Anxiolytic and Hypnotic Agents PDF

**Dopamine** Pleasure, reward, motivation, motor control Enhances mood, motivation, movement Parkinson's disease, addiction **Glutamate** Learning and memory (excitatory neurotransmitter) Stimulates nerve cells Epilepsy, neurodegeneration **Serotonin** Mood regulation, sleep, appetite, emot...

**Dopamine** Pleasure, reward, motivation, motor control Enhances mood, motivation, movement Parkinson's disease, addiction **Glutamate** Learning and memory (excitatory neurotransmitter) Stimulates nerve cells Epilepsy, neurodegeneration **Serotonin** Mood regulation, sleep, appetite, emotion Promotes calmness, regulates mood Depression, anxiety, sleep disorders **Norepinephrine** Alertness, attention, stress response Increases focus, energy, and arousal ADHD, anxiety, hypertension **Epinephrine** Fight-or-flight response Increases heart rate, blood flow, energy Stress disorders, heart conditions Sedative A drug that reduces excitement, calms the patient (without inducing sleep) Sedatives in therapeutic doses are anxiolytic agents Most sedatives in larger doses produce hypnosis (trans like state in which subject becomes passive and highly suggestible) Site of action is on the limbic system which regulates thought and mental function. Hypnotic A drug which produces sleep resembling natural sleep They are used for initiation and/or maintenance of sleep. Hypnotics in higher doses produce General anaesthesia. Site of action is on the midbrain and ascending RAS which maintain wakefulness. 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 The stages of sleep are divided into two main types: Non-REM (Rapid Eye Movement) and REM sleep. Non-REM sleep is further divided into three stages: Non-REM Sleep: Stage 1 (N1): Light sleep, transition from wakefulness to sleep, lasting a few minutes. Muscle activity slows, and eye movements are minimal. (2-5%) Stage 2 (N2): Deeper sleep, characterized by sleep spindles and K-complexes (brain wave patterns). Heart rate slows, and body temperature drops. (67-75%) Stage 3 (N3): Deep sleep (slow-wave sleep). It\'s the most restorative stage, where tissue growth and repair occur, and the immune system strengthens. It's hard to wake up from this stage. (15-25%) REM Sleep: The stage where dreaming occurs. The brain is highly active, resembling wakefulness, but the body remains immobile due to muscle atonia (temporary paralysis). This stage is important for memory consolidation and mood regulation. (25-33%) This is where dreams occur. The sleep cycle typically repeats every 90-110 minutes, with several cycles occurring throughout the night. Benzodiazepines are a class of medications that act on the central nervous system, primarily used for their sedative, anti-anxiety, muscle relaxant, and anticonvulsant properties. They work by enhancing the effect of the neurotransmitter GABA (gamma-aminobutyric acid), which has inhibitory effects on brain activity. Short acting benzodiazepines: Triazolam Oxazepam Midazolam Intermediate acting benzodiazepines: Alprazolam Estazolam Temazepam Lorazepam Nitrazepam Long acting benzodiazepines: Diazepam Flurazepam Clonazepam Chloroziadepoxide Hypnotic Benzodiapines Diazepam Flurazepam Nitrazepam Alprazolam Temazepam Triazolam Antianxiety Benzodiapines Diazepam Chlorodiazepoxide Oxazepam Lorazepam Alprazolam Anticonvulsant Benzodiapines Diazepam Lorazepam Clonazepam Clobazam 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; 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 Alcohol withdrawal symptoms -- chlordiazepoxide, chlorazepate, diazepam and oxazepam Sleep disorders midazolam: Facilitate amnesia while causing sedation prior to anesthesia lorazepam and diazepam: drug of choice in terminating status epilepticus diazepam: Muscular disorders or spasticity from degenerative disorders such as multiple sclerosis and cerebral palsy Nursing Implementation Do not mix intravenous (IV) drugs in solution with any other drugs to avoid potential drug--drug interactions. 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. Give IV drugs slowly because these agents have been associated with hypotension, bradycardia, and cardiac arrest Arrange to reduce the dose of narcotic analgesics in patients receiving a benzodiazepine to decrease potentiated effects and sedation. 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. 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. 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 Barbiturates are sedative-hypnotic medications, meaning they cause you to feel relaxed or sleepy. For over a century, they've treated many conditions, including seizures, migraines, insomnia and more. 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, preanesthesia, and the treatment of seizures 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 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. Give IV medications slowly because rapid administration may cause cardiac problems. Provide standby life-support facilities in case of severe respiratory depression or hypersensitivity reactions. Taper dose gradually after long-term therapy, especially in patients with epilepsy. Acute withdrawal may precipitate seizures or cause withdrawal syndrome in these patients. 