30-10-23 - Sedatives anxiolytics Flashcards
Learning outcomes
- Define the terms anxiolysis and sedation
- Outline the pharmacodynamics & pharmacokinetics of benzodiazepines & z-drugs
- Identify other classes of drugs used in the management of anxiety
- Define the terms tolerance, dependence & withdrawal
- Be aware of the clinical indications to prescribe anxiolytics
- Understand the role of B blockers in managing anxiety
- Discuss the therapeutic role of melatonin
- Be able to provide practical sleep hygiene advice
Describe the 4 levels for sedation sleep depth.
Describe their effects on the body (in picture)
- 4 levels for sedation sleep depth
1) Minimal
* Also called anxiolysis
* The patient remains awake but relaxed, able to interact.
2) Moderate
* Also called conscious sedation
* The patient has depressed consciousness but will respond to verbal requests or react to touch.
* Breathing remains intact, and no support is needed.
3) Deep:
* The patient cannot be easily aroused but will respond to repeated or painful stimuli.
* Breathing may be impaired and may need to be supported.
4) Dissociative
* A trance-like state wherein the patient remains awake but unaware of the pain and retains no memory of the event.
* They can follow commands, and airway reflexes remain intact.
- Sedation depth effects on body (in picture)
What can anxiolysis be used for?
- Anxiolysis can be used for therapeutic procedures where the patient needs to be conscious e.g endoscopy
What medications can be used to treat prolonged epileptic seizures?
What is IV access is not available?
- For prolonged epileptic seizures lasting longer than 5 minutes, we can use intravenous lorazepam
- If IV access is not available consider rectal diazepam or intranasal / buccal midazolam
What medications are often used in the Anticipatory Care Plan (ACP) for End Of Life (EOL) care?
- In the Anticipatory Care Plan (ACP) for End Of Life (EOL) care, Benzodiazepines often used in the last days or weeks of life
- Midazolam IV is usually drug of choice in order to manage anxiety
NHS Fife Alcohol Withdrawal guideline
What medication used in alcohol withdrawal?
- Chlordiazepoxide is often used to treat alcohol withdrawal
NICE Clinical Guidelines Feb 2010 Chlordiazepoxide dosing regimes in alcohol withdrawal (in picture)
What is anxiety a response to?
What 5 factors make up anxiety?
What are anxiety states?
What is the difference between ‘pathological’ and ‘normal’ state of anxiety?
- Anxiety is a normal fear response to threatening stimuli:
- 5 factors make up anxiety:
1) Defensive behaviours
2) Autonomic reflexes
3) Arousal and alertness
4) Corticosteroid secretion
5) Negative emotions. - Anxiety states are reactions that occur in an anticipatory manner with no apparent stimuli.
- Difference between ‘pathological’ and ‘normal’ state of anxiety is not clear-cut.
- Defined at the point at which the symptoms interfere with normal productive activitie
What are 7 symptoms of anxiety?
- 7 symptoms of anxiety:
1) Apprehension
2) Cued Panic Attacks
3) Spontaneous Panic Attacks
4) Irritability
5) Poor sleeping
6) Avoidance
7) Poor concentration
What are 3 classifications of anxiety disorders?
- 3 classifications of anxiety disorders:
1) Generalised Anxiety Disorder (GAD)
* Over-arousal, irritability, poor concentration, poor sleeping and worry over several areas most of the time
2) Panic disorder
* Intermittent episodes of panic or anxiety and taking / avoiding action to prevent these feelings.
* Panic disorder may be with or without agoraphobia (a fear of being in situations where escape might be difficult or that help wouldn’t be available if things go wrong.)
* Marked somatic symptoms, such as sweating, tachycardia, chest pains, trembling and choking
3) Other anxiety disorders
* Includes:
* Phobias (episodes of anxiety triggered by external stimuli)
* Obsessive Compulsive Disorders (distressing, intrusive thought ands and related compulsions “rituals”)
* Post Traumatic Stress Disorder (delayed and / or protracted response to a stressful event or situation).
What are 3 non-pharmacological treatments for anxiety?
- 3 non-pharmacological treatments for anxiety?
1) Reassurance and Lifestyle Advice
* Anxiety is normal.
* No “quick fix”.
2) Guided self help
* Mantras, mindfulness, worry time
* www.moodcafe.co.uk
3) Psychological Therapy
* Cognitive behaviour therapy
What are 6 types of Pharmacological treatments for anxiety?
What are 3 types of anti-depressants? What are examples of each?
- 3 types of anti-depressants? What are examples of each:
1) Selective serotonin (5-HT) reuptake inhibitors (SSRIs)
* e.g. escitalopram , sertraline and paroxetine )
2) Serotonin/noradrenaline reuptake inhibitors (SNRIs
* e.g. venlafaxine and duloxetine
3) Older antidepressants
* Tricyclic antidepressants e.g. amitriptyline
* Monoamine oxidase inhibitors (MAOIs) are also effective
What are 3 examples of benzodiazepines?
What are they effective for?
How quickly do they act?
Describe the tolerance and dependence of benzodiazepines?
What is a potential adverse effect of benzodiazepines?
- 3 examples of benzodiazepines:
1) Diazepam
2) Lorazepam
3) Temazepam - Benzodiazepines are effective anxiolytic drugs
- Act within 30 minutes, - useful for patients who need acute treatment, and can be taken on an ‘as needed’ basis.
- Induce tolerance
- Dependence – both physical and psychological
- Benzodiazepines can be drugs of abuse and can also have unwanted side effects e.g. amnesia