Drugs for Anxiety and Insomnia 9 Drugs for Anxiety and Insomnia

Directory Classroom Response System Lecture Note Presentation

Question 1 After 8 months of use, the patient abruptly discontinues his zaleplon (Sonata). The patient is now complaining of anxiety and inability to sleep. The nurse suspects:

Question 1 Choices A panic disorder Long-term insomnia Behavioral insomnia Rebound insomnia

Question 1 Answer A panic disorder Long-term insomnia Behavioral insomnia Rebound insomnia

Question 2 The nurse educates the patient on zolpidem (Ambien) that it:

Question 2 Choices Will take a week for the medication to be effective May be taken 2 to 3 hours before bedtime Should be taken just prior to going to bed Must be used long term to be effective

Question 2 Answer Will take a week for the medication to be effective May be taken 2 to 3 hours before bedtime Should be taken just prior to going to bed Must be used long term to be effective

Question 3 The patient is sleeping at the time the next sedative is ordered. The nurse should:

Question 3 Choices Wake the patient and administer the next dose of sedative Notify the physician Hold the dose and document the reason Hold this dose and administer it with the next dose

Question 3 Answer Wake the patient and administer the next dose of sedative Notify the physician Hold the dose and document the reason Hold this dose and administer it with the next dose

Question 4 Your patient was started on buspirone (BuSpar) for his anxiety disorder 3 days ago. The patient now calls the physician’s office stating that it “just isn’t working.” The nurse’s best response would be:

Question 4 Choices “BuSpar should give you immediate relief. I will notify the physician that this medication is not effective.” “It will take 3 to 4 weeks for BuSpar to be fully effective.” “You may need an increased dose of BuSpar for it to work.” “You will need additional medications to ease your anxiety.”

Question 4 Answer “BuSpar should give you immediate relief. I will notify the physician that this medication is not effective.” “It will take 3 to 4 weeks for BuSpar to be fully effective.” “You may need an increased dose of BuSpar for it to work.” “You will need additional medications to ease your anxiety.”

Learning Outcomes Identify the major categories of anxiety disorders. Discuss factors contributing to anxiety and explain some nonpharmacological therapies used to cope with this disorder. Identify the four categories of CNS agents used to treat anxiety and sleep disorders.

Learning Outcomes Explain the pharmacological management of anxiety and insomnia. Categorize drugs used for anxiety and insomnia based on their classification and mechanism of action. For each of the classes listed in the Drug Snapshot, know representative drugs and explain their related clinical uses.

Core Concept 9.1 Anxiety disorders fall into several categories.

Anxiety According to the International Classification of Diseases, 10th edition (ICD-10), anxiety is a state of “apprehension, tension, or uneasiness that stems from the anticipation of danger, the source of which is largely unknown or unrecognized.”

Generalized Anxiety Disorder Difficult-to-control, excessive anxiety that lasts 6 months or more. Most common type of stress disorder

Generalized Anxiety Disorder Symptoms Restlessness, fatigue, muscle tension, nervousness, inability to focus or concentrate, an overwhelming sense of dread, and sleep disturbances. Sweating, blood pressure elevation, heart palpitations, varying degrees of respiratory change, and dry mouth.

Panic Disorder Intense feelings of immediate apprehension, fearfulness, terror, or impending doom Panic attacks usually last less than 10 minutes, patients may describe them as seemingly endless.

Panic Disorder As many as 5% of the population will experience one or more panic attacks during their lifetimes, and women are affected about twice as often as men.

Other Types Phobias Post-traumatic stress disorder (PTSD) Fearful feelings attached to specific objects or situation Post-traumatic stress disorder (PTSD) response to re-experiencing a previous traumatic life Obsessive-compulsive disorder (OCD) describes recurrent, disturbing thoughts or repetitive behaviors

Core Concept 9.2 Specific regions of the brain are responsible for anxiety and wakefulness.

Two Areas of Brain Limbic System Reticular Formation Emotional expression,learning and memory Reticular Formation Network of neurons along entire length of brain stem Increased alertness and arousal

Two Areas of Brain Reticular Activating system Controls sleep and wakefulness Helps focus attention Responsible for anxiety and fear

Core Concept 9.3 Anxiety is managed with both pharmacological and nonpharmacological strategies.

Management of Anxiety Nonpharmacologic Behavorial therapy Biofeedback Meditation Other complimentary therapy

Management of Anxiety Pharmacologic Anxiolytics Drugs for seizures Depression Cardiovascular

Figure 9. 1 This model shows how stressful events can lead to anxiety Figure 9.1 This model shows how stressful events can lead to anxiety. Nonpharmacologic coping strategies often help to eliminate shortterm anxiety, whereas medication may be needed if anxiety and related symptoms begin to occur on a longer basis.

Concept Review 9.1 What does the term anxiolytic mean? What disorders do anxiolytic drugs treat?

An inability to sleep is linked with anxiety. Core Concept 9.4 An inability to sleep is linked with anxiety.

Insomnia Inability to fall asleep or remain asleep Need for sleep Gives body time to repair Protective mechanism Electrical charging and discharging of brain Brain needs to process and file new information

Types of Insomnia Short-term or behavioral Long-term Stress, worries, food, beverages Long-term Depression Manic disorders Chronic pain

Types of Insomnia Rebound When a sedative is stopped abruptly Drug dependence Alcohol abuse

Concept Review 9.2 Why might a patient not be able to enjoy normal sleep? Why is long-term drug therapy for lack of sleep not a good idea?

Core Concept 9.5 Anxiety and insomnia are treated with many types of central nervous system (CNS) agents.

Drug Classes Antidepressants CNS Depressants Alter norepinephrine and serotonin SSRI, tricyclic MAOI’s CNS Depressants Benzodiazepines Barbituates Slow neuronal activity

Drug Classes Nonbarbituates and nonbenzodiazepines Valproate (Depakote),Buspirone (BuSpar) Atenolol (Tenormin),Propanolol (Inderal)

Concept Review 9.3 Describe what each of the following terms means in relation to anxiety and alertness: CNS depressants, sedatives, hypnotics, sedative-hypnotics, and tranquilizers.

Core Concept 9.6 When taken properly, antidepressants reduce symptoms of panic and anxiety.

Panic Symptoms Anticipatory Anxiety Physical Symptoms Shortness of breath Rapid heart beat Muscle tension

Table 9.1 (continued) Antidepressants for Anxiety Disorders

Table 9.1 (continued) Antidepressants for Anxiety Disorders

Core Concept 9.7 Benzodiazepines are useful for the short-term treatment of anxiety and insomnia.

Benzodiazepines Most widely prescribed Uses Panic disorders Generalized anxiety Phobias and insomnia

Table 9.2 (continued) Benzodiazepines for Anxiety and Insomnia

Barbiturates depress CNS function and cause drowsiness. Core Concept 9.8 Barbiturates depress CNS function and cause drowsiness.

Barbituates Powerful CNS depressants Used to be drug of choice Rarely used for treatment of anxiety or insomnia Significant side effects High risk of dependence

Concept Review 9.4 Identify the major drug classes used for sedation and insomnia. Why are CNS depressants especially dangerous if administered in high doses?

Core Concept 9.9 Additional drugs provide therapy for anxiety-related symptoms and sleep disorders.

Table 9.4 (continued) Nonbenzodiazepine, Nonbarbiturate CNS Agents for Anxiety and Insomnia

Concept Review 9.5 What are the major drug classes used to treat generalized anxiety disorder and panic disorder? Name popular drugs within these classes.