Antianxiety

Question 1

Chlordiazepoxide

Diazepam

Answer 1

Benzodiazepine derivative
Use - anxiety, sedation, EtOH withdrawal, seizures

Adverse effects: lethargy, hangover, respiratory depression, HYPOtension

Rn considerations: CNS depressant (EtOH INCREASES CNS depression)
Potential toxic buildup in elderly
Potential for physiological addiction, overdose. Can develop tolerance and cross-tolerance
Cigarette smoking INCREASEs clearance of rx

Question 2

Alprazolam
Lorazepam
Oxazepam

Answer 2

Benzodiazepine derivative

Adverse effects: drowsiness, lightheadedness, HYPOtension/orthostasis
HEPATIC dysfunction
Increased salivation
memory impairment/confusion

Rn considerations: CNS depressant - don’t combine w/EtOH/other depressants
safer for elderly
CHECK RENAL/HEPATIC FUNCTION
don’t discontinue abruptly - true of all anti anxiety agents.
Teach addictive potential

Question 3

Midazolam

Answer 3

Benzodiazepine derivative
Use - pre operative sedation, conscious sedation for endoscopic procedures and diagnostic tests

Adverse effects:
Retrograde amnesia
Euphoria
HYPOtension, dysrhythmia, cardiac arrest
Respiratory depression

Rn considerations: CNS depressant

Question 4

Buspirone

Answer 4

Anxiolytics - NONbenzodiazepine

Adverse effects:
Lightheadedness, confusion, HYPOtension
Palpitations

Rn considerations:
Little sedation, no abuse potential (used with pts with previous addiction). Requires 3 weeks to be effective - cannot be given PRN
Particularly useful for Generalized Anxiety Disorder. Monitor for worsening depression/suicidal tendencies
AVOID ETOH + GRAPEFRUIT JUICE

Question 5

Hydroxyzine

Answer 5

Anxiolytics - NONbenzodiazepine

Adverse effects: drowsiness, ataxia
Leukopenia
HYPOtension

Rn considerations: produces no dependence, tolerance, intoxication
Can be used for anxiety relief for indefinite periods

Question 6

Kava

Answer 6

Antianxiety - herbal

Adverse effects: impaired thinking, judgment, motor reflexes, vision
Decreased plasma proteins, thrombocytopenia, leukocytopenia
Dyspnea, pulmonary HTN

Rn considerations: similar activity to benzos
Suppresses emotional excitability and produces mild euphoria
Do NOT take with CNS depressants
Should not be taken by pregnant/lactating women/children under 12

Question 7

Melatonin

Answer 7

Antianxiety- herbal

Adverse effects: sedation, confusion, headache, tachycardia

Rn considerations; influences sleep-wake cycles (HIGH MELATONIN levels during SLEEP)
Used for prevention/tax of jet lag + insomnia
Use cautiously if given with benzos and CNS depressants

CONTRA HEPATIC insufficiency, history of STROKE/cerebrovascular disease, DEPRESSION, and neurological disorders

Question 8

Antianxiety meds - general

Answer 8

Action: affects neurotransmitters

Indications: anxiety disorders, insomnia, focal seizures, panic attacks, acute manic episodes
Benzo’s also used as muscle relaxants, sedatives, hypnotics, anticonvulsants

Adverse effects: sedation, depression, confusion, headache
anger, hostility
Dry mouth, constipation, urinary retention
Bradycardia,
elevations in LDH, AST, ALT

Rn considerations: MONITOR LIVER FCT
Monitor for therapeutic blood levels
AVOID ETOH
Caution when performing tasks that require alertness (driving)