Antianxiety Medications

antidepressants

treats anxiety

antianxiety medication classes

antidepressants, benzos, nonbenzos, sedatives/hypnotics

what are the first line medications for anxiety?

SSRIs

what are the first line additive medications for anxiety?

nonbenzodiazepines

selective serotonin reuptake inhibitors meds

paroxetine, sertraline, fluoxetine, citalopram

what are the indications/ uses for SSRIS?

GAD, OCD, panic attacks, PTSD, and social phobias

adverse effects of SSRIs

nausea, agitation, drowsiness, and sexual dysfunction

selective serotonin-norepinephrine reuptake inhibitors (SNRIS) meds?

venlafaxine and duloxetine

adverse effect of SNRIS

appetite suppressant

how long does it take for antidepressants to become effective ?

takes weeks to be effective

when is the best time for a patient take antidepressants?

at night because it can have a sedative affect

benzodiapines meds

lorazepam, alprazolam, clonazepam, diazepam, chlordiazepoxide

what are the indications for benzos?

• anxiety disorders

• co administration with SSRI or SNRI

• acute agitation or acute panic attacks

• alcohol withdrawal

• catatonia

• helps regulate GABA

what is catatonia?

when you are in a fixated state like psychosis

lorazepam (ativan)

• for anxiety disorders, antiemetic, agitation

• better for patients with impaired liver function and older adults

alprazolam (xanax)

• for anxiety disorders, antitremors

• increases risk for addiction and dependence

diazepam (valium)

• Indications: anxiety disorders, antitremors, acute alcohol withdrawal

clonazepam (klonopin)

• for anxiety disorders (panic disorder), anticonvulsant, benzodiazepine withdrawal

• needs to be tapered

• abrupt withdrawal can cause status epilepsies- seizures

what should be implemented with there is a withdrawal of clonzaepam?

seizure precautions- padded bed rails, oxygen, suction

what clients shouldn’t take benzos?

glaucoma, CNS depression, pregnant

what should you do before administering a benzo?

check vitals for cns depression and assess neurological status

what if a benzo is ordered and a patient is experiencing CNS depression?

hold med and notify provider

what are side effects of benzos?

• anterograde amnesia- no new memories

• ataxia- no coordination

• confusion

• drowsiness

• dysarthria- slurred speech

• headache

what shouldn’t a patient do on benzos?

drink alcohol or grapefruit juice, don’t drive

what are physical dependence effects of benzos?

• agitation

• tremor

• irritability

• insomnia

• vomiting

• sweating

• convulsions

what are withdrawal effects of benzos?

similar to dependence + psychosis

how long should the withdrawal process of benzos be?

taper over 7 weeks

benzo and alcohol effect

increased sedation and CNS depression

benzo and antacid effect

impaired absorption rate of benzo

benzo and Disulfiram (Antabuse) and cimetidine (Tagamet) effect

increased level of benzo

benzo and phenytoin effect

increased anticonvulsant serum level

benzo and grapefruit juice effect

extends the life of benzo

signs of a benzo overdose

somnolence, confusion, coma, diminished reflexes, hypotension

what is the treatment of a benzo overdose?

emptying stomach, gastric lavage, activated charcoal

nurse interventions for a benzo overdose

• monitor blood pressure, pulse, and respirations

• give flumazenil for toxicity and withdrawal

what could happen to the baby if mom take benzo pregnant?

cleft lip, cleft palate, and floppy infant syndrome

why should you be cautious when giving older adults benzos?

• increases risk of falls and cognitive problems

• diazepam and chlordiazepoxide metabolize in the liver and older adults have impaired metabolism

patient teaching for benzos

what drug class is buspirone (buspar) in?

nonbenzodiazepines

what is buspirone?

• first line additive agent

• take in divided doses

• long term

advantages of buspirone

• Nonsedating

• No highs—decreased abuse potential

• No cross-tolerance with alcohol, sedatives

• No dependence, withdrawal, or tolerance

• Fewer drug-drug interactions

disadvantages of buspirone

• provides relief in 7 to 10 days but takes until 3 to 6 weeks for full therapeutic effect

• avoid grapefruit juice

what class is zolpidem in?

sedative-hypnotics

what does zolpidem do?

• treat insomnia, but it may also have some beneficial effects on anxiety. 

• enhances GABA

what are adverse effects and teaching of zolpidem?

• hallucinations (elderly)

• be careful driving until tolerance is built

propranolol

• treats physical symptoms of anxiety and slows HR

• AE- dizziness, tired, cold, hands or feet, difficulty sleeping and nightmares, normally short-lived and mild

• Cannot take if have asthma, be careful with other CNS depressants

flumazenil

• for benzo toxicity and withdrawal

• Response occurs in 30 to 60 seconds

• Repeated does if needed

• Does not reverse benzodiazepine-induced respiratory depression

• Can precipitate seizures