Chapter 14Drugs for Anxiety and Insomnia Treatment for Anxiety and Insomnia: Include benzodiazepines, barbiturates, sedative-hypnotics,

and antidepressants Side Effects: drowsiness, lethargy, confusion, amnesia, impaired coordination, ataxia, and paradoxical activity **CNS Depression = Respiratory Depression** Adrenergic and cholinergic drugs (-OL, -INE) Alpha1-receptor: treats nasal congestion Alpha2-receptor: treats HTN Beta1-receptor: treats cardiac arrest, HF, shock Beta2-receptor: treats asthma Antidepressants/Antianxiolytics:

Tricyclic Antidepressants (TCAs): Imipramine (Tofranil)

Treat: Depression MOA: TCA that inhibit presynaptic reuptake of neurotransmitters (5-HT3 and NE), also anticholinergic Nursing Considerations: Fall risk Metabolosis: Liver Side Effects: sedation, anticholinergic effects, confusion, disturbed concentration -rash, nasal congestion, blurred vision, IOP -orthostatic hypotension, syncope, hypertension, tachycardia -dry mouth, constipation, paralytic ileus, nausea -urinary retention, weight gain/loss Adverse Effects: MI, bone marrow depression, withdrawal of abrupt discontinuation Drug Interactions: Contraindicated w/MAOI use, recent MI Use w/caution: CV disorders, seizure disorders, hyperthyroidism, close-angle glaucoma, IOP, ureteral spasm, impaired hepatic/renal impairment, EtOH

Selective Serotonin Reuptake Inhibitors (SSRIs): Escitalopram (Lexapro), Sertraline (Zoloft), Sumatriptan (Imitrex)
Treat: Depression, anxiety, OCD MOA: inhibits reuptake of 5-HT3, ing 5-HT3 levels at neuroreceptors, prolonging positive mood Nursing Considerations: contraindicated in pregnancy, hepatic/renal impairment, DM -administer in AM and monitor closely Metabolosis: Liver Side Effects: headache, lethargy, nervousness, insomnia, drowsiness, anxiety, tremor, dizziness, agitation -hot flashes/flushing, palpitations, sweating, rash, pruritus, asthenia (weakness) -N/V/D, dry mouth, constipation, taste changes Adverse Effects: tremor, agitation -palpitations, anorexia, dyspepsia, dysphagia -sexual dysfunction

-URIs, pharyngitis, dyspnea -weight loss, fever Drug Interactions: do not use with TCAs, MAOIs (malignant hyperthermia), or St. Johns Wort

Monoamine Oxidase Inhibitors (MAOIs): (-INE)

Treat: Depression MOA: inhibit breakdown of E, NE, and 5-HT3, resulting in availability -less popular than TCAs and SSRIs Nursing Considerations: for Pts who have neurotic forms of depression that cannot be treated w/other SSRIs or TCAs -patient teaching to avoid dairy products or fermented meat/fishHTN crisis!! Metabolosis: Liver Side Effects: dizziness, vertigo, headache, agitation, anxiety, sweating -N/D/C, abdominal pain, edema, dry mouth, anorexia, weight changes -urinary retention Adverse Effects: HTN, hypertensive crisis, tremors, mania, memory impairment, orthostatic hypotension, disturbed HR&R Drug Interactions: HTN crisis w/TCAs, other MAOIs - hypoglycemic effects w/insulin -hypotensive affects w/beta blockers, thiazide diuretics -avoid w/SSRIs

Mood Stabilizers/Antimanics: Lithium (Eskalith)

Treat: bipolar disorder MOA: inhibits release of NE, D, and alters Na+ transport in nerve and muscle cells -selectively modulates responsiveness of hyperactive neurons that might contribute to the manic state -heavy metal that alters electrical conduction of nerves that may influence the reuptake of NTs Nursing Considerations: narrow therapeutic range, symptoms R/T to serum-level -contraindicated for Pts w/renal or cardiac disease, dehydration, Na+ depletion, or CF Metabolosis: Liver Side Effects: fatigue, stupor, slurred speech, muscle weakness, fine hand tremor -N/V/D, thirst, polyuria, GI upset, salivation Adverse Effects: seizures, bradycardia, hypotension, pulmonary complications, CV collapse Drug Interactions: thiazide diuretics (Li+ Na+ reabsorption, Na+ depletion Li+ retention) -ACE inhibitors, NSAIDs, caffeine CNS Stimulants: Methylphenidate (Ritalin) Treat: Attention deficit disorders, narcolepsy MOA: similar to an amphetamine, stimulates CNS Nursing Considerations: do give if Pt has anxiety, tension, or agitation -contraindicated w/glaucoma, severe depression -careful use w/seizure disorders, alcoholism Metabolosis: Liver Side Effects: nervousness, dizziness, headache, palpitations

