Chapter 14 - Drugs for Anxiety and Insomnia

Question 1

Escitalopram Class: SSRI

Answer 1

Action:
Selective serotonin re-uptake inhibitor (SSRI) that increases the availability of
serotonin at specific postsynaptic receptor sites located within the CNS

Uses:
Generalized anxiety and depression. Unlabeled uses include the treatment of panic
disorders

Contraindications:
Allergy to this medication, citalopram, MAOI’s

Adverse Effects:
Dizziness, nausea, insomnia, somnolence, confusion, and seizures if taken in
overdose.

Patient Teaching:

• Therapeutic effect may take up to 1-4 weeks
• Do not abruptly discontinue
• May cause drowsiness
• To avoid alcohol or other CNS depressants
• May cause orthostatic hypotension, change positions slowly

Side Effect: Low libido, sexual dysfunction, weight gain, insomnia,

Question 2

Lorazepam Class: Benzodiazepine

Answer 2

Action:
bind with the GABA receptor–chloride channel molecule, which intensifies the GABA
effect in the thalamic, hypothalamic, and limbic levels of the CNS

Uses:
reduce anxiety disorders and insomnia

Contraindications:
Pregnancy, breastfeeding, allergy to benzodiazepines, benzyl alcohol; closed-angle
glaucoma, psychosis, history of drug abuse, COPD, sleep apnea,

Adverse Effects:
drowsiness, dizziness, and respiratory depression

Patient Teaching:

• Do not take more then prescribed; may be habit forming
• Avoid hazardous activities that require alertness
• Avoid alcohol, other psychotropic medications unless directed PCP.
• Safety, changing postion slowly (elderly)

-* risk for abuse
-may cause withdrawals if stopped adruptly
- take once a day dosage, long duration
Pregnancy Category: D

Question 3

Zolpidem Class: Sedative/Hypnotic

Answer 3

Action:
Bind to GABA receptors, thereby preserving sleep stages III and IV and offering
minor effects on REM sleep

Uses:
Primary use is as a hypnotic

Contraindications:
Allergy to benzodiazepines

Adverse Effects:
Mild nausea, dizziness, diarrhea, daytime drowsiness, amnesia, sleepwalking, and
ingesting carbohydrates while sleepwalking.

Patient Teaching:

• Dependence is possible after long rime use
• Avoid alcohol
• Avoid driving and other hazardous activities
• Avoid other CNS depressants

Side Effects: sleep hangovers, wake up depressed

Pregnancy Category: C

• • fast action
• • 2 - 4hr half life
• • 6 - 8hr duration
• • 7 - 27 mins onset
• • Needs the avaliablity to sleep for at least 8hrs