Introduction to Clinical Pharmacology Chapter 20 Antianxiety Drugs

1. Introduction to Clinical PharmacologyChapter 20Antianxiety Drugs

2. Introduction to Antianxiety Drugs • Antianxiety drugs or anxiolytics • Benzodiazepines: long-term use can result in physical dependence or psychological addiction • Can be given intramuscularly, intravenous, or orally • Nonbenzodiazepines: useful antianxiety drugs

3. Antianxiety Drugs: Actions • Anxiolytic drugs: block neurotransmitter receptor sites • Benzodiazepines: potentiate effects of gamma-aminobutyric acid an inhibitory neurotransmitter which decreases the neuron’s action potential and therefore neurons will not get excited; examples are alprazolam, chlordiazepoxide, lorazepam, clonazepam, clorazepate, diazepam, and oxazepam • Nonbenzodiazepines: exert effect in various ways examples are: • doxepin • Buspirone: acts on serotonin receptors • Hydroxyzine: acts on hypothalamus and brainstem reticular formation

4. Antianxiety Drugs: Uses • Isolated episodes of intense anxiety • Temporary use for those with severe functional impairment such as panic attacks • Preanesthetic sedatives, muscle relaxants • Convulsions or seizures • Alcohol withdrawal

5. Antianxiety Drugs: Adverse Reactions • Early reactions: mild drowsiness or sedation, lightheadedness or dizziness, and headache • Other adverse body system reactions: • Lethargy, apathy, fatigue • Disorientation, anger, restlessness • Nausea, constipation or diarrhea, dry mouth • Visual disturbances

6. Antianxiety Drugs: Dependence • Long-term use: resultsin physical drug dependence and tolerance and more likely can happen with benzodiazepines such as alprazolam or chlordiazepoxide among the other benzodiazepines • Withdrawal symptoms may occur with as few as 4 to 6 weeks of therapy with benzodiazepines • Nursing Alert • Symptoms of benzodiazepine withdrawal: increased anxiety and panic, tremors, fatigue, hypersomnia and nightmares, metallic taste, concentration difficulties, headache, tinnitus, numbness in the extremities, tachycardia, hypertension, nausea, vomiting, diarrhea, fearing, sweating, muscle tension, aching and cramps, psychoses and hallucinations, agitation, memory impairment, and possible convulsions

7. Antianxiety Drugs: Contraindications • Patients: hypersensitivity, psychoses, and acute narrow-angle glaucoma • During pregnancy (category D) and labor due to floppy infant syndrome manifested by sucking difficulties, lethargy, hypotonia in the newborn • Lactating women • In patients in coma or shock orif vital signs of patientin acute alcoholic intoxication are low

8. Antianxiety Drugs: Precautions • Used cautiously with elderly patientsand patient-impaired: • Liver function • Kidney function • Debilitation

9. Antianxiety Drugs: Interactions

10. Nursing Process: Assessment #1 • Preadministration assessment • Nurse obtains medical history, mental status exam, anxiety level and medication history before initiating therapy • Physical assessment, physiologic manifestations of anxiety such as tenseness, extreme restlessness, or grimacing of face, inability to focus; skin would feel cool and appear pale, may find vital signs are elevated • Assess and record blood pressure, pulse, respirations, and weight

11. Nursing Process: Assessment #2 • Ongoing assessment • Check blood pressure before drug administration • Periodically monitor mental status and anxiety level • Ask patient or family about adverse effects of drug • Document general summary of patient’soutward behavior, complaints, or problems

12. Nursing Process: Nursing Diagnosis and Planning • Nursing diagnoses • Risk for Injury related to dizziness or hypotension and gait problems • Impaired Comfort related to dryness in gastrointestinal (GI) tract from medications • Ineffective Individual Coping related to situation causing anxiety • Expected patient outcome: optimal response to drug therapy, knowledge of and compliance with prescribed therapeutic regimen, managing adverse drug reactions

13. Nursing Process: Implementation #1 • Promoting an optimal response to therapy • During initial therapy the nurse observes for adverse drug reactions • The antianxiety drugs are not recommended for long-term use • If used for short periods (1 to 2 weeks), tolerance, withdrawal, and dependence do not usually develop • Report

