Drugs for Anxiety, Daytime Sedation, and Insomnia

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Drugs for Anxiety, Daytime Sedation, and Insomnia

• Chapter 8

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Introduction

• More clients routinely experience nervousness and
  tension than any other symptom.
• Most health care providers agree that even though
  drugs are not the cure for this problem, they can
  help on a short-term basis to calm clients who
  are apprehensive or have difficulty falling
  asleep.

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Classifications of Anxiety

• Two major classifications of anxiety are
  generalize anxiety disorder and panic disorder

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Classifications of Anxiety

• Anxietystate of apprehension and ANS activation
  resulting from exposure to a nonspecific or
  unknown cause.
• Generalized anxietydifficult to control,
  excessive anxiety that lasts 6 months or more and
  interferes with normal day-to-day functions or
  causes considerable distress.

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Classifications of Anxiety

• Panic disordersis characterized by episodes of
  immediate and intense apprehension, fearfulness,
  or terror associated with dread of future attacks
  and changes in behavior to avoid them. When a
  panic attack occurs, it is usually over within 10
  minutes, although it may be described by a client
  as seemingly endless.

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Classifications of Anxiety

• Phobiasare fearful feelings attached to specific
  situation or objects that compel a client to
  avoid the fearful stimulus.

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Classifications of Anxiety

• Obsessive-compulsive disordersinvolves
  recurrent, intrusive impulses or thoughts and
  repetitive behaviors aimed at reducing the
  distress associated with them.

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Classifications of Anxiety

• Post-traumatic stress disordersa type of anxiety
  that develops in response to the threat or
  experience of severe injury or death.
• War, physical or sexual abuse, natural disasters,
  and murder may lead to a sense of helplessness
  and re-experiencing of the traumatic event.

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Classifications of Anxiety

• Fast Facts pg. 109

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Specific Brain Regions

• Specific regions of the brain are responsible for
  anxiety and wakefulness.
• Neural systems associated with anxiety and
  restlessness include the limbic system and the
  reticular activating system.

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Specific Brain Regions

• Limbic Systemregion in the middle of the brain
  responsible for emotional expression, learning,
  and memory.
• Signals routed through the limbic system
  ultimately connect with the hypothalamus.
• Emotional states associated with this connection
  include anxiety, fear, anger, aggression,
  remorse, depression, sexual drive, and euphoria.

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Specific Brain Regions

• Reticular formationa network of neurons found
  along the entire length of the brain stem.
• Stimulation of the reticular formation causes
  heightened alertness and arousal, while
  inhibition of the reticular formation causes
  general drowsiness and the induction of sleep.

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Specific Brain Regions

• Reticular activating system (RAS)it is
  responsible for sleeping and wakefulness and
  performs an alerting function for the cerebral
  cortex.
• It also helps a client to focus attention on
  individual tasks by transmitting information to
  higher brain centers.

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Insomnia

• Insomnia has more than one cause.
• Insomniathe inability to fall asleep or stay
  asleep.

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Short Term or Behavioral Insomnia

• Stress by a hectic lifestyle.
• Worry about work, marriage, children, or health.
• Foods or beverages containing stimulants such as
  caffeine

• Nicotine
• Uncomfortable room temperature
• Snoring
• Sleep apnea
• Recurring nightmares

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Long-Term Insomnia

• Psychiatric disorders
• Chronic pain
• Medication side effect

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Insomnia

• Long-term use of sleeping medications is likely
  to worsen insomnia and may cause physical or
  psychological dependence.
• Some may experience a phenomenon referred to as
  rebound insomnia when hypnotic medications are
  discontinued abruptly or after taken for a long
  time sleeplessness and symptoms of anxiety
  become markedly worse.

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Insomnia

• Fast facts pg. 111!

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Antidepressants
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Antidepressants

• Typical antidepressants used to treat anxiety and
  insomnia include
• SSRIselective serotonin reuptake inhibitors
• TCAstricyclic antidepressants
• MAOIsmonoamine oxidase inhibitors.
• Mechanism covered in chapter 9, however, look at
  the bulleted section on pg. 113!!

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CNS Depressants

• CNS depressants used to treat anxiety and
  restlessness.
• Calms clients
• Sedativesdepress the CNSable to sedate and
  relax
• HypnoticsCNS depressant drugs prescribed to help
  patient sleep.
• Tranquilizera drug that produces a calm or
  tranquil feeling.

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CNS Depressants

• CNS depressants used for anxiety and sleep
  disorders are categorized into 2 major classes
• Benzodiazepines
• barbiturates

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CNS Depressants

• The withdrawal syndrome for some CNS depressants
  can cause life-threatening neurologic reactions,
  including fever, psychosis, and seizures.
• Other withdrawal symptoms include increased
  heart rate, lowered BP, loss of appetite, muscle
  cramps, impaired memory, concentration, and
  orientation abnormal sounds in the ears and
  blurred vision insomnia, agitation, anxiety, and
  panic.
• Noticeable withdrawal symptoms typically last 2
  to 4 weeks. Subtle ones can last months

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Benzodiazepines

• Benzodiazepinestreat panic disorder, generalized
  anxiety, phobias, and insomnia.
• Chlordiazepoxide (Librium) and diazepam
  (Valium)introduced in 1960s
• Schedule IV drugs
• Prescribed for seizure activity, alcohol
  withdrawal symptoms, muscle relaxation, induction
  agent in general anesthesia
• DPlorazepam (Ativan) pg. 117.

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Benzodiazepines forSleep Disorders

• Benzodiazepines are drugs of choice for
  short-term insomnia caused by anxiety.
• Increase total sleep time

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Barbiturates

• Barbiturates are drugs derived from barbituric
  acid
• They act as CNS depressants and are used for
  their sedative, hypnotic, and anti-seizure effects

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Barbiturates

• Barbiturates are used for the short-term therapy
  of severe insomnia.
• Should be short-term because of the risk of
  psychological and physical dependence.

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Barbiturates

• The withdrawal syndrome from barbituates is
  extremely severe and can be fatal.
• Overdose results in profound respiratory
  depression, hypotension, and shock.
• People have used to commit suicide, and death due
  to overdose is not uncommon.