Anxiolytic and Hypnotic Agents PDF

NCM 235 Drugs Acting on the central and peripheral nervous system For review of the Anatomy and Physiology of the Nervous System Copy this link: https://www.youtube.com/ watch?v=44B0ms3XPKU  Neurotransmitters and their Functions: Dopamine, Glutamate, Serotonin, Norepinephrine,...

NCM 235 Drugs Acting on the central and peripheral nervous system For review of the Anatomy and Physiology of the Nervous System Copy this link: https://www.youtube.com/ watch?v=44B0ms3XPKU  Neurotransmitters and their Functions: Dopamine, Glutamate, Serotonin, Norepinephrine, and Epinephrine Copy this link: https://www.youtube.com/watch? v=09eVouoCLaw  NCM 235 Anxiolytic and Hypnotic Drugs Anxiolytic and Hypnotic Drugs: Anxiety – is a feeling of tension, nervousness, apprehension, or fear that usually involves unpleasant reactions to a stimulus, whether actual or unknown. Anxiolytic and Hypnotic Drugs: Sedation - the loss of awareness and reaction to environmental stimuli Hypnosis – extreme sedation results in further central nervous system (CNS) depression and sleep States Affected by Anxiolytic and Hypnotic Drugs: Anxiety – is a feeling of tension, nervousness, apprehension, or fear that usually involves unpleasant reactions to a stimulus, whether actual or unknown. Sedation - the loss of awareness and reaction to environmental stimuli Hypnosis – extreme sedation results in further central nervous system (CNS) depression and sleep,  NCM 235 Benzodiazepines  Adverse Effects Drowsiness and confusion Ataxia occurs at high doses Cognitive impairment (decreased long- term recall and retention of new knowledge) Used cautiously in patients with liver disease Alcohol and CNS depressants enhance the sedative-hypnotic effects Administration in 3rd trimester can result in “floppy-infant syndrome” Therapeutic Uses; 1. Anxiety disorders secondary to panic disorder, generalized anxiety disorder (GAD), social anxiety disorder, performance anxiety, post traumatic stress disorder, obsessive-compulsive disorder, extreme anxiety disorder associated with phobias, and anxiety related to depression and schizophrenia 2. Alcohol withdrawal symptoms – chlordiazepoxide, chlorazepate, diazepam and oxazepam Therapeutic Uses; 3. Sleep disorders 4. midazolam: Facilitate amnesia while causing sedation prior to anesthesia 5. lorazepam and diazepam: drug of choice in terminating status epilepticus 6. diazepam: Muscular disorders or spasticity from degenerative disorders such as multiple sclerosis and cerebral palsy  Nursing Implementation 1. Do not mix intravenous (IV) drugs in solution with any other drugs to avoid potential drug–drug interactions. 2. Give parenteral forms only if oral forms are not feasible or available and switch to oral forms, which are safer and less likely to cause adverse effects, as soon as possible. 3. Give IV drugs slowly because these agents have been associated with hypotension, bradycardia, and cardiac arrest 4. Arrange to reduce the dose of narcotic analgesics in patients receiving a benzodiazepine to decrease potentiated effects and sedation. 5. Maintain patients who receive parenteral benzodiazepines in bed for a period of at least 3 hours. Do not permit ambulatory patients to operate a motor vehicle after an injection to ensure patient safety. 6. Taper dose gradually after long-term therapy, especially in epileptic patients. Acute withdrawal could precipitate seizures in these patients. It may also cause withdrawal syndrome. 7. Provide comfort measures to help patients tolerate drug effects, such as having them void before dosing, instituting a bowel program as needed, giving food with the drug if GI upset is severe, providing environmental control (lighting, temperature, stimulation), taking safety precautions (use of side rails, assistance with ambulation), and aiding  NCM 235 Barbiturates Barbiturates used as anxiolytic– hypnotics include: amobarbital (Amytal Sodium) butabarbital (Butisol), mephobarbital (Mebaral) pentobarbital (Nembutal) phenobarbital (Luminal) secobarbital (Seconal)  Barbiturates are general CNS depressants that inhibit neuronal impulse conduction in the ascending RAS, depress the cerebral cortex, alter cerebellar function, and depress motor output. Can cause sedation, hypnosis, anesthesia, and, in extreme cases, coma Indicated for the relief of the signs and symptoms of anxiety and for sedation, insomnia,  CNS effects: drowsiness, somnolence, lethargy, ataxia, vertigo, a feeling of a “hangover,” thinking abnormalities, paradoxical excitement, anxiety, and hallucinations GI effects: nausea, vomiting, constipation, diarrhea, and epigastric pain may occur  Cardiovascular effects: bradycardia, hypotension (particularly with IV administration), and syncope Serious hypoventilation may occur, and respiratory depression and laryngospasm may also result, particularly with IV administration  Nursing Implementation 1. Give parenteral forms only if oral forms are not feasible or available, and switch to oral forms as soon as possible to avoid serious reactions or adverse effects. 2. Give IV medications slowly because rapid administration may cause cardiac problems. 3. Provide standby life-support facilities in case of severe respiratory depression or 4. Taper dose gradually after long- term therapy, especially in patients with epilepsy. Acute withdrawal may precipitate seizures or cause withdrawal syndrome in these patients. 5. Provide comfort measures to help patients tolerate drug effects, including small, frequent meals; access to bathroom facilities; bowel program as needed; consuming food with the drug if GI upset is severe; and Advantages of Benzodiazepines over Barbiturates  The “Z-drugs” are oral drug for short-term treatment of insomnia Special considerations: patient should take before bed and devote 4–8 h to sleep, use with caution in patients with hepatic or renal impairment, elderly patients are especially sensitive to these drugs so administer a lower dose and monitor these patients carefully