14. Nursing Process: Implementation #2 • Monitoring and managing patientneeds: • Risk for injury • During outpatient therapy the nurse should instruct the family and patientabout adverse reactions • Gerontologic alert: Lorazepam and oxazepam and buspirone are safer for the geriatric patient and likely to cause less sedation therefore less risk of falling • Nursing care plan- would be a priority in the care of patient receiving a benzodiazepine due to dizziness and lightheadedness

15. Nursing Process: Implementation #3 • Monitoring and managing patientneeds (cont.) • Monitoring • Instruction • Sedation, drowsiness • Intramuscular administration -done primarily in an acute state; monitored for at least 3 hours and should be kept lying down for 30 minutes to 3 hours after administration. When administered to older patient need to assure have resuscitative equipment handy in case of apnea or cardiac arrest • Parenteral administration given in large muscle

16. Nursing Process: Implementation #4 • Impaired comfort • Cause • Nursing interventions • Administer • Meals include fiber, fruits, and vegetables to aid in preventing constipation because can slow down the intestinal movement • Careful with oral route due to dry mouth causing swallowing problems may advise to use hard sugarless candy to help

17. Nursing Process: Implementation #5 • Ineffective individual coping • Outpatient: the nurse observes the patient for response to therapy at time of each clinic visit • Question about response to therapy; use open-ended questions • Once anxiety reduced the nurse may be able to help patientidentify precipitation of panic/cause of anxiety

18. Nursing Process: Implementation #6 • Ineffective individual coping (cont.) • Important to help patient understandthere are health care providers who can help them gain coping skills • Benzodiazepine toxicity • Flumazenil-is antidote for benzodiazepine overdose or toxicity • Adverse reactions to flumazenil include agitation, confusion, seizures, and, in some cases, symptoms of benzodiazepine withdrawal, relieved with administration of benzodiazepine

19. Nursing Process: Implementation #7 • Educating the patient and family • The nurse needs to evaluate the patient’sability to assume responsibility for taking the drugs at home • The nurse explains adverse effects of specific drugs and encourages the patient and family to contact primary health care provider if serious adverse effects occur

20. Nursing Process: Implementation #8 • Educating the patient and family (cont.) • Teaching plan: • Take drug as directed • Avoid performing hazardous tasks, alcohol • Do not discontinue drugs abruptly will need to gradually decrease dosage over time • Do not take OTC drugs or supplements without consulting primary health care provider • Inform dentist, physicians, and health care providers of your therapy

21. Nursing Process: Implementation #9 • Educating the patient and family (cont.) • Teaching plan (cont.) • If dizziness occurs when changing positions do so slowly; if severe, ask for help • Eat food rich in fiber and increase fluid intake to prevent constipation • Keep all appointments with primary health care provider • Report any unusual changes

22. Nursing Process: Implementation #10 • Evaluation • Therapeutic effect achieved • Patient reports decrease in feelings of anxiety • Adverse reactions identified, reported to health care provider • Verbalize importance of complying with prescribed therapeutic regimen

23. Question #1 • Is the following statement true or false? • Anxiety involves a feeling of apprehension, worry, or uneasiness that may or may not be based on reality.

24. Answer to Question #1 • True • Anxiety involves a feeling of apprehension, worry, or uneasiness that may or may not be based on reality. Anxiety is a normal feeling, yet as anxiety increases it can interfere with day-to-day functioning. Because it is a subjective feeling, patients can be asked to rate anxiety similar to rating pain.

25. Question #2 • Is the following statement true or false? • Benzodiazepines and nonbenzodiazepine anxiolytics are used to treat anxiety on a long-term basis.

26. Answer to Question #2 • False • Benzodiazepines and nonbenzodiazepine anxiolytics are used to treat anxiety on a short-term basis. Physical and psychological dependence can occur with the use of these drugs; typically, psychiatric anxiety disorders (that need long-term treatment) use antidepressants for treatment instead of benzodiazepines.

27. Question #3 • Is the following statement true or false? • Benzodiazepine doses should always be tapered and never stopped abruptly; withdrawal can occur with symptoms such as a return of anxiety, concentration problems, tremors, and sensory disturbances.

28. Answer to Question #3 • True • Benzodiazepine doses should always be tapered and never stopped abruptly; withdrawal can occur with symptoms such as a return of anxiety, concentration problems, tremors, and sensory disturbances.