. SSRIs can be taken long-term, which is important for patients with chronic anxiety disorders.

The patient's age, race, and medical history are all factors that support the use of an SSRI. Older adults are more likely to experience side effects from certain medications, so it is important to choose a medication with a favorable side effect profile for this patient population. Additionally, the patient's hypertension and hyperlipidemia may limit the choice of medications available to him. Some medications can interact with lisinopril and atorvastatin, so it is important to choose a medication that is safe to use in combination with these medications.

Why I did not select the other two options

I did not select a benzodiazepine as the first-line treatment for this patient because benzodiazepines can be addictive and have other side effects, such as sedation and drowsiness. Benzodiazepines should be reserved for patients with severe anxiety or anxiety that is not responding to other medications.

I did not select an SNRI as the first-line treatment for this patient because SNRIs are not as well-studied as SSRIs for the treatment of anxiety disorders. Additionally, SNRIs are more likely to cause side effects, such as nausea and insomnia, than SSRIs.

What I hope to achieve by making this decision

I hope to achieve the following by prescribing an SSRI to this patient:

• Reduce his anxiety symptoms
• Improve his quality of life
• Allow him to function normally at work and in his social life

Ethical considerations

It is important to consider ethical considerations when prescribing medication to any patient. Some ethical considerations that may be relevant to this patient include:

• Informed consent: It is important to obtain informed consent from the patient before prescribing any medication. This means explaining the potential benefits and risks of the medication to the patient and allowing them to make a decision about whether or not they want to take the medication.
• Beneficence: Beneficence is the ethical principle of doing good for the patient. When prescribing medication, it is important to choose a medication that is likely to benefit the patient and that has a favorable side effect profile.
• Non-maleficence: Non-maleficence