CHAPTER 14
DRUGS FOR ANXIETY AND INSOMNIA
LEARNING OUTCOME 1
Identify the major types of anxiety disorders.
Concepts
1. The major types of anxiety disorders are situational anxiety, generalized anxiety disorder (GAD), panic
disorder, phobias, obsessive-compulsive disorder, and post-traumatic stress disorder.
2. There is a model of anxiety that indicates when stressful events or changing mental conditions can produce
the feelings of anxiety.
LEARNING OUTCOME 2
Discuss factors contributing to anxiety and explain some nonpharmacologic therapies used to cope with
this disorder.
Concepts
1. The most common factors or causes of anxiety are phobias, post-traumatic stress, generalized anxiety,
obsessive-compulsive feelings, and panic disorders.
2. Some nonpharmacologic therapies used to cope with stress are cognitive behavioral therapy, counseling,
biofeedback techniques, and meditation. These may help individuals change the way they think and
eliminate the cause of the anxiety.
LEARNING OUTCOME 3
Identify the regions of the brain associated with anxiety, sleep, and wakefulness.
Concepts
1. The limbic system is in the middle of the brain and is responsible for emotional expression, learning, and
memory. Signals pass through the limbic system and connect with the hypothalamus. This connection is
associated with emotional states, anxiety, fear, anger, aggression, remorse, depression, sexual drive, and
euphoria. See Figure 14.1.
2. The hypothalamus is responsible for unconscious responses to extreme stress, such as high blood pressure,
elevated breathing rate, and dilated pupils. The hypothalamus connects with the reticular formation.
3. The reticular formation is a network of neurons along the length of the brainstem. Stimulation causes
heightened awareness and arousal. Inhibition causes general drowsiness and the induction of sleep.
4. The reticular activating system (RAS) projects from the reticular formation in the brainstem to the thalamus.
The RAS is responsible for sleeping and wakefulness. Signals from the hypothalamus pass through the RAS
and on to higher brain centers.
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Provide a blank diagram of the brain, and have students label the limbic system, reticular formation,
hypothalamus, and reticular activating system.

and/or barbiturate; the reason for ordering the medication; and its effectiveness.
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Ch 14-1
LEARNING OUTCOME 4
Identify the three classes of medications used to treat anxiety and sleep disorders.
Concepts
Antidepressants, benzodiazepines, and barbiturates are three classes of medications used to treat anxiety and
sleep disorders.
LEARNING OUTCOME 5
Explain the pharmacological management of anxiety and insomnia.
Concepts
1. Antidepressants are used to treat anxiety and reduce symptoms associated with panic, obsessive-compulsive
behavior, and phobia.
2. Benzodiazepines used to treat short-term insomnia are different from those used to treat generalized anxiety
disorders.
3. Low doses of barbiturates reduce anxiety, and moderate doses promote sleep.
LEARNING OUTCOME 6
Describe the nurse’s role in the pharmacologic management of anxiety and insomnia.
Concepts
1. The nurse should monitor the patient’s condition and provide education as it relates to the prescribed drug
treatment. Obtain baseline vital signs, medical and drug history, lifestyle and dietary habits, and what
activities the patient was involved in at the onset of the symptoms.
2. The nurse should assess patient needs for antianxiety or insomnia drugs, including intensity and duration of
symptoms. Identify factors that precipitate anxiety or insomnia. Identify coping mechanisms used in
managing stress, anxiety, and insomnia. Assess for a primary sleep disorder.
3. Obtain a drug history, including hypersensitivity and the use of alcohol and other CNS depressants. Assess
for drug abuse and dependence.
4. Use benzodiazepines cautiously in the elderly and in patients with a suicidal potential or impaired renal or
liver function.
5. Benzodiazepine and nonbenzodiazepine: Assess for common side effects related to CNS depression;
neurological status; level of consciousness. Monitor vital signs. Observe respiratory patterns particularly
during sleep. Monitor the patient’s intake of stimulants, such as caffeine and nicotine. Monitor affect and
emotional status.
