Julia Seabolt, Pharm.D.
Spring 1998
Anxiety Disorders
Julia Seabolt, Pharm.D.
Spring 1998
Anxiety Disorders
Presentation:
DL is a 70 year-old female who presents to your office complaining that she is not able to concentrate at home because of persistent anxiety. DL appears tense, ringing her hands, and shaking her foot during the interview. The patient also describes that she frequently loses her temper with her granddaughter. The patient also complains of shoulder and neck stiffness that persists throughout the day. DL describes frequent nocturnal awakenings at night with difficulty falling asleep. DL stated that there is no reason why she feel anxious all the time. She also is worried that she may become addicted to medications.
Axis I: Generalized Anxiety Disorder (GAD)
Axis II: deferred
Axis III: NIDDM & HTN
Past Psychiatric History: Pt has been treated with benzodiazepines for GAD 2 years ago.
Past Medical History: NIDDM, HTN, +family history of cardiovascular disease & diabetes.
Allergies: Penicillin
Social History: 2ppd. cigarettes, no polysubstance abuse
Labs: Thyroid profile, Chemistry profile and CBC with differential are WNL
Current medications: Glyburide 5 mg po bid, Enalapril 5 mg po qd, Entex LA 1 tablet po bid
Assessments:
Potential Problems:
Treatment Options:
Goals:
Monitor:
Case Study #1
Presentation:
DL is a 70 year-old female who presents to your office complaining that she is not able to concentrate at home because of persistent anxiety. DL appears tense, ringing her hands, and shaking her foot during the interview. The patient also describes that she frequently loses her temper with her granddaughter. The patient also complains of shoulder and neck stiffness that persists throughout the day. DL describes frequent nocturnal awakenings at night with difficulty falling asleep. DL stated that there is no reason why she feel anxious all the time. She also is worried that she may become addicted to medications.
Axis I: Generalized Anxiety Disorder (GAD)
Axis II: deferred
Axis III: NIDDM & HTN
Past Psychiatric History: Pt has been treated with benzodiazepines for GAD 2 years ago.
Past Medical History: NIDDM, HTN, +family history of cardiovascular disease & diabetes.
Allergies: Penicillin
Social History: 2ppd. cigarettes, no polysubstance abuse
Labs: Thyroid profile, Chemistry profile and CBC with differential are WNL
Current medications: Glyburide 5 mg po bid, Enalapril 5 mg po qd, Entex LA 1 tablet po bid
Assessments:
1. How well is DL’s blood pressure and blood sugar controlled? Increased serum glucose may cause increased urinary frequency and nocturnal awakenings. Blood glucose and blood pressure appears stable therefore determined that the diabetes is controlled and not exacerbating symptoms of anxiety/insomnia.
2. What are the anxiety target symptoms for DL? When did the anxiety symptoms re-emerge? When and why was the Entex LA started? Did the Entex LA affect DL’s sleep/symptoms? Target symptoms listed by DL is decrease concentration, irritability, shoulder and neck stiffness, nocturnal awakening, difficulty falling asleep, and fidgeting. Determined that Entex LA was started 1 week ago for congestion which coincides with the insomnia and may increase a patient’s baseline symptoms of anxiety/insomnia. Drug-induced anxiety can be cause by central nervous stimulants like caffeine, and decongestant.
3. What is DL’s past medication history and response? Profile states that she has used benzodiazepines in the past for GAD. Which benzodiazepines was used? How much? How long and how effective was it for DL? She used Xanax in the past at 3mg/day for 2 years. She felt like she could tell when the medication was wearing out of her system. Only side effect from Xanax was sedation initially.
Problems:
1. Elderly patient with recent increase in anxiety symptoms and insomnia possible related to the current start of Entex LA. Unable to determine baseline level of anxiety until Entex LA is discontinued.
2. Possible re-emergence of GAD.
Treatment Options:
1. Refer patient to her general medicine or internal medicine physician if HTN or NIDDM is not controlled.
2. Discontinue Entex LA.
3. Assess for the need of psychotherapy
4. If anxiety is not improved in 1 week consider:
A. starting a benzodiazepine - consider using the past medication that was effective for the patient. However, she is considered elderly with possible reduction in hepatic oxidation (Phase I metabolism). Would consider using benzodiazepines that are metabolized by conjugation (Phase II) like lorazepam, oxazepam, & temazepam. One must be aware that benzodiazepine’s can possible lead to a paradoxical reactions in children and the elderly. Also be concern about the potential for falls and broken hips. Patient expressed concern about being addicted to the medication.
B. starting buspirone -a fairly benign medication. Only side effects include CNS and GI disturbances. No addiction property for the patient. This medication takes ~2 weeks to see the beneficial effect. The patient may need supplemented during this 2 week period with a low dose benzodiazepine (i.e., bedtime).
Goals:
1. Resolution of anxiety target symptoms & insomnia in ~ 1 week.
2. Patient learn some relaxation techniques & stress management.
3. Patient will be compliant with medication.
Monitor:
1. Patient/family to monitor blood pressures and blood glucose regularly as instructed by primary care physician.
2.Evaluate target symptoms of anxiety and their response.
3.Evaluate for possible side effects of the medication (i.e., excessive sedation).
 Previous |
 Next |
 Syllabus |
| The College of Pharmacy | UICPHARM@uic.edu | |
| The University of Illinois at Chicago | Last modified: Dec 31, 1997 | |