1. Drugs for Anxiety and Insomnia9
Drugs for Anxiety and Insomnia

2. Directory
Classroom Response System
Lecture Note Presentation

3. 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:

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

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

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

7. 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

8. 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

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

10. 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

11. 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

12. 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:

13. 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.”

14. 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.”

15. 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.

16. 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.

17. Core Concept 9.1
Anxiety disorders fall into several categories.

18. 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.”

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

20. 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.

21. 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.

22. 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.

23. 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

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

25. 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

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

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

28. Management of Anxiety Nonpharmacologic Behavorial therapy Biofeedback
Meditation
Other complimentary therapy

29. Management of Anxiety Pharmacologic Anxiolytics Drugs for seizures
Depression
Cardiovascular

30. Figure 9. 1 This model shows how stressful events can lead to anxiety
Figure 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.

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

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

33. 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

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

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

36. 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?

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

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

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

40. 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.

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

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

44. Table 9.1 (continued) Antidepressants for Anxiety Disorders

45. Table 9.1 (continued) Antidepressants for Anxiety Disorders

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

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

49. Table 9.2 (continued) Benzodiazepines for Anxiety and Insomnia

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

51. 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

53. 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?

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

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

57. 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.