Anxiolytic and Hypnotic Drugs -Anxity: unplesant feeling of tension, fear, or nervousness in

response to an environmental stimulus, whether real or imaginary.

- Anxiolytic: drug used to depress the central nervous system

(CNS); prevent the signs and symptoms of anxity.

- Hypnotic: drug used to depress the CNS; causes sleep.

Benzodiazepines:
Benzodiazepines, the most frequently used anxiolytic drugs, prevent anxiety without causing much associated sedation.

1-Therapeutic Actions and Indication: The benzodiazepines are indicated for the treatment of the following condition: anxiety disorders, alcohol withdrawal, hyperexcitability and agitation, and preoperative relief of anxiety and tension to aid in balanced anesthesia. These drug act in the limbic system and the RAS to make gamma aminobutyric acid (GABA) more effective, causing interference with neuron firing . GABA stabilize the postsynaptic cell. This leads to an anxiolytic affect at doses lower than those required to induce sedation and hypnosis. The exact mechanism of action is not clearly understood. 2-Pharmacokinetics: - Absorbed from gastrointestinal (GI) tract. - Crossing placenta and entering breast milk - Metabolized in the liver .(pt. with liver disease must receive a smaller dose and monitored closely) - Excretion in urine. 3- Contraindications: - Allergy

- Acute narrow-angle glaucoma, shock, coma, or acute alcoholic intoxication - In pregnancy and breast feeding - Neonatal withdrawal syndrome 4- Caution: - In elderly or debilitated patients - Renal or hepatic dysfunction 5- Adverse effects: - CNS: sedation, drowsiness, depression, lethargy, blurred vision, hedaches, apathy, light-headedness, and confusion. - GI: dry mouth, constipation, nausea, vomiting. - Hematological: blood dyscrasias, anemia. - Genitourinary: urinary retention, hesitancy, loss libido, changes in sexual functioning. 6- Clinically important drug-drug interactions: - With alcohol or other CNS depressants. - Cimetidine, oral contraceptives, or disulfiram. - Theophyllines or rantidine. 7- Nuring Implementaion: Do not administer Intra-arterially Do not mix IV drugs in solution with any other drugs Give parenteral forms only if oral forms are not available Give IV drug slowly Maintain pt in bed for a period at least 3 hours Monitor hepatic and renal function Provide comfort measures Teach pt about drug Monitor pt response to drug Monitor adverse effect

 Barbiturates: The barbiturates were once the sedative/hypnotic drugs of choice. Not only is the likelihood of sedation and other adverse effect greater with these drug than with newer sedative/hypnotic drugs, but the risk of addiction and dependence is also greater.

1- Theraputic Action and Indication: - General CNS depressants - They can cause sedation, hypnosis, anesthesia, and in extreme cases, coma - Relief of the signs and symptoms of anxiety and for sedation, insomnia, preanesthesia, and the treatment of seizures. - Treatment of acute manic reaction. 2- Pharmacokinetics: - Metabolized in the liver - Excreted in the urine - Crossing placenta and entering breast milk , pt. with liver disease must receive a smaller dose and monitored closely

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Contraindication: Allergy Latent or manifest prophyria Marked hepatic impairment or nephritis Respiratory distress or severe respiratory dysfunction In pregnancy Caution: Acute or chronic pain Seizure disorders Chronic hepatic, cardiac, or respiratory disease Care should be taken with lactating women Adverse effects: CNS: drowsiness, somnolence, lethargy, ataxia, vertigo, a feeling of a 'hangover,' thinking abnormalities, paradoxical excitement, anxiety, hallucinations GI: nausea, vomiting, constipation, diarrhea, epigastric pain Cardiovascular: bradycardia, hypotension, syncope Hypoventilation, respiratory depression, laryngospasm Clinically important drug-drug interaction: With CNS depressant, alcohol, antihistamines, other tranquilizers Phenytoin Monamine oxidase (MAO)

7- Nuring Implementaion: Do not administer Intra-arterially Do not mix IV drugs in solution with any other drugs Give parenteral forms only if oral forms are not available Give IV drug slowly Monitor hepatic and renal function Provide comfort measures Teach pt about drug Monitor pt response to drug Monitor adverse effect

 References:
Amy M. Karch. Focus on Nursing Pharmacology 5th edition. Lippincott.