Pharmacology for Nurses: Drugs for Anxiety and Insomnia

Flashcards on drugs for anxiety and insomnia.

List some types of anxiety disorders.

Situational anxiety, generalized anxiety disorder (GAD), panic disorder, phobias, social anxiety disorder, obsessive-compulsive disorder (OCD), and post-traumatic stress disorders (PTSD).

What is the role of the limbic system in the brain?

Responsible for emotional responses, learning, and memory. Signals pass to the hypothalamus.

What is the role of the hypothalamus?

Responsible for unconscious responses and connects with the reticular formation.

What is the function of the reticular formation?

Stimulation causes heightened awareness and arousal; inhibition causes general drowsiness and sleep.

What is the function of the reticular activating system (RAS)?

Responsible for sleeping and wakefulness, and thought to be responsible for feelings such as anxiety and fear, restlessness and interrupted sleeping pattern.

List some nonpharmacologic therapies to cope with anxiety.

Cognitive behavioral therapy, counseling, biofeedback techniques, and meditation.

What are anxiolytics?

Drugs having the ability to relieve anxiety, used when anxiety begins to significantly affect daily activities.

What are the four classes of CNS depressants used to treat anxiety and sleep disorders?

Antidepressants, Benzodiazepines, Nonbenzodiazepine anxiolytics, and Barbiturates.

What are sedatives?

CNS depressants that have the ability to sedate or relax a patient

What are hypnotics?

CNS depressants that have the ability to induce sleep.

What should you monitor and assess when caring for a patient with anxiety or insomnia?

Vital signs, medical and drug history. Discuss lifestyle, dietary habits and what precipitated the feelings of anxiety

What should you assess to see a patient’s need for antianxiety or insomnia drugs?

Intensity and duration of symptoms, identify precipitating factors, identify coping mechanisms and assess for sleep disorder.

What should you obtain in the patient’s drug history?

Hypersensitivity, use of alcohol and other CNS depressants, drug abuse and dependence

When should antianxiety and insomnia drugs be used cautiously?

The elderly, those with suicidal potential, and those with impaired renal or liver function.

What is insomnia?

Sometimes associated with anxiety. Acts of sleeping and waking are synchronized to many different bodily functions. Short-term or behavioral insomnia is sometimes attributed to stress. Food or beverages with stimulants may disturb sleep.

What are some causes of long-term insomnia?

Often caused by depression, manic disorders, chronic pain.

What is rebound insomnia?

Caused by discontinuation of long-used sedative drug.

What is an electroencephalogram (EEG)?

Tool for diagnosing sleep disorders, seizure activity, depression, and dementia. Can identify two types of sleep: nonrapid eye movement (NREM) and rapid eye movement (REM).

Describe normal sleep patterns.

Involve NREM and REM; occur every 90 minutes. NREM sleep has three stages. REM sleep follows NREM sleep. During REM sleep, dreaming occurs.

What happens when patients are deprived of REM sleep?

Experience depression, apathy, and fatigue. Lack of REM sleep causes sleep debt, and the patient becomes frightened, irritable, paranoid, and even emotionally disturbed.

What are the stages of sleep? (NREM stage 1)

At the onset of sleep, the patient is in a stage of drowsiness for about 5 to 10 minutes. During this time, the patient can be easily awakened.

What are the stages of sleep? (NREM stage 2)

The patient is still in light sleep. The heart rate slows and the body temperature drops.

What are the stages of sleep? (NREM stage 3)

This is the deepest stage of sleep. It is harder to wake up the patient in this stage. The patient is disoriented for a brief time.

What are the stages of sleep? (REM sleep)

This stage is characterized by eye movement and loss of muscle tone. Eye movement occurs in bursts of activity. Dreaming takes place in this stage. The mind is very active and resembles a normal waking state.

What are some primary medications to reduce symptoms of panic and anxiety?

Tricyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAOIs), selective serotonin reuptake inhibitors (SSRIs) and atypical antidepressants

Escitalopram (Lexapro): Mechanism of action

Increases availability of serotonin at specific postsynaptic receptor sites located within the CNS.

Escitalopram (Lexapro): Primary use

Generalized anxiety and depression.

Escitalopram (Lexapro): Adverse effects

Dizziness, nausea, insomnia, somnolence, confusion, seizures.

Escitalopram (Lexapro): Therapeutic Class

Antidepressant; anxiolytic

Escitalopram (Lexapro): Pharmacologic Class

Selective serotonin reuptake inhibitor (SSRI)

Escitalopram (Lexapro): Black Box Warning

Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults with major depressive disorder and other psychiatric disorders.

