exam 3 lecture #2 The Nervous System: Drugs for Anxiety and Sleep Disorders

what is the limbic system responsible for

emotional expression, learning, and memory

what is hypothalamus associated with

autonomic nervous system, fight or flight response, sympathetic nervous system

what is connected to the hypothalamus

reticular formation

what does stimulation of the reticular formation cause

alertness, arousal

what does inhibition of the reticular formation cause

drowsiness, induction of sleep

what system is part of the reticular formation

reticular acting system

what does the reticular acting system do

regulates sleep-wake cycle

what is a neuromodulators

how strongly a neuron fires

what type of anxiety is normal

situational anxiety

when is anxiety not normal

persistent for more than 6 months

what are the different types of anxiety

general anxiety disorder, panic disorder, phobias, separation anxiety disorder

social anxiety disorder

persistent, irrational fear of being judged or ridiculed

agroaphobia

fear of situations, places

acrophobia

fear of heights

aerophobia

fear of flying

acrachnophobia

fear of spiders

astraphobia

fear of thunder, lightning

autophobia

fear of being alone

claustrophobia

fear of confined or crowed spaces

hemophobia

fear of blood

hydrophobia

fear of water

what are other disorders close to anxiety disorders

ocd, ptsd

what are the essential of diagnosis for anxiety disorders

persistent excessive anxiety or chronic fear and associated with behavioral disturbances, somatic symptoms referable to the autonomic nervous system, not limited to an adjustment disorder, not a result of physical disorder or condition or drug abuse

insomnia

inability to fall asleep or stay asleep

what is the cause of insominia

multifactorial, commonly associated with anxiety disorders

what are disorders associated with excessive daytime sleepiness

narcolepsy, obstructive sleep apnea, restless leg syndrome

what the medication classes that are used for insomnia and anxiety

sedative hypnotic, anxiolytics

what are sedative-hypnotic

a drug with the ability to produce a calming effect at smaller doses, induce sleep at higher doses

what are anxiolytics

drugs that have an ability to reduce anxiety symptoms by altering levels of norepinephrine and serotonin 

what are commonly used classes for medications for insomnia and anxiety

benzodiazepines, nonbenzodiazepines, antidepressants, barbiturates, first generation antihistamines

what do benzodiazepines do

reduces anxiety, causes sleepiness

what did benzodiazepines do for pharmacy companies

made them rich

what are benzodiazepines 

strong central nervous system depressant with significant abuse potential

when are benzodiazepines useful

in short periods

what should benzodiazepines SHOULD NOT be used as

maintenance treatment for anxiety

what risk does benzodiazepines have for the elderly

high fall risk

who should be cautious when taking benzodiazepines 

elderly, pregnant, lactating women

what does benzodiazepines do to GABA

binds to GABA receptors, enhances GABA effects

what are anxiety benzodiazepines

alprazolam (xanax), diazepam, clonazepam, lorazepam (ativan)

what are the FDA approved insomnia benzodiazepines

temazepam, triazolam, estazolam

temazepam

sleep onset and maintenance 

triazolam

sleep onset

what are some adverse effects of benzodiazepines

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

what are the significant issues of benzodiazepines

tolerance, physical dependence, addiction, oral overdose, IV toxicity

what is the reversal agent of the significant issues of benzodiazepines

flumazenil

what do antidepressants do

raise chemicals in brain to improve mood or sleep

what are the 3 antidepressants to treat anxiety and insomnia

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

what are the first line pharmacological treatment for anxiety and depression

selective serotonin reuptake inhibitors (SSRIs)

what are SSRIs also effective in treating other than anxiety and depression

eating disorders, panic disorders, OCD

what does selective serotonin reuptake inhibitors do not affect the reuptake of

norepinephrine, dopamine

what do selective serotonin reuptake inhibitors affect the reuptake of

serotonin

does selective serotonion reuptake inhibitors have agonist or antagonist activity

no they have no activity at any neurotransmitter receptor

what is the safest class of antidepressants

selective serotonin reuptake inhibitors (SSRIs)

what side effects are common for selective serotonin reuptake inhibitors

sympathomimetic side effects

what type of side effect do selective serotonin reuptake inhibitors have fewer of

fewer anticholinergic side effects

what are examples of selective serotonin reuptake inhibitors

fluoxetine (prozac, sarafem, prozac weekly), citalopram (celexa), escitalopram (lexapro), paroxetine (paxil, pexeva), sertraline (zoloft), fluvoxamine (luvox)