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 environmental control, safety precautions, orientation, and appropriate skin care as needed. Z Drugs Zolpidem Zopiclone Zalepion Melatonin receptor agonist = Ramelteon 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 carefull Here are 30 NCLEX-style questions based on Anxiolytic and Hypnotic Agents: A patient is receiving lorazepam for the management of anxiety. What neurotransmitter is enhanced by benzodiazepines? A\) Dopamine B\) Serotonin C\) GABA D\) Glutamate Answer: C) GABA Rationale: Benzodiazepines enhance the inhibitory effects of GABA (gamma-aminobutyric acid), which reduces brain activity and helps manage anxiety. Which benzodiazepine is most appropriate for terminating status epilepticus? A\) Triazolam B\) Midazolam C\) Lorazepam D\) Oxazepam Answer: C) Lorazepam Rationale: Lorazepam is the drug of choice for terminating status epilepticus due to its rapid onset and long duration of action. A nurse is providing care to a patient receiving diazepam. Which adverse effect should the nurse monitor for? A\) Hypertension B\) Ataxia C\) Hyperactivity D\) Diarrhea Answer: B) Ataxia Rationale: Ataxia (lack of muscle coordination) can occur at high doses of benzodiazepines, such as diazepam. Which medication is used to manage alcohol withdrawal symptoms? A\) Midazolam B\) Chlordiazepoxide C\) Zolpidem D\) Pentobarbital Answer: B) Chlordiazepoxide Rationale: Chlordiazepoxide is commonly used to manage alcohol withdrawal symptoms. A patient on a barbiturate presents with hypotension and respiratory depression. What is the likely cause? A\) Hypersensitivity reaction B\) Rapid IV administration C\) Withdrawal syndrome D\) GI upset Answer: B) Rapid IV administration Rationale: Rapid administration of barbiturates can lead to cardiovascular and respiratory depression, including hypotension. A patient asks about the purpose of hypnotics. The nurse correctly explains that hypnotics are used for: A\) Muscle relaxation B\) Reducing anxiety C\) Initiating and maintaining sleep D\) Treating seizures Answer: C) Initiating and maintaining sleep Rationale: Hypnotics are primarily used for the initiation and maintenance of sleep. Which of the following is a Z-drug used for short-term treatment of insomnia? A\) Diazepam B\) Zolpidem C\) Lorazepam D\) Phenobarbital Answer: B) Zolpidem Rationale: Zolpidem is one of the Z-drugs used for short-term treatment of insomnia. When giving IV benzodiazepines, what should the nurse ensure to prevent adverse effects? A\) Administer rapidly B\) Avoid mixing with other drugs C\) Provide a high-dose to sedate the patient quickly D\) Discontinue immediately after 3 doses Answer: B) Avoid mixing with other drugs Rationale: IV benzodiazepines should not be mixed with other drugs due to the risk of drug-drug interactions. Which stage of sleep is characterized by deep, restorative sleep and is the most difficult to wake from? A\) Stage 1 (N1) B\) Stage 2 (N2) C\) Stage 3 (N3) D\) REM sleep Answer: C) Stage 3 (N3) Rationale: Stage 3 (N3) is the deep sleep stage where tissue growth and repair occur, making it the hardest to wake from. A nurse is caring for a patient on clonazepam. Which condition is this medication commonly used to treat? A\) Depression B\) Seizures C\) Insomnia D\) Anxiety Answer: B) Seizures Rationale: Clonazepam is an anticonvulsant benzodiazepine used for seizure management. What is a common adverse effect of barbiturates? A\) Diarrhea B\) Lethargy C\) Hypertension D\) Hyperactivity Answer: B) Lethargy Rationale: Lethargy is a common CNS effect of barbiturates. Which medication is a melatonin receptor agonist used for insomnia? A\) Zolpidem B\) Ramelteon C\) Diazepam D\) Pentobarbital Answer: B) Ramelteon Rationale: Ramelteon is a melatonin receptor agonist used to treat insomnia. Which benzodiazepine is long-acting and used in the treatment of muscle spasms? A\) Oxazepam B\) Lorazepam C\) Diazepam D\) Temazepam Answer: C) Diazepam Rationale: Diazepam is a long-acting benzodiazepine used to treat muscle spasms and spasticity. A patient is prescribed oxazepam for anxiety. Which of the following is important for the nurse to monitor? A\) Renal function B\) Liver function C\) Blood glucose D\) Blood pressure Answer: B) Liver function Rationale: Benzodiazepines should be used cautiously in patients with liver disease due to the risk of impaired metabolism. What is the therapeutic use of midazolam in surgical procedures? A\) Muscle relaxation B\) Termination of seizures C\) Amnesia and sedation prior to anesthesia D\) Managing chronic anxiety Answer: C) Amnesia and sedation prior to anesthesia Rationale: Midazolam is used to facilitate amnesia while causing sedation before anesthesia. A nurse is administering temazepam to a patient. Which condition is this drug primarily prescribed for? A\) Anxiety B\) Seizures C\) Sleep disorders D\) Muscle spasms Answer: C) Sleep disorders Rationale: Temazepam is an intermediate-acting benzodiazepine primarily used to treat sleep disorders such as insomnia. Which statement about the use of barbiturates in seizure management is accurate? A\) They are preferred over benzodiazepines for first-line treatment. B\) They act by inhibiting neuronal impulse conduction in the ascending RAS. C\) They increase dopamine levels to control seizures. D\) They are safe for long-term use without the risk of