Chapter 14 Drugs for Anxiety and Insomnia

also called short term insomnia which may be attributed to stress caused by hectic lifestyle or the inability to resolve day to day conflicts

Behavioral Insomnia

fearful feelings attached to situations or objects

Phobias

a persistent and unreasonable fear of being judged, ridiculed, or embarrassed by others.

Social Anxiety Disorder

a component of the reticular activating system (RAS) that given rise to fibers connecting with various areas of the neuraxis

Locus Coeruleus

some patients experience this when a sedative drug is discontinued abruptly or after it has been taken for a ling time; sleeplessness and symptoms of anxiety then become markedly worse.

Rebound Insomnia

medication that enhance mood

Antidepressants

a state of apprehension tension, or uneasiness resulting from imminent or perceived danger, the source of which is largely unknown 

Anxiety 

drugs that induce sleep

Hypotonics

this system is a cluster of areas in the brain responsible for emotional expression, learning, and memory.

Limbic System

this type of anxiety is defined as temporary anxiety experienced by people faced with a stressful environment. It is not considered a major anxiety disorder because it is not disabling or persistent.

Situational

excessive anxiety that lasts 6 months or more; focuses on a variety of life events or activities and interferes with normal day to day functions; most common type of stress disorder.

Generalized Anxiety Disorder

medications that depress the Central Nervous System (CNS)

Sedatives

when test subjects are deprived of REM sleep, they experience this and become frightened, irritable, paranoid, and even emotionally disturbed. Judgement is impaired, and reaction time is slowed. 

Sleep Debt 

these drugs slow neuronal activity in the brain and spinal cord 

CNS Depressants

an older term that is sometimes used to describe a drug that produces a tranquil feeling

Tranquilizer

a tool for diagnosing sleep disorders, seizure activity, depression, and dementia.

Electroencephalogram (EEG)

this is in a larger area of reticular formation; help the individual to focus attention on tasks as needed; if signals are prevented from passing through this area, no emotion related signals are transmitted to the brain, resulting in general dampening of neural activity. 

Reticular Activating System 

this type of insomnia lasts 30 days or longer; often caused by depression, manic disorders, or chronic pain.

Long-Term

a type of extreme situational anxiety that develops in response to re-experiencing a previous life event such as war, physical or sexual abuse, rape and domestic violence, natural disasters, or homocidal situation may lead to a sense of helplessness and to reexperience the traumatic event.

Post-Traumatic Stress Disorder (PTSD)

this disorder is a type of anxiety characterized by intense feelings of immediate apprehension, fearfulness, terror, or impending doom, accompanied by increased autonomic nervous system activity. Patient describe episodes as seemingly endless even though they usually last less than 10 minutes.

Panic Disorder

this disorder involves recurrent, intrusive thoughts or repetitive behaviors; to be diagnosed with this, the behavior or thought must occupy more than 1 hour each day and negatively impact he patients normal daily activities or relationships. 

Obsessive Compulsive Disorder (OCD)

this stage of sleep is often called paradoxical sleep because the brain wave patter of this stage is similar to the pattern of people who are drowsy or awake. During this stage, dreaming occurs; the stage is characterized by eye movement and loss of muscle tone.

Sedative-hypnotic

This area of the brain is a network of neurons found along the entire length of the brainstem. Stimulation of this area causes heightened alertness and arousal, inhibition causes general drowsiness and the induction of sleep.

Reticular formation

These drugs have the ability to relieve anxiety

Anxiolytics

his condition is characterized by overwhelming daytime drowsiness and sudden attacks
of sleep during the day

Narcolepsy 

a condition characterized by a patient's inability to fall asleep or remain asleep,
pharmacotherapy may be indicated if the sleeplessness interferes with activities of daily
living (ADLs)

Insomnia

Therapeutic class: Sedative-hypnotic; anxiolytic anesthetic

Pharmacologic class: Benzodiazepine; GABAA-receptor agonist.

Benzodiazepine that acts by potentiating the effects if GABA, an inhibitory neurotransmitter.

Take orally one or twice a day.

If given IV monitor every 5 to 15 minutes for respirations. Fetal harm in pregnancy.

Adverse effects: drowsiness and sedation as well as cognitive state. When given IV route more severe effects such as amnesia, weakness, disorientation, ataxia, sleep disturbance, bp changes, blurred/double vision, nausea/vomiting.

Contraindications: Not given to patients with acute narrow-angle glaucoma, liver disease, thoughts of suicide.

Overdose: Treatment is flumazenil a specific benzodiazepine receptor antagonist can reverse CNS depressant effects.

Overdose will cause coma, lethargy, and sedation.

Lorazepam

Therapeutic class: Antidepressant; anxiolytic

Pharmacologic class: Selective serotonin reuptake inhibitors (SSRI)- safest

SSRI that increases availability of serotonin- promotes well being. Used for generalized anxiety and depression, and panic disorders.

In cases of renal or hepatic impairment reduced doses are advised.

Adverse effects: Dizziness, nausea, insomnia, somnolence, confusions, and seizure in overdose.

Antidepressants increase risk of suicidal thinking. Not used for kids under 12.

Contraindications: Dont uses within 14 days of MAOI therapy.

ST Johns wort SSRI can cause increase effects

Overdose: no specific treatment. Symptoms include dizziness, vomiting, confusion, nausea, tremor, sweating, tachycardia, and seizures.

Escitalopram (Lexapro) 

Therapeutic class: sedative-hypnotic

Pharmacologic class: Nonbenzodiazepine

GABA-mediated CNS depression in limbic, thalamic, and hypothalamic region.

Give immediately before bedtime due to rapid onset.

Adverse effects: Dizziness, headache, drowsiness. Abnormal thinking and suicidal thinking, hallucinations, sensory distortion, and nocturnal eating. Sleepwalking

Schedule IV(4) can lead to dependency.

Contraindications: known sensitivity to zolpidem.

When taken with food absorptions is slowed.

Overdose: Gastric lavage, iv fluids, flumazenil as a benzo receptor antagonist may be helpful.

Zolpidem (Ambien, Edluar, Intermezzo)

are used for a diverse collection of medical conditions, including anxiety, seizure disorders, muscle spasms, premedication for medical procedures and anesthesia, and alcohol withdrawal

act by binding to the gamma-aminobutyric acid (GABA) receptor–chloride channel molecule. These drugs intensify the effect of GABA, which is a natural inhibitory neurotransmitter found throughout the brain.

benzodiazepines

Safer than other classes of antidepressants; less common sympathomimetic effects (increased heart rate and hypertension) and fewer anticholinergic effects; can cause weight gain and sexual dysfunction; an overdose of these medications can cause confusion, anxiety, restlessness, hypertension, tremors, sweating, fever, and lack of muscle coordination. Patients taking these medications must be carefully monitored for changes in behavior or suicidal tendencies.

SSRIs

Adverse effects include abnormal dreams, sweating, constipation, dry mouth, loss of appetite, weight loss, tremor, abnormal vision, headaches, nausea and vomiting, dizziness, and loss of sexual desire. Patients taking these medications must be carefully monitored for changes in behavior or suicidal tendencies.

Atypical antidepressants, including serotonin–norepinephrine reuptake inhibitors (SNRIs)

Not recommended in patients with a history of myocardial infarction, heart block, or arrhythmia; patients often have annoying anticholinergic effects such as dry mouth, blurred vision, urine retention, and hypertension ); some may cause fetal harm; concurrent use with alcohol or other CNS depressants should be avoided; patients with asthma, gastrointestinal disorders, alcoholism, schizophrenia, or bipolar disorder should take with extreme caution.

TCAs