drugs that treat mood and sleep disorders

class: benzodiazepines

diazepam

MOA of diazepam

enhances the effect if GABA at various GABA receptors throughout the CNS

indications of diazepam

anxiety disorders, alcohol withdrawal, hyper-excitability, agitation, seizure disorders, insomnia, preoperative relief of anxiety and tension. can be prescribed for other mental health disorders such as phobias, OCD, PTSD

side effects of diazepam

sedation, amnesia, confusion, urinary retention, changes in libido, cardiovascular effects (brady/tachy), GI effects

black box warning for diazepam

excessive sedation when taken with opioids that can lead to respiratory depression, coma, or death

antidote for diazepam

flumazenil

contraindications for diazepam

hypersensitivity, psychosis, narrow-angle glaucoma, elderly patients, pregnancy

nursing considerations for diazepam

controlled substance- short term , if prescribed for seizures ensure seizure precautions, monitor injection sites for phlebitis, taper medication, caution with CNS depressants and theophyllines (used for asthma/lung disease)

patient teaching for diazepam

do not drive while taking, do not abruptly stop medications, avoid CNS depressant substances (alcohol, antihistamines, tranquilizers)

other anxiolytic and hypnotic drugs

buspirone, antihistamine, eszopiclome, zolpidem

indication of buspirone

reduces the signs and symptoms of anxiety without many of the CNS effects and severe adverse effects

MOA of buspirone

unclear but dies bind to both serotonin and dopamine receptors

nursing consultant for buspirone

takes 1-4 weeks for full effect, educate patient on this timeline (long term use is okay), avoid grapefruit juice

what are antihistamines

can be very sedating, can be used pre/post op to decrease the need for narcotics

what is eszopiclone

indicated for insomnia, possible reacts with GABA sites near benzodiazepine receptors

what is zolpidem

causes sedation, indicated for short term treatment of insomnia, binds selectively to GABA receptors, not universally as seen with benzodiazepines and barbiturates

black box warnings for eszopiclone and zolpidem

unusual sleep behaviors (sleepwalking, sleep driving, operating dangerous machinery) need to be taken in the evening when the patient goes to sleep (allow for 7-8 hrs of sleep)residual day time sleepiness can occur, patient education is important

class: antidepressant SSRI

sertraline

moa of sertraline

specifically blocks the reuptake of 5HT (serotonin) with little to no effect on NE (norepinephrine)

indications of sertraline

treatment of depressions, social anxiety disorder, OCDs, PTSD, panic disorders, bulimia, PMDD

side effects of sertraline

suicidal ideations/behaviors, anxiety, sexual dysfunction, weight gain, dry mouth, headache, drowsiness or insomnia, GI effects, serotonin syndrome

contraindications of sertraline

children/adolescents, pregnancy

nursing considerations for sertraline

assess for suicidal ideations, serotonin syndrome, and side effects. thorough patient teaching can be life saving

patient teaching for sertraline

full effect can take up to 4 weeks, teach patient and family the signs and symptoms of worsening delression and to minitor SI. St. Johns Wort can cause an increased risk of serotonin syndrome

alternative therapies to treat sleep disorders and mood

St. Johns Wort, Melatonin, Valerian

what is St. Johns Wort

affects serotonin, producing antidepressant effects, used for mild depression, sometimes used orally as an analgesic to relieve pain/inflammation, topical use for infection. most commonly found in OTC in supplements

what is melatonin

naturally occurring in the body, regulates sleep-wake cycles. OTC is used for insomnia and jet lag

what is valerian

increases GABA to prevent insomnia and reduce anxiety. OTC can be found in supplements, teas, and extracts

class: barbiturates

phenobarbital

MOA of phenobarbital

General CNS depressants that inhibit neural impulse conduction in the ascending RAS, depress cerebral
cortex and motor output causing sedation, hypnosis, anesthesia, and potentially coma

indications of phenobarbital

sedation, insomnia (short term treatment), preanesthetic, seizure treatment (tonic-clonic, cortical focal), emergency control of acute convulsive episodes

side effects of phenobarbital

Sedation, agitation, confusion, hyperkinesia, ataxia, CNS depression, hallucinations, syncope, withdrawal syndrome, Stevens- Johnson syndrome

contraindications of phenobarbital

Hypersensitivity, previous history of addiction to sedative hypnotic drugs, latent or manifest porphyria, marked hepatic impairment or nephritis, respiratory distress or severe respiratory dysfunction, use in conjunction with other CNS depressants, pregnancy (congenital anomalies), acute/chronic pain (increased risk of paradoxical excitement

nursing considerations for phenobarbital

controlled substance with an increased risk of dependence, if prescribed for seizures ensure seizure precautions, monitor injection sites for phlebitis , taper this medication, caution with CNS depressant ps and many other medications. monitor renal/hepatic function, lower doses may be needed

patient teaching for phenobarbital

do not drive, do not abruptly stop, avoid CNS depressant substances (alcohol, antihistamines, tranquilizers), has many drug-drug interactions, discuss with provider prior to adding any medications

phenobarbital is less what

desirable, because it is an older medication associated with serious adverse effects and interacts with many medications