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NRSG Pharm CH 14
Drugs for anxiety/insomnia
| Question | Answer |
|---|---|
| Types anxiety | Situational, GAD, panic disorders, phobias, social, OCD, PTSD |
| Limbic system | Middle of brain, emotional responses, learning, memory, sig --> hypothalamus |
| Hypothalamus | Unconscious responses of SNS. Connects with reticular formation |
| Reticular formation | Network neurons along brainstem, stim = awareness / arousal. Inhibit = drowsiness/sleep |
| RAS | Reticular Activating System Brainstem --> thalamus Sleeping/wakefulness Sig from hypothalamus to higher brain centers Anxiety, fear, restlessness, interrupted sleep |
| 4 classes of CNS depressants for anxiety and sleep disorders | Antidepressants, benzodiazepines, nonbenzodiazepine anxiolytics, barbiturates, |
| CNS depression continuum | Relax -> sedation -> sleep (hypnotic) / anesthesia |
| EEG: | Electroencephalogram, diagnosis tool for sleep disorders, seizure activity, depression, dementia. can ID 2 types of sleep: NREM and REM pt deprived of stage III REM --> depression, apathy, fatigue |
| Primary antidepressant meds to reduce sx of major depression, panic, anxiety | Tricyclic antidepressants (TCA), Monoamine oxidase inhibitors (MAOI) Selective serotonin reuptake inhibitors (SSRIs) Atypical antidepressants (not fit in other categories) |
| Prototype drug: escitalopram (Lexapro) classes, mech | T: antidepressant, anxiolytic, OFFLABEL: panic disorders P: SSRI Mech: increases available serotonin @ specific postsynaptic sites in CNS by inhibiting reuptake |
| escitalopram (lexapro) side/adverse: | wt gain, nausea, insomnia, somnolence, confusion, sex dysfunction, OD = seizures. BLACKBOX: teen SI / not approved ped >12YO |
| SSRI considerations | Most widely used, safer than other classes. Less common sympathomimetic and anticholinergic. |
| fluoxetine (Praozac) class, uses, | SSRI, antidepressant, anxiolytic: approved - panic disorder, OCD OL: GAD, PTSD |
| paroxetine (Paxil) class, uses | SSRI, antidepressant, anxiolytic: approved - GAD, panic disorder, social anxiety, OCD, PTSD. |
| sertraline (Zoloft) class, uses | SSRI, antidepressant, anxiolytic: approved- panic disorder, social anxiety, OCD, PTSD OL: GAD |
| SNRIs side effects | abnormal dreams, sweating, constipation, dry mouth, loss appetite, wt loss, tremor, abnormal vision, headache, N/V dizziness, loss sex desire |
| venlafaxine (Effexor) classes, uses | SNRI antidepressant anxiolytic, non-benzodiazepine, inhibits NE, serotonin, and dopamine reuptake approved - GAD, panic, social, OL: OCD headache/migraine, narcolepsy/somnolence, neuropathy, |
| TCA considerations | Anticholinergic ex dry mouth, blurred vision, urinary retention, sedation. C/V sx, tachy, ortho hypo, extreme hypertension. photosensitivty/hypersensitivity. Avoid w/ other CNS depressants Black BOX: inc SI |
| amitriptyline (Elavil) classes, mech, uses | TCA, blocks reuptake serotonin and NE into nerve terminals. antidepressant. OL: Panic, social, insomnia |
| MAOIs considerations | Not typically for anxiety. Many food/drug interactions - tyramine! "fancy foods" Low safety margin - only after SSRI and TCA tried 2-3wk washout. Serious adverse: hypertensive crisis (tyramine), resp depression |
| lorazepam (Ativan) classes, mech | P: Benzodiazepine, T: anxiolytic, sedative-hypnotic, anesthesia adjunct GABA A receptor agonist CNS depressant |
| lorazepam (Ativan) uses | relieve anxiety, provide sedation, short term seizues/SE |
| lorazepam (Ativan) considerations: | Preg Cat D, interacts with many drugs, drowsiness/sedation, hangover, physical dependance/abuse hepatotoxicity -> monitor liver function! Labs! |
| Treatment of benzodiazepine OD | flumazenil (Romazicon) - benzodiazepine receptor antagonist |
| Benzodiazepine indications/use | Seizure, alcohol withdrawal, central muscle relaxation, induction agents in anesthesia |
| temazepam (Restoril) | Benzo for insomnia. Drowsiness, somnolence, headache, memory impairment, Serious: agranulocytosis, coma, physical dependance. PO 7.5 - 30mg at bedtime |
| diazepam (Valium) | Benzo for anxiety drowsiness, sedation, lethargy, Serious: physical dependance, acute hyperexcited states, hallucintions, renal impairment, preg, resp depression d/t hypersalvation, resp dep, laryngospasm, C/V collapse |
| alprazolam (Xanax) | Benzo for anxiety drowsiness, sedation, lethargy, Serious: physical dependance, acute hyperexcited states, hallucintions, renal impairment, preg, resp depression d/t hypersalvation, resp dep, laryngospasm, C/V collapse |
| Benzo withdrawal sx | restlessness, inc anxiety/insomnia, tremor, muscle tension, inc HR, auditory hypersensitivity TAPER OFF! |
| Barbiturates for anxiety | Rare! Mostly prescribed for sedative, hypnotic, antiseizure high risk of dependance |
| Considerations | Assess for CNS depression, neuro status, LOC, vitals, intake stim caffeine, nicotine, affect and emotional status |
| zolpidem (Ambien) classes, mech | T: Sedative-hypnotic P: GABA A receptor agonist, nonbenzo, nonbarb CND depressant |
| zolpidem (Ambien) uses | GABA-mediated CNS depression, preserve stage 3 sleep only minor effect on REM short term (7-10) days insomnia management - adverse effects noted esp on women |
| zolpidem (Ambien) considerations | Admin: repid onset, 7-27 min, immediately before bed. Preg cat B SCH IV |
| zolpidem side/adverse | drowsiness, fatigue, lethargy (hangover) confusion, dizziness, potential amnesia |
Created by:
kmulla
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