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Ch 14-2
Have students design and implement a plan to educate a patient who has been ordered an antianxiety or
insomnia drug.
Adams_IRM
LEARNING OUTCOME 7
Identify normal sleep patterns and explain how these might be affected by anxiety and stress.
Concepts
1. People with normal sleep patterns move from nonrapid eye movement (NREM) to rapid eye movement
(REM) sleep about every 90 minutes. There are four progressive stages of NREM sleep; then the sequence
goes into reverse. After returning to stage I of NREM, REM sleep occurs. During REM sleep, dreaming
occurs. See Table 14.1 for the stages of sleep.
2. Stress interrupts normal sleeping patterns because the patient’s mind is too active.
LEARNING OUTCOME 8
Categorize drugs used for anxiety and insomnia based on their classification and mechanism of action.
Concepts
1. Benzodiazepines act by binding to the gamma-aminobutyric acid (GABA) receptor-chloride channel
molecule, intensifying the effects of GABA. Additional examples: Xanax, Librium, Tranxene.
2. Barbiturates act by binding to GABA receptor-chloride channel molecules, intensifying the effect of GABA
throughout the brain. Additional examples: Nembutal, Seconal, Amytal.
3. Nonbenzodiazepines, nonbarbiturates (CNS depressants) act by binding to the GABA receptor, preserving
sleep stages III and IV and offering minor effects of REM sleep. Additional examples: Buspar, Noctec,
Placidyl.
LEARNING OUTCOME 9
For each of the classes listed in Drugs at a Glance, know representative drugs and explain their
mechanisms of action, primary actions, and important adverse effects.
Concepts
1. Benzodiazepines: The prototype drug is lorazepam (Ativan). The mechanism of action is to bind with the
GABA receptor-chloride channel molecule, which intensifies the GABA effect. The primary use is to
reduce anxiety disorders and insomnia. The important adverse effects include drowsiness, dizziness, and
respiratory depression.
2. Barbiturates: The prototype drug is diazepam (Valium). Its mechanism of action is to bind to GABA
receptor-chloride molecules, intensifying the effect of GABA throughout the brain; it also inhibits brain
impulses from traveling through the limbic system and the reticular activating system, thereby calming
without strong sedation. Its primary use is as a sedative and a hypnotic. The important adverse effects
include tolerance, respiratory depression, and psychological and physical dependence.
3. Nonbenzodiazepines, nonbarbiturates (CNS depressants): The prototype drug is zolpidem (Ambien). The
mechanism of action is to bind to GABA receptors, thereby preserving sleep stages III and IV and offering
minor effects of REM sleep. The primary use is as a hypnotic. The important adverse effects include mild
nausea, dizziness, diarrhea, daytime drowsiness, amnesia, sleepwalking, and ingesting carbohydrates while
sleepwalking.
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LEARNING OUTCOME 10
Use the nursing process to care for patients receiving drug therapy for anxiety and insomnia.
Concepts
1. Assessment occurs prior to the administration of the drug and includes potential nursing diagnoses, reason
for the drug, taking vital signs, cautions and contraindications of the drug, possible drug interactions, taking
a complete health history including allergies, drug history, and evaluation of lab findings.
2. Nursing diagnosis: risk for injury, knowledge deficient, related to drug therapy, and ineffective individual
coping.
3. Planning includes patient goals and expected outcome. The patient will exhibit a decrease in symptoms of
anxiety and insomnia, demonstrate an understanding of the drug’s activity, accurately describe drug side
effects and precautions, and demonstrate proper administration technique.
4. Implementation of drug therapy includes interventions and rationales, administration of the drug, observing
for adverse effects, and patient education and discharge planning.
5. Evaluate the effectiveness of the drug therapy by confirming that the patient’s goals and expected outcomes
have been met (see Planning above).
Ch 14-4
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