Anxiolytics

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Sleep Aide

Classes

Antidepresants

Benzodiazapines

Barbiturates

NonBenzo/NonBarbituate CNS depressants

lorazepam (Ativan)

• Class: Sedative-Hypnotic
• Potentiates effects of GABA
• Half life= 10-20 hours
• anxiolytic and preanestisia Rx
• IV; monitor for 5-15min after giving
• Category D
• contraindicated for: narrow angle glaucoma, psychosis, depression
• avoid using for pain
• OD= Romazicon- Benzo antagonist

zolpidem (Ambien)

• Class: Sedative-Hypnotic
• GABA mediated CNS depression in the limbic, thalmic, and hypothalmic areas
• Meant for short term insomnia mngt (7-10 days)
• Rapid onset
• Category B (Contraindicated for lactation)
• Interaction= Phenothiazines augment CNS depression
• half life= 1.7-2.5hours
• duration= 6-8 hours

phenytoin (Dilantin)

Class: Hydantoin

Unlike Barbituates low abuse risk

Narrow therapeutic range (10-20mcg/ml)

Metabolized differently=inividualized doses

Effective agaist all Sz except; absence Sz

Not compatible w/ many RX

flush lines w/ any dextrose poducts= risk for emboli

Use IV line w/ filter when infusing

Soft tissue irritant-avoid hand sites

Category D

Cand cause: Bradycardia, V-Fib, Hypotesion, and Hyperglycemia

valproic acid (Depakote)

class: Valproate (anti-Sz)

Less side effects than Dilantin

DOC for tonic-clonic, partial and absense Sz.

also used for BPD

GI iritant, doNOT mix w/ carbonated soda=immediate release of Rx and risk for oral tissue damage

Preganancy D

Contraindicated for Liver Disease, Pancreatitis, Bleeding Dysfunction, or Metabolic disorders

Can cause Hyponatremia

luminal (Phenobarbitol)

Class: Barbiturate (schedule II Rx)

Half-life= 2-6 days Duratrion= 6-10hrs PO, 4-10hrs IV

Can increase increased sensitivity to pain

Side effects:

Drowsiness

Addiction

Vitamin D deficiency (folate, B,and B12)

Resp Depression

CNS Depression

Coma/Death

Increases metabolism of othe Rx= Reduced effectiveness

Parkinson's Triad

Tremors

Bradykenisis

(Slowed ability to start and continue movements)

Rigidity

carbidopa-levodopa (Sinemet)

Class= Dopamenergic

Restores extrapyrimidal dopamine

carbidopa prevents enzymatic breakdown-helps levodopa across blood brain barrier

Can take up to 6mo to see therapeutic effects

Abrupt withdrawal= risk for parkinsonism crisis or NMS

Side effects:

Orthostatic Hypotension (common)

Involunatry movements

Fatigue

Insomnia

Dry Mouth

Blurred Vision

Loss of Appetite

Urinary Retention

Dyskenisia

Severe Depression

N/V

Palpations/Dysrhythmia

*TCAs decrease efficacy and increase postural hypotension

Do NOT take w/ MAO (risk for HTN crisis)

Anti-HTN meds= risk for Hypostension

*Pyridoxine reverses effects of L-dopa

Contraindiated for nrrow angle glaucoma

NMS

Neurolyptic Malignant Syndrome

Muscle rigidity

Fever

autonomic instability

delirium

ass. w/ elevated creatnine phosphkinase (CPK)

fluphenazine(Prolixin)

Class: Phenothiazine (typical anti-psychotic)

indication= acute/chronic pschosis

Action= alters effect of Dopamine in CNS (anticholergenic and anti-adrenegic blocking activity)

Can cause Tardive Dyskanisia

phenothiazines

Prolixin

Thorazine

Phenazine

Mellaril

phenothiazine side effects

Acute dystonia

Akathesia

Anticholergenic effects

Hypotension

Neurolyptic Malignant Syndrome

Parkinsonian

Sedation

Sexual Dysfunction

Tardive Dyskinesia

Non-Phenothiazines

Haldol

Tarctan

Loxitane

Moban

Orap

Navene

Non-phenothiazne Side effects

Sedation

Transient Drowsiness

Extrapyramidal effects

Tremors

Orthostatic Hypotension

Meds used to Tx Anxiety

 Antidepressants

Anti-seizure

Antihypertensives

Antidysrhytmics

*Primary Rx= TCAs, MAOs, and SSRIs

SSRIs

Selective Seratonin Reuptake Inhibitor

Safer

side effects: increased HR and HTN, N/V, Dry mouth, insomnia,

Sexual Dysfunction, fatigue, agitation

Anticholinergic Effects

Are caused by drugs that block the action of acetylcholine. Acetylcholine is a neurotransmitter—a chemical messenger that helps nerve cells communicate.

Confusion, blurred vision, constipation, dry mouth, light-headedness, difficulty starting and continuing to urinate, and loss of bladder control.

sertaline (Zoloft)

Class: SSRI

Tx for depression, anxiety, panic, and OCD

*Do NOT give with MAO or up to 14 days post d/c

Pregnancy C

Assess for suicidal idiation esp. in Teenagers

Avoid protein bound meds like Digoxin or Warifin= toxicity and bleeding

imipramine (Tofranil)

Class: Tricyclic Antidepressant

Blocks reuptake of seratonin and norepinepherine

Used to Tx major depression, nocturnal enurisis in peds, and withdrawal of ETOH and Cocaine

Anticholinergic effects

Do NOT d/c abruptly

Category C

Side effects; Dysrythmia, heart-block, HTN, drowsiness, fatigue

Contraindicated for hear pts.

phenelzine (Nardil)

Class: Monoamine oxidase inhibitor (MAO)

Action= irreversible inhibition of MAO

intensifies effects of norepinephrine in arenergic synapse

used only when other meds do not work

Effects may coninue for up to 2-3 weeks after d/c

Abrupt d/c= rebound hypertension

Category C

side effects; dry mouth, orthostatic hypotension, insomnia, loss of appetite, diarrhea, headache

Potentiates the effects of insulin

food containing tyrosine=severe HTN!!!

Lithium

Class: Glutamate inhibitor; serotonin receptor antagonist

Action: stabilization of mood during manic phases of BPD

(has neither antimanic or antidepresant properties in ptsw/out BPD)

Therapeutic results seen in 2-3 weeks

Narrow therapeutic range (0.5-1.5)

Pregnancy D category

Diurectics increase the removal of Lithium by the kidneys

Adverse effects:

Dizziness

Fatigue

Short Term Memory

Increased Urination

N/V

Loss of Appetite

Dry Mouth

Muscle Weakness

*Salt free diet= reduces excretion of lithium