Antianxiety and Hypnotic Drugs Flashcards
Anxiety
Anxiety is an uncomfortable state that has both psychological and physical components.
The psychological component can be characterized with terms such as fear, apprehension, dread, and uneasiness.
The physical component may exhibit as tachycardia, palpitations, trembling, dry mouth, sweating, weakness, fatigue, and shortness of breath.
Anxiety - Generalized Anxiety Disorder
Generalized anxiety disorder is a chronic condition characterized by uncontrollable worrying.
Most patients with generalized anxiety disorder also have another psychiatric disorder, usually depression.
The hallmark of this disorder is unrealistic or excessive anxiety about several events or
activities (e.g., work or school performance).
Generalized anxiety disorder may last for six months or longer.
Anxiety - Panic Disorder
Panic disorder is characterized by recurrent, intensely uncomfortable episodes known as panic attacks.
Panic attacks have a sudden onset, reaching peak intensity within ten minutes.
Symptoms may include trembling, shortness of breath, heart palpitations, chest pain (or chest tightness), sweating, nausea, dizziness (or slight vertigo), light-headedness, hyperventilation, paresthesias (tingling sensations), and sensations of
choking or smothering.
These symptoms typically disappear within
30 minutes.
Many patients go to an emergency department because they think they are having a heart attack. Some patients experience panic attacks daily; others have only one or two per month.
Onset of panic disorder usually occurs in the late teens or early twenties.
Anxiety - Obsessive-Compulsive Disorder
Obsessive-compulsive disorder is a potentially disabling condition characterized by persistent obsessions and compulsions that cause marked distress, consume at least one hour per day, and significantly interfere with daily living.
An obsession is defined as a recurrent, persistent thought, impulse, or mental image that is unwanted and distressing, and comes involuntarily to mind despite attempts to ignore or suppress it.
A compulsion is a ritualized behavior or mental act that a person is driven to perform in response to his or her obsessions.
Anxiety - Social Anxiety Disorder
Social anxiety disorder, formerly known as social phobia, is characterized by an intense, irrational fear of situations in which one might be scrutinized by others, or might do something that is embarrassing or
humiliating.
Exposure to the feared situation almost always elicits anxiety. As a result, the person avoids the situation, or, if it cannot be avoided, endures it with intense anxiety.
Manifestations include blushing, stuttering, sweating, palpitations, dry throat, and muscle tension.
Social anxiety disorder is one of the most common psychiatric disorders and the most common anxiety disorder. This disorder typically begins during the teenage years, and if left untreated, is likely to continue lifelong.
Sleep Disorders - Insomnia
Insomnia is the inability to fall asleep or stay asleep.
Difficulty in falling asleep or disturbed sleep patterns both result in insufficient sleep.
Sleep disorders are common and may be short in duration or may be longstanding.
They may have little or no apparent relationship to other immediate
disorders.
Sleep disorders can be secondary to emotional problems, pain, physical disorders, and the use or withdrawal of drugs.
Excess alcohol consumed in the evening can shorten sleep and lead to withdrawal effects in the early morning.
Sedatives and Hypnotics
Th e sedative-hypnotics are agents that depress central nervous system
(CNS) function.
These drugs are widely used primarily to treat anxiety and insomnia.
Agents given to relieve anxiety are known as antianxiety agents or anxiolytics. They were previously known as tranquilizers.
Drugs given to promote sleep are known as hypnotics.
Th e distinction between antianxiety and hypnotic effects is oft en a matter of dosage.
Sedative-hypnotics relieve anxiety in low doses and induce sleep in higher doses. Therefore, a single drug may be considered both an antianxiety agent and a hypnotic agent, depending upon the reason for its use and the dosage employed.
Sedative-hypnotic drugs include barbiturates, benzodiazepines, and
benzodiazepine-like drugs.
Anxiety and insomnia are treated primarily with the benzodiazepines.
Benzodiazepines are used primarily for one condition (generalized anxiety disorder).
In contrast, the selective serotonin reuptake
inhibitors (SSRIs) are now used for all anxiety disorders.
It should be noted that, although SSRIs were developed as antidepressants, they are highly effective against anxiety (with or without depression).
First-Line Drugs for Anxiety Disorders
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Drugs for Anxiety and Insomnia
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Benzodiazepines
Benzodiazepines are the drugs of first choice for treating anxiety and insomnia.
The popularity of the benzodiazepines as sedatives and hypnotics stems from their clear superiority over the alternatives, such as barbiturates and other general CNS depressants.
The benzodiazepines are safer than the general CNS depressants and have a lower potential for abuse.
Benzodiazepines - Mechanism of Action
The mechanism of action of benzodiazepines on the CNS appears to be
closely related to their ability to potentiate GABA (gamma-aminobutyric
acid)-mediated neural inhibition.
Recent research has identified specific binding sites for benzodiazepines in the CNS, and has established the close relationship between the sites of action of the benzodiazepines and GABA.
Benzodiazepines - Indications
Benzodiazepines are useful for the short-term treatment panic disorder, generalized anxiety, phobias, and insomnia.
Chlordiazepoxide (Librium) and diazepam (Valium) are the most widely prescribed in medicine.
The benzodiazepines are categorized as Schedule IV drugs.
Benzodiazepines are also used in absence seizures and myoclonic seizures.
Parenteral diazepam is used to terminate status epilepticus.
Benzodiazepines - Adverse Effects
Adverse effects of benzodiazepines are drowsiness, ataxia, impaired judgment, dry mouth, fatigue, visual disturbances, rebound insomnia, and development of tolerance.
Overdosage may result in CNS and respiratory depression as well as hypotension and coma.
Gradual withdrawal of these drugs is recommended.
Although the use of any of the benzodiazepines during pregnancy is likely to cause fetal abnormalities, flurazepam is entirely contraindicated during pregnancy.
Benzodiazepines produce considerably less physical dependence and result in less tolerance than barbiturates.
Benzodiazepines - Contraindications and Precautions
Benzodiazepines are contraindicated in patients with known hypersensitivity to the drugs.
Benzodiazepines are also contraindicated in patients with acute narrow-angle glaucoma, psychosis, liver or kidney disease, and neurological disorders.
Benzodiazepines should be used cautiously during pregnancy (category D), and in elderly or debilitated patients.
Benzodiazepines - Drug Interactions
Benzodiazepines increase CNS depression with alcohol and omeprazole.
They also increase pharmacological effects if combined with cimetidine, disulfiram, or hormonal contraceptives.
The effects of benzodiazepines
decrease with theophyllines and ranitidine.
