Anxiolytics for Nursing: Mental Health Modulators

• Anxiolytics are mood modulators that are used in nursing care for mental health.

Anxiety

• Derived from the Latin "anxietas" meaning anguish or affliction.
• Involves feelings of fear, apprehension, and uncertainty without a justified cause.
• Can be physiological, or pathological
• Involves a state of restlessness or excitement
• Functions as a normal defensive response of stress, but it becomes a pathology when its intensity impedes the persons normal functioning
• Anxiety can also manifest as dyspnea, sweating, insomnia, tremor, tachycardia, headache, myalgias, or gastric distress.

Anxiolytics

• They are drugs with a depressive action on the central nervous system (CNS)
• Used to diminish or eliminate anxiety symptoms.
• The neurotransmitters involved include gamma-aminobutyric acid (GABA), serotonin, and noradrenaline.
• Peptide neurotransmitters like cholecystokinin, corticotropin-releasing factor, neuropeptide Y, substance P, and tachykinins involve novel anxiolytic approaches.

Benzodiazepines

• Slow down nervous functions, promoting relaxation or a sense of calm.
• Useful in treating panic attacks, muscular contractures, nervousness, insomnia, anxiety, and convulsions.
• Clonazepam, diazepam, lorazepam, clobazam, and flumazenil share the same therapeutic effects and pharmacokinetics.
• The choice of benzodiazepines depends on their distribution and effect duration.
• Benzodiazepine use over six months may lead to tolerance and dependence, causing withdrawal symptoms upon drug discontinuation.

BDZ Ansioliticas (Benzodiazepines)

• Vary in duration of action
• Short-acting: triazolam.
• Intermediate-acting: alprazolam, lorazepam.
• Long-acting: diazepam, chlordiazepoxide.

BDZ Hipnoticas (Benzodiazepines)

• Not all benzodiazepines are useful as hypnotics, some that are employed include:
• Triazolam (short action)
• Flunitrazepam (intermediate action)
• Flurazepam (prolonged action)

Agonistas Parciales de los Receptores 5-HT o Hipnoticos (Partial Agonists of 5-HT Receptors or Hypnotics)

• Include zolpidem, zopiclone, and buspirone.
• Serotonin receptors mediate buspirone's actions, potentially involving other receptors.
• Zolpidem and zopiclone lack anticonvulsant and muscle relaxant effects.

Barbituricos

• Impede sodium flow between neurons while favoring chloride flow.
• Binds to GABA receptors at a different site than benzodiazepines, enhancing GABA's action.
• They are not typically used for anxiety or insomnia today
• They function as general anesthetics, sedatives and anticonvulsants.
• Barbituricos have disadvantages, this includes potentially fatal respiratory depression, a narrow therapeutic index, hepatic induction leading to drug interactions, and are very short-lived, making them suitable as IV anesthetics.

Ansioliticos indicatdions and interactions

• Anxioliticos are the first choice for anxiety treatment
• Has therapeutic stability of 6-10 days.
• Alcohol, barbiturates, opiates, sedatives, and antihistamines cause bad interactions when combined

Enfermeria (Nursing Care)

• Nursing should not abruptly stop or modify treatment.
• Patients should be advised about the possibility of retrograde amnesia.
• Flumazenil serves as an antidote for benzodiazepine intoxication.
• Pyschological support is important.
• Nurses should supervise the administration of medications.

Moduladores del Animo (Mood Disorders)

• Mood disorders include conditions like:
• Depression
• Bipolar disorder/Mania,
• Anxiety
• Post-traumatic stress.

Mania

• Characterized by the obsessive presence of a fixed idea, leading to an abnormal state of agitation.
• Involves feelings of rejection or disgust towards someone or something, like antipathy.
• Antimaniac drugs are used in in the treatment of bipolarity

Transtorno Bipolar (Bipolar Disorder)

• A condition characterized by alternating periods of elevated mood, irritability, and depression.
• TAB Type I involves at least one full manic episode with periods of severe depression.
• TAB Type II occurs where people have never experienced a full manic episode
• Involves periods of excitement and impulsivity that are not as extreme as mania (hypomania).

Indicaciones del Litio (indications of lithium)

• Depression when it's resistant or recurrent.
• Bipolar disorder.
• Personality disorder.
• Aggressiveness and impulsivity.

Eutimizantes (Mood Stabilizers)

• Used for bipolar disorder also known as (maniacal symptoms)
• Help prevent frequent episodes of recurrent symptoms.
• Treatment includes lithium, atypical antipsychotics (olanzapine, quetiapine), and anticonvulsants like oxcarbazepine and lamotrigine.
• Carbonato de Litio is an essential medicine (OMS), mechanism of action is unsure
• Mechanism action
  • Substitute other ions in neurophisiologic and neurochemicals
  • Tranports Na+
  • Elavates Ca+ intracellularly
  • Sínstesis APMc and GMPc (Adenosine and Guanosive monophosphate cyclic)
• Litio should be administered with lab results, after food, in renal function, cariologic valorization, electrolitos, thyroid fuction
• Carbonato de Litio and other indications/uses
  • Anti gottoso, Anticonvulsivos, sustituto sal in HTA
  • Carbonato Litio composrimidos 300mg VO
• Dosis initial is between 600–900mg/day
  • Litemia days 5-7, 1.2–1,5mEq
  • 2 months first year, 3 months the second.
• Dosificación de litio should begin with 300mg

Important notes

• Look for drug interactions
• Be observant for hospital pacientes
• Watch for people on mayores 55 años, use diaréticas for Litio problems Common Secundarios de litio
• Accidential intoxacion de litio can lead to intentional sucide
• Contraindications are leucemia, severe dehydration, Parkinson, epilepsia, diabetes mellitus, hipo-hiperparatiroidismo EUTIMIZANTES Secundarios e Interacciones
• Nauseas, diarreas, abdominals, vertigos
• Diabetes, hipotiioidismo, otros (sobrepeso, edema, leucocitosis) Diureticos Tiazidicos = retienen Li; Ahoradores K+(niveles sericos Li
• Interacions and interactions with : AINES, Beta, Psicofarmacos

EDUCACION

Contnuidad, dietas hiposodicas