dependence. Answer: B) They act by inhibiting neuronal impulse conduction in the ascending RAS. Rationale: Barbiturates depress the central nervous system by inhibiting neuronal conduction in the reticular activating system (RAS), which helps in managing seizures. A patient is prescribed zolpidem for insomnia. Which of the following should the nurse include in patient teaching? A\) Take the medication immediately after dinner. B\) Take the medication and devote 7--8 hours to sleep. C\) It is safe to take this drug while operating machinery. D\) Zolpidem can be taken for long-term management of insomnia. Answer: B) Take the medication and devote 7--8 hours to sleep. Rationale: Zolpidem should be taken before bed with the patient allowing enough time (7--8 hours) for sleep to avoid next-day drowsiness. What is the primary adverse effect that a nurse should monitor in patients receiving intravenous benzodiazepines? A\) Hyperactivity B\) Respiratory depression C\) Hypertension D\) Tachycardia Answer: B) Respiratory depression Rationale: IV benzodiazepines can cause respiratory depression, especially when administered rapidly or in combination with other CNS depressants. Which benzodiazepine is commonly used to facilitate sedation and anesthesia in short surgical procedures? A\) Diazepam B\) Midazolam C\) Lorazepam D\) Oxazepam Answer: B) Midazolam Rationale: Midazolam is often used for its sedative properties during short surgical procedures due to its rapid onset and short duration of action. Which condition would contraindicate the use of barbiturates? A\) Depression B\) Insomnia C\) Respiratory depression D\) Anxiety Answer: C) Respiratory depression Rationale: Barbiturates can worsen respiratory depression and are contraindicated in patients with pre-existing respiratory issues. The nurse is teaching a patient about the potential adverse effects of benzodiazepines. Which adverse effect is the most concerning for elderly patients? A\) Memory loss B\) Drowsiness C\) Increased anxiety D\) Hyperactivity Answer: A) Memory loss Rationale: Elderly patients are at greater risk for cognitive impairment, including memory loss, when using benzodiazepines. A patient with generalized anxiety disorder (GAD) is prescribed alprazolam. What is the main action of this drug? A\) Decreases norepinephrine activity B\) Enhances GABA activity C\) Increases serotonin release D\) Blocks dopamine receptors Answer: B) Enhances GABA activity Rationale: Alprazolam, like other benzodiazepines, enhances the activity of GABA, an inhibitory neurotransmitter, which helps reduce anxiety. A nurse is caring for a patient who is tapering off a long-term benzodiazepine therapy. Why is it important to taper the dose? A\) To prevent hypertension B\) To avoid withdrawal symptoms C\) To avoid hallucinations D\) To prevent over-sedation Answer: B) To avoid withdrawal symptoms Rationale: Abruptly discontinuing long-term benzodiazepine therapy can lead to withdrawal symptoms, including anxiety, seizures, and agitation. What is the main reason why benzodiazepines should be used cautiously in patients with liver disease? A\) They cause renal toxicity. B\) They are metabolized by the liver. C\) They reduce liver function. D\) They cause hypermetabolism. Answer: B) They are metabolized by the liver. Rationale: Benzodiazepines are metabolized in the liver, so impaired liver function can lead to drug accumulation and increased risk of toxicity. Which of the following is a common side effect associated with zolpidem? A\) Diarrhea B\) Hyperactivity C\) Drowsiness D\) Hypertension Answer: C) Drowsiness Rationale: Zolpidem can cause next-day drowsiness, especially if not enough sleep time is devoted after taking the medication. A nurse is administering phenobarbital to a patient with epilepsy. Which of the following should be closely monitored? A\) Blood pressure B\) Liver enzymes C\) Respiratory function D\) Muscle strength Answer: C) Respiratory function Rationale: Phenobarbital, a barbiturate, can depress respiratory function, especially when administered intravenously or at higher doses. A patient taking zolpidem for insomnia reports nightmares. What could be the reason? A\) The drug was taken too early in the day. B\) The patient is experiencing increased REM sleep. C\) The drug dose is too high. D\) The patient has liver disease. Answer: B) The patient is experiencing increased REM sleep. Rationale: Zolpidem can alter sleep architecture by increasing REM sleep, which may result in vivid dreams or nightmares. Which benzodiazepine is long-acting and commonly prescribed for anxiety disorders and muscle relaxation? A\) Alprazolam B\) Diazepam C\) Lorazepam D\) Oxazepam Answer: B) Diazepam Rationale: Diazepam is a long-acting benzodiazepine commonly prescribed for anxiety disorders, muscle relaxation, and seizures. A patient taking benzodiazepines reports increased confusion and difficulty recalling recent events. What is the most likely cause of these symptoms? A\) Excessive dopamine B\) Cognitive impairment due to drug therapy C\) Hyperactivity in the RAS D\) Increased serotonin release Answer: B) Cognitive impairment due to drug therapy Rationale: Cognitive impairment, including confusion and difficulty with memory, is a known side effect of benzodiazepine therapy, especially in elderly patients.