Analyses of case 4 case examples will be completed over the course of the semester. These analyses must demonstrate comprehension of material including appropriate diagnosis, pharmacokinetics, pharmacodynamics, and clinical implications.

Gary is a 42-year-old African American engineer at a local firm. He has always been a high achiever and can drive himself hard. In the past year he was in a serious car accident when he was hit by a drunk driver and he lost his 69-year-old mother after a 4 month bout of pancreatic cancer. While Gary has recovered fully from the accident he is very nervous driving. He has started experiencing panic attacks and general anxiety about driving. He tried counseling once but said it wasnt for me. He has been diagnosed with Panic Disorder and Post Traumatic Stress Disorder. He is a regular though moderate user of alcohol (4-6 drinks per week, mostly on the weekend). His physician initially prescribed paroxetine (20 mg. a day) but Gary said it killed his sex drive and he quit taking it after 10 days. His doctor is open to prescribing him a benzodiazepine but wants Gary to try counseling one more time if she prescribes that. She says that the PTSD is the primary problem and if he can treat that the panic will likely subside. Again Gary was hesitant to go to counseling

  1. Why do you think Gary is so reticent about counseling? How could you discuss this with him if you were the therapist?

Until Gary could make up his mind about counseling the doctor wanted to try buspirone. Gary took it for the recommended two weeks but said it made him feel sedated and he had more nightmares while taking it. Gary finally agreed to counseling and the doctor prescribed alprazolam .50 mg 1-2 times daily. Gary wants to know what the side effects of this drug will be.

  1. What would you tell Gary about the side effects?
  2. Why do you think the doctor was hesitant to prescribe the alprazolam?

Gary stated he did much better with the alprazolam but a friend of his told him it was Valium and he could get addicted to it.

  1. Gary asks you if he will get strung out on the alprazolam. How do you respond?