Anxiolytics & Drugs for Insomnia Flashcards by Erin Morton

Hypnotic

Promoting sleep

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Sedative

Tranquilizing like effect to cause sedation

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Sedative-hypnotic

Drug that causes relaxation at lower doses and sleep at higher doses.

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lorazepam/Ativan

Benzodiazepine

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diazepan/Valium

Benzodiazepine

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alprazalom/Xanax

Benzodiazepine

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temazepam/Restoril

Benzodiazepine; often used for sleep

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clonazepam/Klonopin

Benzodiazepine; often used for PTSD

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Benzodiazepine use-

Intended to be used short term and PRN, as they can be very addictive so tolerance and dependence may develope.

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Benzodiazepine therapeutic effect

Reduce anxiety, agitation, promote relaxation or sleep and prevent alcohol withdrawl symptoms.

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Benzodiazepine drugs have…

faster onset. Risk for toxicity is a concern in patients with liver or kidney impairment.

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Benzodiazepine side effects

drowsiness, sedation (do not take with other drugs affecting the CNS), weakness, memory impairment, hypotension, dependence and tolerance.

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buspirone/BuSpar

Is the most commonly used Non-benzodiazepine drug for anxiety. It is intended to be used regularly NOT PRN. Has a significantly LESSER risk for addiction/dependence and tolerance than Benzodiasepines. It may take a few weeks to achieve the effect of the drug.

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zolpidem/Ambien, Ambien CR

Non-Benzodiazepines; are used for insomnia. Regular Ambnien is used to help patients get to sleep and has a fast onset of about 15-30 minutes. Ambien CR helps patients get to sleep but also has an extended release layers of the medication that helps patients stay asleep. Patients should plan to get 7-8 hours of sleep with Ambien CR otherwise they can experience significant drowsiness or even experience being sleeping while awake.

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hydroxyzine/Vistril/Atarax

Non-Benzodiazepines

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dipenhydramine/Benadryl

Non-Benzodiazepines; commonly in OTC sleep aids.

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Non-Benzodiazepines; Side effects

mild drowsiness (less than with Benzodiazepines), disorientation, fatigue or restlessness, headache, anger, nausea, CONSTIPATION, DRY MOUTH, VISUAL DISTURBANCE (think of anticholinergic effects such as with antihistamines).

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Antidepressants

Most commonly used are SSRIs

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paroxetine/Prozac

Antidepressants: SSRIs

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fluoxetine/Paxil

Antidepressants: SSRIs

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sertraline/Zoloft

Antidepressants: SSRIs

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SSRIs use

used for anxiety as well as depression especially when sleep disruptions are a symptom of anxiety.

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trazadone/Desyrel/Olepto

Older TCA antidepressants that are used for insomnia.

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atenolol/Tenomin

Betablockers, may be used to slow the heart rate which can result in a calming effect.

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propranolol/Inderal

Betablockers, may be used to slow the heart rate which can result in a calming effect.

valproate/Depakote

Antiseizure drugs can be used to promote a calming effect as it causes CNS depression.

Barbituates

Are powerful CNS depressant drugs having sedative, hypnotic, and antiseizure effects. They are rarely used to treat anxiety or insomnia now better drugs are available.

Barbituates: side effects

high risk for sedation (except phenobarbital/Luminal), psychological or physical dependence and overdose potential.

Anxiolytics should not... but...

Not- discontinued abruptly. But- tapered off (especially Benzodiazepines).

Withdrawal with Benzodiazepines

When taken for >3 months. Withdrawal with non-benzodiazepines is much less.

Benzodiazepine interaction effects:

Know when used with cigarettes, caffeine, alcoholm, or other CNS depressants.

Elderly observation.

with impaired organ function for signs of toxicity, especially Benzodiazepines.

Benzodiazepine: Signs of toxicity.

respiratory depression and over sedation.

Benzodiazepine: avoid in...

Avoid in patients with a history of drug abuse or suicidal ideation.

Benzodiazepine: Monitor for

compliance and signs of drug abuse

Benzodiazepine: antagonist (reversal agent)

flumazenil/Romazicon, given IV and acts quickly

Nurses should monitor patients taking anxiolytics for

Risk of falls- may be unsteady due to hypotension or become dizzy or drowsy.

Nurses should check the blood pressure and report to the doctor if

SBP drops 20mm/hg or greater (more common when taking Benzodiazepines)

Patients should be instructed to...

change positions slowly, increase dietary fiber intake, and to use hard candy or gum for dry mouth. To avoid alcohol, tabacco, and caffeine, and not to take other drugs that cause CNS depression with their medications for anxiety or insomnia.

imipramine/Tofranil

tricyclic antidepressants (TCA)

amitriptyline/Elavil

tricyclic antidepressants (TCA)

nortriptyline/Pamelor

tricyclic antidepressants (TCA)

Drugs for emotional and mood disorders

monoamine oxidase inhibitors (MAOIs)

Drugs for emotional and mood disorders

selective serotonin reuptake inhibitors (SSRIs)

Drugs for emotional and mood disorders

atypical antidepressants

Drugs for emotional and mood disorders

Antidepressants

are used to treat depression, anxiety disorders (OCD, phobias, panic), and chronic pain.

phenelzine/Paxil

selective serotonin reuptake inhibitors (SSRIs)

tranylcypromine/Parnate

monoamine oxidase inhibitors (MAOIs)

sertraline/Zoloft

selective serotonin reuptake inhibitors (SSRIs)

phenelzine/Nardil

monoamine oxidase inhibitors (MAOIs)

citalopram/Celexa

selective serotonin reuptake inhibitors (SSRIs)

fluoxetine/Prozac

selective serotonin reuptake inhibitors (SSRIs)

escitalopram oxalate/Lexapro

selective serotonin reuptake inhibitors (SSRIs)

duloxetine/Cymbalta

atypical antidepressants

venlafaxine/Effexor

atypical antidepressants

bupropion/Wellbutrin

atypical antidepressants

trazadone/Desyrel/Olepto

atypical antidepressants

mirtazapine/Remeron

atypical antidepressants

Antidepressants work by...

blocking neurotransmitter receptors, blocking breakdown of neurotransmitters or inhibiting reuptake or neurotransmitters.

Side effects: SSRIs

weight gain and sexual dysfunction (both lead to non-compliance), insomnia or drowsiness, nausea, dry mouth, dizziness, diarrhea or constipation, headache and serotonin syndrome.

Serotonin syndrome

Side effects: TCAs

annoying anticholinergic effects (dry mouth or eyes, constipation, urinary retension, increased HR, blurred vision) or other side effects such as drowsiness, orthostatic hypertension, weight gain, sexual dysfunction, seixures, and liver damage.

Hypertensive crisis

Side effects: MAOIs

orthostatic hyupertension, insomnia, diarrhea, headache, and hypertensive crisis.

Cause, symptoms. and treatment of hypertensive crisis

Foods that contain tyramine

Drugs to avoid while taking MAOIs due to risk of hypertensive crisis.

Side effects: Atypicals: like TCAs

anticholoinergic effects. Seizures, weight gain, nausea, headache, drowsiness or restlessness, dizziness, tremors, hypotension and sexual dysfunction.

Anxiolytics & Drugs for Insomnia Flashcards

(69 cards)