Anxiolytics and Sedative-Hypnotics

Benzodiazepines
- Bind to GABA A receptors
- Effects:
  - ↑ frequency of Cl⁻ channel opening
  - ↑ Cl⁻ influx
  - Resulting in membrane hyperpolarization
  - ↓ neuronal excitability
Barbiturates
- Bind to GABA A receptors
- Effects:
  - ↑ duration of Cl⁻ channel opening
  - ↑ Cl⁻ influx
  - Resulting in membrane hyperpolarization
  - ↓ neuronal excitability

Benzodiazepines:
- Anxiety
- Preoperative sedation
- Anesthesia induction
- Sedation for mechanical ventilation
- Alcohol withdrawal syndrome
- Status epilepticus
Barbiturates:
- Anxiety
- Preoperative sedation
- Convulsions
- Induced coma

Benzodiazepines:
- Short-acting (-azolam):
- alprazolam (Xanax)
- midazolam (Nayzilam)
- Intermediate-acting (-azepam):
- lorazepam (Ativan)
- clonazepam (KlonoPIN)
- Long-acting (-azepam):
- diazepam (Valium)
Barbiturates:
- butabarbital
- pentobarbital (Nembutal sodium)
- phenobarbital

Benzodiazepines:
- Headache
- Sedation
- Dizziness
- Blurred vision
- Dry mouth
- Urinary incontinence
- Constipation
- Leukopenia
- Paradoxical stimulation
- Tolerance, dependence, and withdrawal symptoms
Barbiturates:
- Headache
- Somnolence
- Confusion
- CNS depression
- Hallucinations
- Vertigo
- Nausea, vomiting, diarrhea
- Asthenia
- Ataxia
- Paradoxical stimulation
- Tolerance, dependence, withdrawal symptoms
- Stevens-Johnson syndrome

Benzodiazepines:
- Myasthenia gravis
- Concomitant use with other CNS depressants
- Acute narrow-angle glaucoma
- Pregnancy, breastfeeding
Barbiturates:
- Concomitant use with other CNS depressants
- Hypotension
- Laryngospasm
- Bronchospasm

Assessment and Monitoring:
- Vital signs including orthostatic hypotension assessment
- Weight
- Level of consciousness (LOC)
- Laboratory values: CBC, hepatic, renal, cardiac function
- Current medications
- Side effects - report to provider and intervene if necessary
- Have resuscitative equipment nearby
Client Education:
- Teach the client to monitor for and report side effects
- Avoid hazardous activities like driving until response is known
- Provide safety measures like raising side-rails and ensuring adequate lighting
- Make position changes slowly to reduce effects of orthostatic hypotension
- Avoid grapefruit juice if taking alprazolam or midazolam therapy
- Administer IV dose slowly

Hypnotic; Non-benzodiazepines
Miscellaneous anxiolytics
- Examples:
- zaleplon
- eszopiclone (Lunesta)
- buspirone

Bind to GABA A receptors
- Effects include increased frequency of Cl⁻ channel opening and increased Cl⁻ influx
- Resulting in membrane hyperpolarization and decreased neuronal excitability
Bind to and activate 5-HT1 receptors
Bind to and block D2 receptors

Assessment and Monitoring:
- Vital signs
- Weight
- Level of consciousness (LOC)
- Laboratory values: CBC, hepatic, renal, cardiac function
- Current medications
- Side effects - report to provider and intervene if necessary
Client Education:
- Teach the client to monitor for and report side effects
- Avoid hazardous activities like driving until response is known
- Provide safety measures like raising side-rails and ensuring adequate lighting
- Take only if able to get a full night’s sleep (7–8 hrs)
- Dangerous sleep behaviors like sleepwalking and sleep-driving may occur
- Notify provider if chronic abnormal movements like dystonia, motor restlessness, or involuntary movement of facial or cervical muscles occurs
- Avoid large amounts of grapefruit.