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49 Cards in this Set
- Front
- Back
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Chapter 20
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Anxiolytic and Hypnotic Agents
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4 Types of Anxiolytic and Hypnotic agents
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Anxiolytics
Sedatives Hypnotics Minor Tranquilizers |
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Anxiolytics
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Prevent feelings of tension, nervousness, apprehansion, fear r/t unpleasant reactions to a stimulus
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Sedatives
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Calm and create a loss of awareness and reaction to environmental stimuli
Causes Drowsiness |
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Hypnotics
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Cause sleep and extreme sedation through further CNS depresion
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Tranquilizers
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Create a state of tranquility in anxious patients
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Benzodiazepines (Diazepam) fall into which class of drugs
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Anxiolytics
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Dedation def
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Loss of awareness adn reaction to environmental stimuli
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Hypnosis def
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Extreme sedation resulting in further CNS depression and sleep
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Hypnotics act on which system
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RAS
Reticular Activating System Block the brain's response to incoming stimuli |
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Benzodiazepines
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Prevent anxiety wo causing much sedation & dec dependence.
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Benzodiazepines act on which system
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Limbic and RAS systems
Make GABA more effective in stabilizing postsynaptic cells. |
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Benzodiazepines are indicated in the treatment of
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Anxiety
Alcohol withdrawal, agitation, preoperative relief of tension |
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Benzodiazepine pharmacokinetics
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GI absorbed
Placenta and breast milk Liver metabolized Urine excretion |
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What are teh most frequently prescribed sedative/hypnotics
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Benzodiazepines
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Benzodiazepine controlled substance schedule and pregnancy category
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CS IV
PC D Considered efficacious and safe |
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Benzodiazepine Actions
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Act in the lymbic system and RAS
Make GABA more effective Cause interference with neurons firing Lower doses can cause anxiolytic effects |
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Benzodiazepine Indications
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Indicated for
Anxiety disorders Sedation Sleep induction Alcohol withdrawal Hyperexcitability and agitation Preoperative relief of anxiety |
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Benzodiazepine Pharmacokinetics
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Well absorbed from the GI
Peak 30 min to 2 hours Lipid soluble and well distributed through body Cross placenta Enters breast milk Liver metabolism Urine excretion |
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Benzodiazepines
Contraindications & Cautions |
Allergy to benzodiazepines
Psychosis Acute narrow angle glaucoma Shock-further depression Coma Acute alcohol intoxication Pregnancy-birth defects |
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Benzodiazepines
Adverse Effects |
Can't pee, see, shit, spit
Sedation, lethargy, depression, blurred vision, confusion, dry mouth, constipation, nausea, vomiting, hypotension, urinary retention |
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Benzodiazepines
Drug-Drug Interactions |
Increase CNS depression with alcohol
Liver enzyme inducers increase BZ effects-cimetidine, contraceptives, disulfiram Liver enzyme reducers decrease effectiveness with theophylline or ranitidine |
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Benzodiazepines
Symptoms of overdose |
Somnolence, confusion, coma
Hypotension, respiratory depression |
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Benzodiazepines
Antidote |
flumazenil IV
(Romazicon) |
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Barbituates are:
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The oldest sedative-hyupnotics
Less efficacious and safe Have a higher risk of addiction and dependence |
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Barbituates
Controlled substance category Pregnancy class |
CS IV
PC D |
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Barbiturates
Actions |
CNS depressant
Inhibit neuronal impulse conduction in the ascending RAS Depress the cerebral cortex Decrease cerebellar function Depress motor output Cause sedation, hypnosis, anesthesia, coma |
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Barbiturates
End in |
"barbatol"
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Barbiturate
Altered cerebellar function includes |
Balance, motor output
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Barbiturates
Indications |
Relief of anxiety
Sedation Insomnia Preanesthesia Seizures |
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Barbiturates
Pharmacokinetics |
Absorbed well via IV and GI
Peak 20-60 minutes Liver metabolism Urine excretion |
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Barbiturates
Contraindications and Cautions |
Allergy to barbiturates
Previous hx of addiction to sedatives/hypnotics Latent or manifest porphyria-enzyme disorder Hepatic impairment or nephritis Respiratory distress or disfunction |
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Barbiturates
Adverse reactions CNS |
Drowsiness
Lethargy Vertigo Coma |
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Barbiturates
Adverse reactions Respiratory |
Depression
Apnea Bronchospasms Cough |
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Barbiturates
Adverse reactions GI |
Nausea
Vomiting Constipation |
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Barbiturate
Prototype drug |
Phenobarbitol for
Seizure Insomnia Preanesthetic |
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Barbiturates
Adverse reactions Other |
Hypotension
Reduced REM sleep Agitation Inability to deal with normal stress |
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Barbiturates
Drug-Drug interactions |
Increased CNS depression when given with alcohol, antihistamines, (tranquilizers)
Altered response to phenytoin-antiepileptic MAOs-increase serum levels of Barbs |
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Barbiturates
Decrease the effectiveness of |
Anticoagulants, digoxin, tricyclic antidepressants, corticosteroids, oral contraceptives
Enzyme inducers with narrow therapeutic indexes |
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Barbiturates
A N X I E T Y |
Avoid abrupt discontinuation after LT use
Not give if inc BP or renal/hepatic disf. Xanax, ativan, seconal Increase in 3D's-drowsiness, dizziness, dec. BP Enhanced action of GABA Teach to rise slowly from supine Yes, alcohol should be avoided |
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Phenobarbital Antidote
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Respiratory support
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Other Anxiolytic and Hypnotic drugs
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Paral-seditive
Miltown-anxiety Aquachoral-nocturnal sedation Sonata/Ambien-insomnia short term Banadryl/Phenergan-pre and post op BuSpar-anxiety w no CNS effects |
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Other Anxiolytic and Hypnotic drugs
Amy is not an AM BIEN |
Anxiety and hypnotic drugs
Morning drowsiness-hang over Beware of drug-drug toxic effects Insomnia treatments Effects REM sleep-suppresses Non-barbiturate |
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Paral
paraldehyde |
sedates pts with delirium tremens or extreme excitement
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Miltown
meprobamate |
Manages acute anxiety for up to 4 months
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Aquachoral
choral hydrate |
Produces nocturnal sedation or preoperative sedation
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Sonata, Ambien
zalepion, zolpidem |
For the short-term treatment of insomnia
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Antihistamines
Phenergan, Benadryl promethazine, diphenhydramine |
Used preoperatively and postoperatively to decrease the need for narcotics
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BuSpar
buspirone |
Reduces the signs and symptoms of anxiety without severe CNS and adverse effects
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