Unit III: The Nervous System

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Unit III The Nervous System

• Chapter 14
• Drugs for Anxiety and Insomnia

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Definitions

• Anxiety
• a state of apprehension, tension or uneasiness
  that stems from the anticipation of danger, the
  source of which is largely unknown or
  unrecognized. (ICD-10)
• Insomnia
• a condition characterized by a clients
  inability to fall asleep or remain asleep. (p.
  156)

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Categories of Anxiety

• Generalized anxiety disorder
• Panic disorder
• Phobias
• Obsessive-compulsive disorder (OCD)
• Post-traumatic stress disorder (PTSD)

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Nonpharmacological Therapies

• Cognitive behavioral therapy
• Counseling
• Biofeedback techniques
• Meditation

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Anxiety and Wakefulness

• Responsible brain regions
• Limbic system
• Responsible for emotional expression, learning,
  and memory
• Reticular activating system

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Insomnia

• short-term (behavioral)- associated with everyday
  stressors
• Food or drinks containing stimulants may
  interrupt sleep
• Alcohol enables sleep but causes vivid dreams and
  frequent awakening
• long-term- associated with depression, manic
  disorders, and chronic pain
• Nonpharmacological measures should be tried first
• Medication-related sleep problems are most common
  in the elderly

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Anxiety and Sleep DisordersMedication
Classifications

• Antidepressants
• Tricyclic, SSRI, MAOI
• Benzodiazepines
• Barbiturates
• Nonbenzodiazepine/nonbarbiturate

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Nursing Role in Management ofAnxiety and Sleep
Disorders

• Monitor condition and provide education
• What does this entail?
• Assess need for antianxiety or insomnia drugs
• What should this include?
• Obtain drug history
• What questions should you ask?
• Use cautiously in certain clients
• Which populations are at risk?

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Nursing Role in Management ofAnxiety and Sleep
Disorders

• Benzodiazepine and nonbenzodiazepine
• Assess for side effects of CNS depression
• Assess neuro status, LOC
• Monitor VS, esp. respiratory pattern during sleep
• Monitor stimulant intake
• Monitor affect and emotional status

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Antidepressants

• Primary medications to reduce anxiety and panic
• Tricyclic antidepressants (TCAs)
• Selective Serotonin Reuptake Inhibitors (SSRIs)
• Monoamine Oxydase Inhibitors (MAOIs)
• Used to treat all categories of anxiety
• escitalopram (Lexapro) prototype drug for
  generalized anxiety disorder (p. 161)

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Considerations for Antidepressants as Anxiolytics

• TCAs
• Not recommended if hx of MI, heart block or
  dysrhythmia
• Use cautiously in asthma, GI disorders,
  alcoholism, schizophrenia or bipolar disease
• SSRIs
• Safer than other classes
• Less common sympathomimetic and fewer cholinergic
  effects
• MAOIs
• Avoid caffeine and foods containing tyramine
• May potentiate the effects of insulin and other
  diabetic drugs

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Benzodiazepines

• Bind to GABA receptor-chloride channel molecule
• Intensify effects of GABA
• Examples
• alprazolam (Xanax)
• chlordiazepoxids (Librium)
• clorazepate (Tranxene)

• Prototype
• lorazepam (Ativan)
• p. 163
• Primary use
• Anxiety disorders and insomnia
• Adverse effects
• Drowsiness
• Dizziness
• Respiratory depression

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Barbiturates

• Bind to GABA receptor-chloride channel molecule
• Intensifies effect of GABA
• Inhibits brain impulses from passing through
  limbic system and RAS
• Examples
• pentobarbital (Nembutal)
• secobarbital (Seconal)
• amobarbital (Amytal)

• Prototype
• Phenobarbital (Luminal)
• p. 176
• Primary use
• Sedative and hypnotic
• Adverse effects
• Tolerance
• Respiratory depression
• Psychological and physical dependence

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Barbiturates

• Several barbiturates are Schedule II drugs.
  What does this mean?
• How often would you expect to see a barbiturate
  prescribed for anxiety or insomnia?
• Why?

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Nonbenzodiazepine/Nonbarbiturates

• Bind to GABA receptors
• Preserve sleep stages III and IV
• Offer minor effects of REM sleep
• Examples
• buspirone (Buspar)
• chloral hydrate (Noctec)
• ethchlorvynol (Placidyl)

• Prototype
• zolpidem (Ambien) p. 164
• Primary use
• hypnotic
• Adverse effects
• Mild nausea, diarrhea
• Dizziness
• Confusion
• Daytime drowsiness
• Amnesia
• Sleepwalking