what are the two types of atypical antidepressants

selective norepinephrine reuptake inhibitors (SNRIs), serotonin modulator 

what are atypical antidepressants

medications that work on different or mixed ways on brain chemicals

what do selective norepinephrine reuptake inhibitors (SNRIs) do

increase serotonin and norepinephrine, blocks reuptake so more is in the brain

what are examples of atypical antidepressants

duloxetine, venlafaxine

what does serotonin modulators do

blocks serotonin receptors, weakly inhibits serotonin reuptakes

what is an example of serotonin modulator

trazodone (oleptro)

what does tricyclic antidepressants (TCAs) do

raises serotonin and norepinephrine, blocks reuptake

what are examples of tricyclic antidepressants (TCAs)

doxepin, imipramine, amitriptyline

what tricyclic antidepressants (TCAs) is FDA approved for insomnia at low doses

doxepin

what is true about many of the antidepressant medications

they have FDA indications for chronic pain

what do non-benzodiazepine do

calm brain by acting on receptors

what are the non-benzodiazepine drugs

z-drugs, first generation antipsychotic drugs, hydroxyzine

what does z-drugs do

help you fall asleep and stay asleep

what do z-drugs bind to

GABA receptors at the benzodiazepine binding site

what are examples of z-drugs that are FDA approved for insomnia

zolpidem (ambien, ambien CR, intermezzo), zaleplon (sonata), eszopiclone (luesta)

what are some first-generation antipsychotic drugs classified as

non-benzodiazepine anxiolytics

what do non-benzodiazepine anxiolytics affect

affect dopamine and serotonin

what are non-benzodiazepine examples 

hydroxyzine (atarax, vistaril), buspirone (buspar), meprobamate

what does hydroxyzine do

non-selectively blocks central and peripheral histamine H1 receptors

what is hydroxyzine also referred to

first-generation antihistamine

what is hydroxyzine used for

anxiety in patients with insomnia and substance use disorders

hydroxyzine has no what….

black box warnings and abuse potential

what is hydroxyzine and first-generation antihistamines

very sedating and highlight anticholinergic

who should cautiously use hydroxyzine

pregnant women

who should avoid hydroxyzine

lactating women

what are the other classes of medications used for anxiety and insomnia

antiseizure medication, beta blockers, barbiturates

what is an example of an antiseizure medication

valproic acid

what is an example of e beta blocker

propanolol

what is an example of a melatonin receptor drug

ramelteon

what are barbiturates

drugs that bind to, enhance, and mimic the activity of GABA

what can be produced with no limit with barbiturates

production of degree of CNS depression

what are examples of barbiturates 

pentobarbital, phenobarbital, methohexial, secobarbital, 

what are significant issues of barbiturates

tolerance, physical dependence, toxicity and overdose

how can overdose and toxicity with barbiturates be treated

supportive care

Which of the following drugs is a benzodiazepine?
1. Diazepam
2. Venlafaxine
3. Fluoxetine
4. Amitriptyline

diazepam

Which of the following drugs is a selective serotonin reuptake inhibitor (SSRI)?
1. Diazepam
2. Venlafaxine
3. Fluoxetine
4. Amitriptyline

fluoxetine

Which of the following drugs is a serotonin norepinephrine reuptake inhibitor (SNRI)?
1. Diazepam
2. Venlafaxine
3. Fluoxetine
4. Amitriptyline

venlafaxine

Which of the following drugs is a Tricyclic Antidepressant?
1. Diazepam
2. Venlafaxine
3. Fluoxetine
4. Amitriptyline

amitriptyline

Which of the following drugs are FDA approved for insomnia?
1.Diphenhydramine
2.Doxepin
3.Trazodone
4.Zolpidem

zolpidem

A patient is diagnosed with narcolepsy.

Which therapeutic effect should the nurse expect when medication to treat this disorder is provided?

• Decreased anxiety

• Decreased sleepiness

• Decreased nausea

• Decreased headache

decreased sleepiness

A patient with anxiety has an elevated blood pressure, rapid respirations, and dilated pupils.

Which brain region should the nurse suspect is causing these physiological changes?

• Hypothalamus

• Hippocampus

• Reticular formation

• Cingulate gyrus

hypothalamus

A patient is prescribed a benzodiazepine.

Which information should the nurse provide to the patient about this medication?

• "Avoid driving until you know the effects of the medication."

• "If you get dizzy, stand still until the dizziness passes."

• "If one pill doesn’t work after 15 minutes, take another."

• "Limit alcohol to one drink per day."

avoid driving until you know the effects of the medication

The nurse teaches a patient about benzodiazepines.

Which patient statement should indicate that the teaching was effective?

• "I'll keep the medication at my bedside in case I need to take it during the night."

• "I'm glad I can still drive my car."

• "I can still have my nightly glass of wine with dinner."

• "I'll change positions slowly."

i’ll change positions slowly