NURS Exam 3 Prep - The Nervous System Drugs for Anxiety and Sleep Disorders

What is the limbic system?

responsible for emotional expression, learning, and memory

What is the hypothalamus?

associated with the autonomic nervous system and the “fight or flight” response

What is connected to the hypothalamus?

reticular formation

What is the reticular formation?

causes alertness/arousal; inhibition causes drowsiness/induction of sleep 

What is the reticular activating system (RAS)?

part of the reticular formation, regulate the sleep-wake cycle

What are anxiety disorders?

generalized anxiety disorder (GAD), panic disorder, phobias, separation anxiety disorder, OCD, PTSD

What are phobias?

a peristent, irrational fear of being judged or ridiculed is termed social anxiety disorder.

What is agoraphobia?

fear of situations or places 

What is acrophobia?

fear of heights

What is aerophobia?

fear of flying

What is arachnophobia?

fear of spiders 

What are other disorders close to anxiety disorders?

obsessive-compulsive disorder (OCD) & post-traumatic stress disorder (PTSD)

What is insomnia?

an inability to fall asleep and/or stay asleep 

What is the cause of insomnia?

multifactorial and is commonly associated with anxiety disorders

What are disorders associated with excessive daytime sleepiness?

narcolepsy, obstructive sleep apnea (OSA), and restless legs syndrome (RLS) 

What are medications for insomnia and anxiety?

sedative-hypnotic & anxiolytics

What are sedative-hypnotic?

a drug with the ability to produce a calming effect at lower doses and the ability to induce sleep at higher doses

What are anxiolytics?

drugs that have an ability to reduce anxiety symptoms by altering levels of two important neurotransmitters in the brain: norepinephrine and serotonin 

What are commonly used classes of sedative-hypnotic & anxiolytic medications?

benzodiazepines, nonbenzodiazepine, antidepressants, barbiturates, first generation antihistamines

What are benzodiazepines?

binds Gamma-aminobutryic acid (GABA) receptor, enhance GABA effects 

What benzodiazepines are used to treat anxiety?

alprazolam (xanax), diazepam, clonazepam, lorazepam (all are FDA approved) 

What benzodiazepines are used to treat insomnia?

FDA approved drugs: temazepam (sleep onset and maintenance), triazolam (sleep-onset), estazolam

What are benzodiazepines useful for?

low doses for short periods of time, should not be used as maintenance treatment for anxiety 

What are adverse effects of benzodiazepines?

drowsiness, sedation, lethargy, somnolence, confusion, headache, respiratory depression

Why should benzodiazepines be used cautiously?

in older adults and pregnant women, increase fall risk, potential cognitive impairments, teratogenic

What are significant issues of benzodiazepines?

tolerance, physical dependence, addiction

What is a reversal agent of benzodiazepines?

flumazenil

What antidepressants are used to treat anxiety and insomnia?

selective serotonin reuptake inhibitors (SSRIs), atypical antidepressants, tricyclic antidepressants (TCAs)

What are selective serotonin reuptake inhibitors (SSRIs)?

first line pharmacological treatment for anxiety and depression 

What are SSRIs used to effectively treat?

eating disorders, panic disorders, and OCD

What don’t SSRIs affect?

reuptake of norepinephrine or dopamine, have no agonist or antagonist activity at any neurotransmitter recpetor

What is the safest antidepressant to treat anxiety and insomina?

SSRIs, sympathomimetic side effects are not common, fewer anticholinergic side effects 

What are some SSRI antidepressants used to treat anxiety and insomnia?

fluoxetine, citalopram, escitalopram, paroxetine, sertraline, fluvoxamine (all are FDA approved) 

What are atypical antidepressants?

selective norepinephrine reuptake inhibitors (SNRIs) & serotonin modulators

What are tricyclic antidepressants (TCAs)?

doxepin (FDA approves for insomina at low dose), imipramine, and amitriptyline 

What are some SNRIs?

duloxetine and venlafaxine (FDA approved) 

What are some serotonin modulators?

low dose of trazodone

What are Z-drugs?

(non-benzodiazepine & FDA approved) GABA receptor of the benzodiazepine-binding site 

What are FDA approved non-benzodiazpeines for insomnia?

zolpidem, zaleplon, eszopiclone

What are some first-generation antipsycohotic drugs classified as non-benzodiazpine anxiolytics?

prochlorperazine, perphenazine, quetiapine, an dtrifluoperazine which are reviewed ynder medications for psychosis

What non-benzodiazepine drugs have an FDA indication for an anxiety disorder?

hydroxyzine, buspirone (FDA approved), and meprobamate 

What is hydroxyzine?

(non-benzodiazepine & FDA approved) non-selectively blocks central and peripheral histamine H1 receptors and is also referred to as a first-generation antihistamine

Who can take hydroxyzine?

anxiety in patients with insomnia and substance use disorders 

What don’t first-generation histamines have?

black box warning and no abuse potential

What limits hydroxyzine’s use as an anxiolytic?

very sedating and highly anticholingeric

What are other classes of medications used for anxiety and insomnia?

antiseizure medications, beta blockers, melatonin receptor drugs, barbiturates 

What are barbiturates?

pentobarbital, phenobarbital, these drugs bind to, enhance the activity of, and mimic GABA

What do barbitrates include?

methohexital, secobarbital, and phenobarbital

What are significant issues of barbiturates?

tolarce, physical dependence, and toxicity/overdose 

What is a first line antihistamine used to treat insomnia?

diphenhydramine (FDA approved)

What are melatonin receptor agonists?

ramelteon (FDA approved)

What neurotransmitters are involved in anxiety disorders?

↓GABA, ↑norepinephrine, dysregulated serotonin (5‑HT)

What TCA medication treats anxiety and insomnia?

doxepin 

What Z-drugs medications treat insomnia?

zolpidem, zaleplon, eszopiclone

What is the safest first-line drug class to treat chronic anxiety?

SSRIs (e.g., sertaline, escitalopram)