Antianxiety and Anti-Alzheimer Medications

Antianxiety Medications

  • Common Classification Suffix:

    • Pramine
    • -triptyline

  • Common Generics:

    • Clonazepam
    • Diazepam
    • Lorazepam
    • Alprazolam

  • Action:

    • These medications are classified as benzodiazepines, which function as muscle relaxants, anticonvulsants, and sedative-hypnotics.
    • They depress the central nervous system (CNS) by stimulating GABA (gamma-aminobutyric acid):
    • GABA inhibits neurotransmitter release, leading to decreased excitability in the brain.

  • Indications:

    • Effective in treating anxiety disorders, absence seizures, status epilepticus, and for sedation.

  • Serious Adverse Reactions:

    • Respiratory depression
    • Drowsiness
    • Liver toxicity
    • Decreased platelet and white blood cell (WBC) count
    • Medication tolerance
    • Dependency

  • Contraindications:

    • Hypersensitivity to benzodiazepines
    • Patients with glaucoma
    • Caution advised in children and elderly patients
Nursing Considerations

  • Patient Education:

    • Avoid alcohol, opioids, and other CNS depressants
    • Do not abruptly stop medication; it should be tapered off over several weeks
    • Take exactly as prescribed; overdose may cause extreme drowsiness
    • Teach safety precautions due to potential drowsiness

  • Monitoring:

    • Vital signs such as blood pressure (BP) and respiratory rate (RR)
    • Liver function tests (LFT), renal function tests (RFT), and CBC with differential
    • Administer intravenously slowly to prevent oversedation and bradycardia
    • Monitor for withdrawal symptoms, including anxiety, irritability, disturbed sleep, muscle pain/cramps, nausea, vomiting, altered mental status, and seizures

  • Therapeutic Monitoring:

    • Lorazepam: therapeutic range of 50-240 ng/mL
    • Clonazepam: therapeutic range of 20-80 ng/mL

  • Antidote:

    • Flumazenil (caution for withdrawal symptoms)
Anti-Alzheimer Medications

  • Class: Anti-Alzheimer

  • Pharmacological Class: Acetylcholinesterase Inhibitor

  • Common Generics:

    • Donepezil
    • Galantamine
    • Rivastigmine

  • Action:

    • Inhibit acetylcholinesterase, increasing levels of acetylcholine to enhance memory and cognitive function.

  • Indications:

    • Used primarily in patients with mild to moderate dementia related to Alzheimer’s disease.

  • Serious Adverse Reactions:

    • Hypersensitivity
    • Caution in patients with peptic ulcer disease (PUD), seizure disorders, asthma, COPD, bradycardia, and urinary obstruction.
    • Side effects can include nausea, vomiting, diarrhea, weight loss, peptic ulcer aggravation, bradycardia, bronchospasm, and sleep disturbances due to increased parasympathetic activity.
Nursing Considerations

  • Assessment:

    • Regularly assess cognitive function throughout the duration of therapy, especially with rivastigmine.
    • Monitor patient weight and any adverse effects closely.

  • Patient Education:

    • Instruct patients to take medication with food to decrease gastrointestinal effects.
    • Emphasize the importance of taking medication exactly as directed.
    • Report any vomiting resembling coffee grounds or worsening nausea/vomiting immediately.