Escitalopram (Lexapro): Contraindications

This drug should not be used in patients who are breast-feeding or within 14 days of MAOI therapy.

Escitalopram (Lexapro): Drug-Drug Interactions

MAOIs should be avoided due to serotonin syndrome, marked by autonomic hyperactivity, hyperthermia, rigidity, diaphoresis, and neuroleptic malignant syndrome. Escitalopram will increase plasma levels of metoprolol and cimetidine. Concurrent use of alcohol and other CNS depressants may enhance CNS depressant effects.

SNRIs: Adverse effects

Abnormal dreams, sweating, constipation, dry mouth, loss of appetite, weight loss, tremor, abnormal vision, headaches, nausea, vomiting, dizziness, and loss of sexual desire.

TCAs: Contraindications

Not for use for patients with heart attack, heart block, or arrhythmia.

TCAs: Potential side effects

Dry mouth, blurred vision, urine retention, and hypertension. Concurrent use with alcohol or other CNS depressants should be avoided

MAOIs: Things to avoid

Avoid foods containing tyramine and potentiate the effects of insulin and other diabetic drugs.

MAOIs: Common adverse effects

Orthostatic hypotension, headache, and diarrhea.

Lorazepam (Ativan): Prototype drug class

Benzodiazepine

Lorazepam (Ativan): Mechanism of action

Binds to GABA receptor-chloride channel molecule, which intensifies GABA effects

Lorazepam (Ativan): Primary Use

For anxiety disorders and insomnia

Lorazepam (Ativan): Adverse Effects

Drowsiness, dizziness, respiratory depression

Lorazepam (Ativan): Therapeutic Class

Sedative-hypnotic; anxiolytic; anesthetic adjunct

Lorazepam (Ativan): Pharmacologic Class

Benzodiazepine; GABAA-receptor agonist

Lorazepam (Ativan): What should you monitor when administering IV?

Monitor respirations every 5 to 15 minutes. Have airway and resuscitative equipment accessible.

Lorazepam (Ativan): Contraindications

This drug should not be used in patients with acute narrow-angle glaucoma, closed-angle glaucoma, misuse or excessive use of drugs, liver disease, impaired brain function, or thoughts of suicide.

Lorazepam (Ativan): Drug-Drug Interactions

Concurrent use of CN.S depressants, including alcohol, potentiates sedative effects and increases the risk of respiratory depression and death. Lorazepam may decrease the antiparkinsonism effects of levodopa and increase phenytoin levels.

Lorazepam (Ativan): Overdose Treatment

Flumazenil (Romazicon), a specific benzodiazepine receptor antagonist, can be administered to reverse CN.S depressant effects.

What is the mechanism of action of benzodiazepines?

Intensify effects of GABA

What are some examples of benzodiazepines?

Xanax, Librium, Tranxene

Diazepam (Valium): Mechanism of action

Binds with GABA receptor-chloride channel molecules, intensifying effects of GABA and inhibits brain impulses from passing through limbic and reticular activating systems

Diazepam (Valium): Primary use

As sedative and hypnotic

Diazepam (Valium): Adverse effects

Tolerance, respiratory depression, psychological and physical dependence

What are some examples of Barbiturates?

Nembutal, Seconal

Zolpidem (Ambien): Mechanism of Action

Binds to GABA receptors

Zolpidem (Ambien): Primary Use

As hypnotic

Zolpidem (Ambien): Adverse Effects

Mild nausea, dizziness, diarrhea, daytime drowsiness, amnesia, sleepwalking, eating while asleep

Zolpidem (Ambien): Therapeutic Class

Sedative-hypnotic

Zolpidem (Ambien): Pharmacologic Class

Nonbenzodiazepine GABAA receptor agonist; nonbenzodiazepine, nonbarbiturate CNS depressant

Zolpidem (Ambien): Administration Alerts

Because of rapid onset, 7–27 minutes, give immediately before bedtime.

Zolpidem (Ambien): Contraindications

Lactating women should not take this drug.

Zolpidem (Ambien): Drug-Drug Interactions

Drug interactions with zolpidem include an increase in sedation when used concurrently with other CNS depressants, including alcohol. Phenothiazines augment CNS depression.

Zolpidem (Ambien): Overdose Treatment

Use of flumazenil (Romazicon) as a benzodiazepine receptor antagonist may be helpful.