Unit 5 Sedatives-Hypnotics and Antianxiety Drug Therapy

UNIT 5: Sedatives, Hypnotics, and Anti-anxiety Drug Therapy

Sedatives and Hypnotics

  • Sedatives:

    • Function: Reduce desire for physical activity and promote mental relaxation.

  • Hypnotics:

    • Function: Induce and maintain sleep.

Sedatives-Hypnotics: Barbiturates

  • Mechanism of Action (MOA):

    • Depress CNS activity.

    • Mimic GABA, enhancing chloride influx causing hyperpolarization of nerve membranes.

    • Decrease activity in the reticular formation.

  • Drugs:

    • Secobarbital (Seconal®)

    • Phenobarbital (Luminal®)

    • Pentobarbital (Nembutal®)

  • Patient Teaching/Side Effects:

    • Disruption of sleep cycle; loss of REM sleep, leading to increased dreaming/nightmares after discontinuation.

    • Other side effects: dry mouth, lethargy, drowsiness, impaired judgment.

    • Caution with driving/heavy machinery; monitor for tolerance/addiction. Alcohol increases sedative effects.

Sedatives-Hypnotics: Non-barbiturates

  • MOA:

    • Metabolized to trichloroethanol; effects similar to alcohol.

    • Used for pediatric sedation during tests/procedures.

  • Drugs:

    • Choral hydrate (Noctec®)

  • Patient Teaching/Side Effects:

    • CNS depression; gastric irritation.

Sedatives-Hypnotics: Nonbenzodiazepines

  • MOA:

    • Increase inhibitory effects of GABA.

  • Drugs:

    • Zolpidem (Ambien®): Decreases awakenings, increases total sleep time.

    • Eszopiclone (Lunesta®): Induces and maintains sleep.

    • Zaleplon (Sonata®): Short duration of action, useful for difficulty falling asleep.

  • Patient Teaching/Side Effects:

    • Possible side effects: headaches, dizziness, GI upset, memory disturbance, confusion.

    • Monitor for dependence/tolerance; alcohol amplifies effects.

    • Ambien may cause nightmares, night terrors, sleepwalking.

Sedatives-Hypnotics: Benzodiazepines

  • MOA:

    • Enhances inhibitory activity of GABA; also used as anti-anxiety medication.

  • Drugs:

    • Temazepam (Restoril®): Intermediate acting.

  • Patient Teaching/Side Effects:

    • Possible hangover effect; monitor for tolerance/dependence.

    • Other side effects include drowsiness and headaches; alcohol increases effects.

    • Does not significantly interfere with REM sleep.

Important Considerations for Sedative Use

  • Avoid alcohol while taking benzodiazepines and barbiturates as it further depresses CNS activity.

  • Medications should be taken on an as-needed basis to limit dependency, tolerance, and withdrawal upon abrupt discontinuation.

Anxiety Disorder Overview

  • Symptoms include:

    • Unpleasant feelings such as uneasiness, fear, or worry occurring more days than not over six months.

    • Increased activity in the sympathetic system, limbic system, and reticular formation.

  • Diagnostic criteria (3 out of 6 symptoms required, 1 for children):

    • Restlessness or feeling keyed up.

    • Easy fatigue.

    • Difficulty concentrating.

    • Irritability.

    • Muscle tension.

    • Sleep disturbances.

  • Significant distress or impairment in social, occupational, or other areas is noted.

  • Biochemical imbalance believed to involve neurotransmitters (GABA, serotonin, dopamine, norepinephrine).

Non-pharmacological Therapies for Anxiety

  • Strategies include:

    • Resting.

    • Counseling groups.

    • Listening to music.

    • Meditation.

    • Exercise.

    • Environmental changes.

    • Aromatherapy.

    • Support from friends/family.

Anti-anxiety Drugs

  • Classes of medication that include:

    • Some antidepressants (SSRIs, SNRIs).

    • Benzodiazepines.

    • Nonbenzodiazepines/Azapirones.

Benzodiazepines: Mechanisms of Action

  • Functions of benzodiazepines include:

    • Increasing inhibitory action of GABA (anti-anxiety).

    • Decreasing CNS activity, emotional responses, alertness, and muscle tone.

    • Multi-functional drug category with various effects on different systems.

Benzodiazepines: Types

  • Short-Acting:

    • Alprazolam (Xanax®)

    • Lorazepam (Ativan®)

    • Temazepam (Restoril®)

    • Triazolam (Halcion®)

    • Midazolam (Versed®)

  • Long-Acting:

    • Clonazepam (Klonopin®)

    • Diazepam (Valium®)

Benzodiazepines: Side Effects & Patient Teaching

  • Common side effects include:

    • Drowsiness, dizziness, confusion, mild GI upset.

    • Monitor for dependence/addiction; long-term use may lead to memory loss.

    • Impaired ability to operate vehicles.

Azapirones

  • MOA:

    • Binds to serotonin (5HT), reducing anxiety levels and lowering 5HT levels.

  • Drug:

    • Buspirone

  • Patient Teaching/Side Effects:

    • Possible dizziness, lightheadedness, tiredness.

    • Full therapeutic effect within 3 to 4 weeks; low abuse potential; does not interact with alcohol.

Case Study: Helga H.

  • 33-year-old female experiencing significant stress due to marital issues, son's drug problem, and family visit.

  • Indicated to consider what medication could be beneficial for her.

Unit 5 Questions

  • Open to addressing further inquiries about sedatives, hypnotics, and anti-anxiety medications.