pharm 20.1- anxiety and sleep

benzodiazepines for anxiety

commonly used for short term anxiety

examples of benzodiazepines

-lam

alprazolam

panic disorders due to short half life

lorazepam

anti anxiety with antiemetic properties, used for n/v associated with chemo

diazepam

reduces anxiety before medical procedures and is used for seizures

midazolam

pre-op for sedation

clonazepam

only benzodiazepines recommended for long term use, less prone to dependency

mechanism of benzodiazepines

binds to GABA receptors with intensifies calming effects of GABA to control anxiety

side effects of benzodiazepines

CNS depression, sedation, respiratory depression (IV), amnesia, confusion, increased risk of falls, ataxia, paradoxical reactions- restlessness and agitation

ataxia

lack of muscle coordination

nursing implications of benzodiazepines

not recommended for long term use, can bridge between immediate and long term medications, quickly develops a tolerance, risk for addiction, reversal agent available for respiratory depression, on beers list

patient education of benzodiazepines

do not stop abruptly, never mix with alcohol, signs of dependency and increased tolerance (like needing a higher dose)

buspirone mechanism

partial serotonin agonist, increases effects of serotonin

uses for buspirone

anxiety, never given prn, can be used short term, takes weeks to reach full therapeutic effect

side effects of buspirone

drowsiness at start of therapy

nursing implications of buspirone

monitor sedation (especially if also on benzodiazepine)

beta adrenergic blocker examples

metoprolol, propanolol

uses for beta adrenergic blocker

situational anxiety, reduces sympathetic flow, reduces heart palpitations

side effects of beta adrenergic blocker

bradycardia, hypertension, brochoconstriction, masks hypoglycemia

nursing implications of beta adrenergic blocker

assess vitals, test out trial dose to evaluate response before important event, can be used for both sleep and anxiety

drugs for sleep disorders

antihistamines, melatonin receptor agonists, barbiturates, benzodiazepines, hypnotics, antidepressants

antihistamines examples

diphenhydramine, doxylamine, common otc sleep aids

mechanism of antihistamines

interact with CNS histamine receptors producing sedation, work short term or prn

side effects of antihistamines

anticholinergic effects, dry mouth, paradoxical reaction

nursing implications of antihistamines

non addictive, cheap and easy access, monitor fall risk, report paradoxical reactions, try non pharmacological methods as well

melatonin receptor agonists example

melatonin, rameleon (prescription)

mechanism of melatonin receptor agonists

acts like endogenous melatonin

side effects of melatonin receptor agonists

fall risk

barbiturates examples

-barbital

Phenobarbital- seizures

pentobarbital- seizures

secobarbital- pre op

mechanism of barbiturates

binds to gaba receptor in the brain

side effects of barbiturates

tolerance and dependence develop quickly, can lead to respiratory arrest on high doses, accidental OD= no reversal agent

nursing implications of barbiturates

usually a last resort treatment, never mix with alcohol, all are controlled substances

benzodiazepines for insomnia examples

Temazepam

Triazolam

mechanism of benzodiazepines

bind to gaba receptors to intensify gaba effect, best for short term use,

side effects of benzodiazepines

hangover effect- suppresses REM sleep slightly, confusion, impaired coordination

nursing implications of benzodiazepines

on beers list, C4, can lead to tolerance and dependence

hypnotics examples

(Z drugs) zolpidem (most common), eszopiclone, zaleplon

hypnotics mechanism

binds to gaba receptors to cause sleep, use short term or prn, will not cause hangover effect or effect REM sleep

side effects of hypnotics

sleep walking, sleep eating, vivid dreams

nursing implications of hypnotics

rapid onset, be alert to sleepwalking activities

antidepressants off label use

sleep and neuropathic pain

examples of antidepressants

amitriptyline, mirazapine, trazado

mechanism of antidepressants for sleep

black reuptake of serotonin to produce a calming feeling and relaxation

orexants

new class of sleep drug, inhibit orexant receptors which are responsible for arousal