Psychopharmacol

Anti-Anxiety Drugs

ogy
peter glen l.
reyes,ptrp,rn,man
 The ANXIOLYTICS AND
HYPNOTICS
 These drugs are used to change
the individual’s responses to the
environment.
 The ANXIOLYTICS AND
HYPNOTICS
 The medications that can prevent
the feelings of tension and fear are
called ANXIOLYTICS.
 Anti-anxiety drugs
 The ANXIOLYTICS AND
HYPNOTICS
 The drugs that can calm
individuals making them unaware
of the environment are called
SEDATIVES.
 The ANXIOLYTICS AND
HYPNOTICS
 The drugs that can induce sleep
are called HYPNOTICS.
 The ANXIOLYTICS AND
HYPNOTICS
 The drugs in this class are the
 BENZODIAZEPINES
 BARBITURATES
 Use of The Drugs
Clinical indications for the use of the
anxiolytics, sedatives and hypnotics
 1. Prevention of anxiety

 2. Formation of sedative state

 3. Induction of sleep
 The BENZODIAZEPINES
The benzodiazepines are the most
frequently used anxiolytic drugs.

These agents prevent anxiety states

without causing much sedation, with
less physical dependence than other
agents.
 The BENZODIAZEPINES
The following are the benzodiazepines
 Alprazolam (Xanax)
 Chlordiazepoxide (Librium)
 clonazepam
 clorazepate
 Diazepam (Valium)
 estazolam
 flurazepam
 lorazepam
 midazolam
 oxazepam
 quazepam
 temazepam
 triazolam
 The BENZODIAZEPINES
Special uses
Diazepam Status epilepticus
(Valium)
Chlordiazepoxide Alcohol
(Librium) withdrawal
Alprazolam Panic attack
(Xanax)
 The BENZODIAZEPINES
The Mechanism of Action of the Benzodiazepines

 These agents act on the Limbic

system and the RAS (reticular
activating system) to make the
GABA ( Gamma-aminobutyric acid)
more effective causing interference
with neuron firing.
 The BENZODIAZEPINES
The Mechanism of Action of the Benzodiazepines

 The GABA is an inhibitory

neurotransmitter.
 This will result to an
anxiolytic effect at lower
doses than required for
sedation/hypnosis.
 The BENZODIAZEPINES

These agents are

indicated for the
treatment of anxiety
disorders

alcohol withdrawal

hyperexcitability, and
agitation
pre-operative relief of
anxiety and tension
and in induction of
balanced anesthesia.
 The BENZODIAZEPINES
Pharmacodynamics: The adverse
effects
 CNS effects= sedation,
drowsiness, depression,
lethargy, blurred vision
 GIT= dry mouth, constipation,
nausea, vomiting
 CVS= Hypotension or
hypertension, arrhythmias,
palpitations, and respiratory
difficulties.
 Hematologic= blood dyscrasias
and anemia
 The BENZODIAZEPINES
Nursing
Considerations:
 Maintain patients
on bed for at
least 3 hours
after drug
administration.
 Instruct to avoid
hazardous
activities like
driving and
machine
 The BENZODIAZEPINES
Nursing Considerations:
 Provide comfort measures to
help patients tolerate drug
effects-
 instruct to urinate before
taking drug
 give high fiber foods
 use side-rails and assistance
with ambulation.
 Have available FLUMAZENIL
as an antidote for
benzodiazepine overdose.
 The BARBITURATES
 These are also anxiolytics and
hypnotics with a greater
likelihood of producing sedation,
with increase risk of addiction
and dependence.
 The BARBITURATES
The following are the barbiturates
 amobarbital
 aprobarbital
 butabarbital
 mephobarbital
 pentobarbital
 Phenobarbital
 secobarbital
 The BARBITURATES
The Mechanism of Action of the
Barbiturates
 They depress the motor output from
the brain.
 The results of their MOA are
sedation, hypnosis and anesthesia,
and if extreme, coma.
 The BARBITURATES
Clinical indications of the
Barbiturates
n Relief of anxiety
manifestations
n For sedation
n For patients with insomnia
n For pre-anesthesia
n seizures/epilepsy
n The rapid acting
barbiturates are also used
for the treatment of acute
manic reactions and status
epilepticus
 The BARBITURATES
Pharmacodynamics: The
Adverse effects
 CNS= CNS depression,
somnolence, vertigo,
lethargy, ataxia, paradoxical
excitement, anxiety and
hallucinations.
 GIT= nausea, vomiting,
constipation/diarrhea and
epigastric pain
 CVS= bradycardia,
Hypotension and syncope.
 Respi= serious
hypoventilation, respiratory
depression and
 The BARBITURATES
Nursing Considerations
 Provide stand-by life support
facilities in cases of severe
respiratory depression or
hypersensitivity reaction.
 Taper the drug gradually after
long-term therapy to avoid
withdrawal syndrome.
 Provide comfort measures
including small frequent meals,
access to bathroom facilities,
high-fiber foods, environmental
control, safety precaution and
 The CNS stimulants
These are drugs used to treat
certain disorders
2. exogenous obesity

3. attention-deficit hyperactivity

disorders (ADHD)
5. narcolepsy
 The CNS stimulants
What is unusual is the
ability of the CNS
stimulants to CALM
hyperactive children, which
allows them to focus on
one activity for a longer
period.
 The CNS stimulants
The following are the CNS
stimulants:
1. Methylphenidate
(Ritalin)= most
commonly used for ADHD
2. Dextroamphetamine= a
CNS stimulant that is
used for short tem
therapy for obesity.
3. Modafinil= used for
narcolepsy
 The CNS stimulants
The Mechanism of Action

These agents act as to stimulate

the cortical and reticular
activating system (RAS) of the
brain.
This is by releasing
neurotransmitters from the nerve
cells leading to increased
stimulation of the post-synaptic
neurons.
 The CNS stimulants
 The paradoxical effect of calming
hyperexcitability through CNS
stimulation seen in ADHD is
believed to be related to the
increased stimulation of an
IMMATURE Reticular Activating
System leading to the ability to
be more selective in response to
incoming stimuli.
 The CNS stimulants
Pharmacodynamics: Adverse
effects of the CNS
stimulants
 CNS= nervousness,
insomnia, dizziness,
headache, and blurred
vision
 GIT= anorexia, nausea and
weight loss
 CVS= hypertension,
tachycardia arrhythmias,
and angina
 Others= rashes,
physical/psychological
 The CNS stimulants
Implementation
 The nurse must ensure that the
drug is only given to the
indicated conditions
 Administer the drug before 6
pm to reduce the effect of
insomnia
 BEST given AFTER meals to
prevent the effect of
anorexia
 Consult with school personnel to
monitor the patient under
 The CNS stimulants
Evaluation
Evaluate the effectiveness of the drug:
3. Calming effect in the patient with
ADHD
4. Alertness for patients with narcolepsy