Anxiety and Insomnia Drugs

Anxiety

• Feeling of fear, dread, or uneasiness

• Physical s/s include sleep disturbances, muscle tension, increased HR, difficulty concentrating, and fatigue

Interventions for Anxiety

• Cognitive Behavioral Therapy (Psychotherapy)

• Self-Care (Meditation, nutrition, and exercise)

• Drug Therapy
  

Which drugs are used for the treatment of anxiety disorders? Which drugs are first and second-line treatments for anxiety?

• SSRIs/SNRIs (First Line Treatment!!)

• Benzodiazepines (Second Line Treatment!!)

• Nonbenzodiazepines/Nonbarbiturates

• Barbiturates

Barbiturates

• prototype: phenobarbital, “-barbital”

• Rarely used to treat anxiety, but it is used as a treatment for seizures

• High risk for addiction and a very narrow therapeutic index

Benzodiazepines

• Second Line Treatment of Anxiety

• Prototype: diazepam (Valium). “pams” and “lams”

• Memory Trick - “Pam and Lam are riding in a Benz”

Indications for Benzos

• Acute/Short-Term Anxiety (2 - 4 weeks treatment)

• Can produce different effects depending on Dosage
  1. Low - Decrease Anxiety
  2. Med - Sleepiness (Insomnia)
  3. High - Anesthesia (Preop sedation)

• Alcohol withdrawal

Side Effects of Benzos

• CNS Depression (LOW AND SLOW!!)
  - Sedation, Drowsiness, ataxia

• Low HR and BP

• Paradoxical Effs - Anxiety, Agitation, Restlessness 

S/S of Overdose for Benzos? What is the antidote?

“A.B.U.S.E.D”

• Altered Mental Status (Stupor/Coma)

• Bradycardia

• Unable to walk/Coordinate (Ataxia)

• Slurred Speech

• Eyes (Blurred/Double Vision)

• Decrease Respirations

Antidote is flumazenil!

• Reverses CNS Depression

Consideration/Education for Benzos

• Avoid taking it with other CNS depressants (Alcohol, Opioids, Antihistamines), as they can cause increased sedation

• May cause hypotension/dizziness
  - change positions slowly

• Avoid activities that require alertness

• Don’t stop abruptly, taper off (Will cause withdrawal symptoms)

• CAUTION USE IN ELDERLY (Hypotension, Dizziness, and Ataxia)

Nonbenzodiazepine/Nonbarbiturate

• Prototype: buspirone (Buspar)

• Used for Generalized Anxiety Disorder
  - Elderly and Alcoholics

• Memory Trick - The elderly and alcoholics ride the BUS

What are the advantages of buspirone?

• Fewer side effects and doesn’t cause significant sedation

• Doesn’t produce tolerance or dependency

What are the disadvantages of buspirone? Side effects?

• Delayed onset of 2 - 3 weeks
  - not effective for immediate relief/panic attacks

• SE includes CNS depression, dizziness, and muscle weakness

Insomnia

• prolonged difficulty of falling asleep or staying asleep long enough to feel rested

Interventions for Insomnia

• CBT

• Sleep Hygiene (Cool and Dark room, decrease screen time, avoid large meals, plenty of exercise)

• Drug Therapy
  - Nonbenzodiazepine sedative hypnotics
  - Melatonin
  - Antihistamines
  

Melatonin

• A hormone that helps regulate sleep/wake cycles (High at night, but low during the day)

• Used for Insomnia and Jet Lag (Circadian Rhythm Disorder)

• Not for prolonged use, as it resets the sleep/wake cycle

Antihistamines

• H1 receptor antagonists (Block receptors, which leads to drowsiness)

• Benadryl, Tylenol P.M.

Nonbenzodiazepines Sedative-Hypnotics

• eszopiclone (Lunesta) and zolpidem (Ambien) “Zz DRUGS”

• CAUTION USE IN ELDERLY

What is the BBW for Nonbenzodiazepines?

SLEEPWALKING/OTHER SLEEP-RELATED ACTIVITIES resulting into injury or death!!