ANTI-ANXIETY AGENTS N O VA S O U TH EAS TERN U N I V ER S ITY A S S A F C OLLEGE OF N U R S IN G N U R 3 1 9 1: P H A R M ACOLOGIC BA S I S F O R N U R S I NG I N TERV EN TI ONS I NEURONS • Respond to stimuli • Conduct electrical impulses • Release neurotransmitters LIFE OF NEUROTRANSMITTER • Current reaches end of cell; • Neurotransmitter released; • Attaches to receptor; • Stimulates or inhibits activity; • Separates from receptor destroyed. NEUROTRANSMITTERS • Role in human behavior and emotions • Mechanism of action in most psychotrophic drugs. • Convey impulses across the synapse. • Chemical messengers of the brain. • Many exists in CNS and Peripheral Nervous System (PNS) ANTIANXIETY AGENTS (ANXIOLYTICS) Benzodiazepines Barbiturates Beta Blockers Antihistamnes Buspirone MECHANISM OF ACTION Benzodiazepines: • Increases neurotransmitters GABA • Preference for limbic system • Depresses CNS • Produces skeletal muscles relaxation • Anticonvulsant properties BENZODIAZEPINES Indications for use: • Short term treatment of anxiety • Treatment of seizure disorder • Useful in the acute stage of panic BENZODIAZEPINES • chlordiazepoxide (Librium) • clonazepam (Klonopin) • diazepam (Valium Serax) • oxazepam (Serax) • clorazepate (Tranxene) • lorazepam (Ativan) • prazepam (Centrax) • alprazolam (Xanax) ADVERSE EFFECTS • Central nervous system • Hypotension • Paradoxical reactions • Hyperactivity and aggressive behavior • Habit-forming and addictive • Xanax (Alpraolam), Valium (diazepam), and Ativan (Lorazepam) should only be used short-term. Dependence and tolerance develop quickly. • Signs and symptoms of withdrawal I. Anxiety, tremors, insomnia II. Grand mal seizures, delirium III. Respiratory depression and death TOXICITY AND MANAGEMENT OF OVERDOSE • Decontamination of the gastrointestinal system • Antidote – flumazenil (Romazicon) BARBITURATES • Prototype sedative-hypnotic drugs • Inhibit nerve cells – producing CNS depression BARBITURATES Used for extreme cases of insomnia and seizures that are unresponsive to other drugs. • phenobarbital (Nembutal sodium) • secobarbital (Seconal sodium) • butabarbital (Butisol sodium) • phenobarbital (Luminal) ANTIHISTAMINES Used to treat allergies, dermatologic reactions, motion sickness, N/V, and drug-induced EPS • diphenhydramine (Benedryl) • hydroxyzine (Atarax, Vistaril) MISCELLANEOUS BUSPIRONE (BUSPAR) • Non-benzodiozepine • Non addicting • Less sedating • No physical or psychological dependence • Can be used for long periods of time • Useful in generalized anxiety disorder CONTRAINDICATIONS OF ANXIOLYTICS • Severe respiratory depression • Open angle glaucoma • History of seizure disorder • Severe liver or kidney disease • Hypersensitivity • Pregnancy PATIENT TEACHING • Routine oral dosing given at bedtime • Avoid alcohol and caffeine • Caution against driving and machinery • Do not stop abruptly • Report sleep pattern changes • Paradoxical excitation (increased talkativeness, emotional release, excitement, and excessive movement) • Observe for therapeutic effects • Observe for adverse effects NURSING ASSESSMENT • Review CBC, electrolytes and kidney function test, if ordered • Vitals signs especially BP • Asses for alertness, orientation, and sensory and motor functioning • Complaints of headache, ataxia or neurological abnormalities • Medication reconciliation • Allergies • Mental status • Drug interactions PATIENT TEACHING • Routine oral dosing given at bedtime • Avoid alcohol and caffeine • Caution against driving and use of machinery • Do not stop abruptly • Report sleep pattern changes • Paradoxical excitation (increased talkativeness, emotional release, excitement, and excessive movement) • Observe for adverse effects • Observe for therapeutic effects REFERENCE Lilley, L. L., Rainforth Collins, S., Harrington, S., & Snyder, J. S. (2017). Pharmacology and the nursing process. (8th ed.) St. Louis, MO: Mosby Elsevier.