-nausea, abdominal pain Adverse Effects: insomnia, tachycardia/bradycardia, hyper/hypotension, angina -tolerance, disrupted sleep patterns Drug Interactions: MAOIs, TCAs, anticoagulants, SSRIs

Antipsychotics:
Risperidone (Risperdal), Clozaril (Clozapine), Quetiapine (Seroquel), Haloperidol (Haldol) Treat: schizophrenia, Tourette syndrome MOA: block D receptors in brain, depress RAS Nursing Considerations: bone marrow depression, Parkinsons Pts, hepatic/renal impairment, coronary disease, severe hyper/hypotension -use cautiously w/glaucoma, BPH, respiratory disorders, epilepsy, peptic ulcer -potential for aspiration Metabolosis: liver Side Effects: drowsiness, pseudoparkinsonism, slurring, seizures -dry mouth/salivation, nasal congestion, N/V/C, anorexia, flushing, sweating, urinary retention, paralytic ileus Adverse Effects: cardiac arrest, arrhythmias, anaphylaxis, suppression of cough reflex and potential for aspiration Drug Interactions: Li+, carbamazepine, anticholinergic drugs (additive effects), ginko biloba

Chapter 15Drugs for Seizures

Barbiturates: (-BARBITAL)
Treat: Seizures, but rarely used to treat insomnia and anxiety b/c of widespread CNS depression MOA: bind to BABA-receptor-Cl channel molecules, GABA effect in the brain, --I impulse conduction in RAS Low dose: reduce anxiety, cause drowsiness Moderate dose: inhibit seizures, promote sleep Nursing Considerations: long-term usestimulation of enzyme that metabolizes barbiturates in the liver, so you have tolerance that crosses over to opioid tolerance, too -administer slowly and give small meals, and take drug w/food, taper dose off -fall risk -renal/hepatic impairment, COPD, emphysema -use cautiously with acute or chronic pain (can mask symptoms), or seizure disorders, fever, hyperthyroidism, DM, or cardiac disease Metabolosis: liver, excreted in kidneys Side Effects: somnolence, agitation, confusion -headache, urticaria, dry mouth, N/V/C/D, epigastric pain -bradycardia, hypotension, syncope -occasional paradoxical excitation -hyperkinesia, ataxia, vertigo Adverse Effects: profound respiratory depression, shock, death w/OD -hypotension, drug dependence/withdrawal -hypoventilation, laryngospasm, bronchospasm Drug Interactions: potentiated effects w/EtOH (CNS depression), antihistamines, MAOIs, and opioids -anticoagulants, CCS, oral contraceptives, estrogens, beta blockers barbiturate effects

Benzodiazepines: (-PAM)
Treat: insomnia, anxiety, seizures disorders, EtOH withdrawal, short-term depression/mania Tx MOA: bind to BABA-receptor-Cl channel molecules, GABA effect in the brain, DO NOT produce lifethreatening respiratory depression or coma w/OD Nursing Considerations: do not use w/acute narrow-angle glaucoma, EtOH, or hepatic/renal failure -take drug w/small meals -warn Pts of potential mood swings Metabolosis: liver, excreted in kidneys Side Effects: sedation, depression, headache, dizziness, disorientation -hostility, restlessness, confusion, crying -physical dependence -constipation, diarrhea, dry mouth, nausea (GI upset) Adverse Effects: phlebitis, tolerance, dependence, withdrawal (long-term use), CNS depression respiratory depression, memory impairment Drug Interactions: potentiated effects w/EtOH and other psychoactive drugs (CNS depression)

Sedative-Hyponotics (non-barbiturates) (-NOLOL, -ONE, INE, ON)

Treat: short-term sleep disorders, anxiety, seizures MOA: --I GABA receptorssleep and sedation Nursing Considerations: rapid-acting -do not use in those w/hepatic/renal impairment, respiratory diseases Metabolosis: liver and excreted in kidneys Side Effects: sedation, dizziness, headache, sleep-walking -nausea, diarrhea Adverse Effects: dependence, CNS depression, apnea, Drug Interactions: other CNS depressants