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Ch 14
Drugs for anxiety and insomnia
23
Nursing
Graduate
04/12/2014

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Cards

Term
Anxiety
Definition
Unpleasant feeling of dread, apprehension or tension resulting from an unexpected threat to one's feeling of self esteem or well being; may be a symptom in many disorders
Term
Sedative (anxiolytic)
Definition
Agent that should reduce anxiety and exert a calming effect
Term
Insomnia
Definition
Inability to fall asleep or remain asleep
Term
Hypnotic
Definition
Produces drowsiness; induces sleep
Term
Antihistamine
Definition

OTC agents that induce drowsiness

Ex: diphenhydramine

Term
Beta blockers
Definition
Reduce tachycardia and other symptoms of anxiety
Term
Antidepressants
Definition
  • Restoring normal NE & serotonin balance helps reduce symptoms associated w/ depression, panic, obsessive-compulsive behavior, & phobia
  • SSRI's
  • SNRI's (atypical antidepressants)
  • TCA's
  • MAOI's
Term
Barbituates
Definition
  • CNS depressant
  • Rarely used to treat anxiety and insomnia because of:
  • life threatening side effects r/t depressing CNS function on all levels- overdose produces extreme respiratory depression, hypotension, & shock
  • High risk of physical and psychological dependence
  • Withdrawal syndrom is extrememly severe, possibly fatal

 

 

Term
Antipyschotics/Anti-siezure agents
Definition
  • Some people use them b/c of sedative side effect
  • Not enough research has been done to determine their safety & effectiveness in treating anxiety/insomnia
Term

alprazolam (Xanax)

lorazepam (Ativan)

diazepam (Valium)

oxazepam (Serax)

Definition
  • Benzodizepines
  • Use to treat anxiety & insomnia
  • MOA: intesify effect of GABA, CNS depressant
  • AE: drowsiness, sedation, lethargy, ataxia, confusion
  • Preferred agent for insomnia cause by anxiety
  • Also used for: seizures, EtOH withdrawal, adjunct to anesthesia, nausea
  • Some agents have metabolites
  • Antidote: flumazenil (Romazicon)
  • Schedule IV
Term
GABA
Definition
  • gamma-amniobutyric acid
  • inhibitory CNS neurotransmitter
Term
buspirone (Buspar)
Definition
  • Serotonin receptor agonist
  • Used to treat anxiety & insomnia
  • MOA: Uknown; exhibits high affinity for serotonin receptors & moderate affinity for dopamine receptors
  • AE: nasuea, dizziness, nervousness, headache, somnolence, tachycardia, heart failure, MI, CVA
  • Many drug-drug interactions
  • Slow onset of action (14 days)
  • Adjust does for liver or renal impairment
  • Not a controlled substance
Term

eszopiclone (Lunesta)

zaleplon (Sonata)

zolpidem (Ambien)

Definition
  • Hypnotics
  • Used to treat anxiety & insomnia 
  • MOA: enhance effect of GABA
  • AE: taste disturbance, vomiting, diarrhea, dizziness, headache, somnolence, visual disturbances, fatigue
  • Rapid onset
  • Zaleplon/zolpidem: short term use only (FDA)
  • Several drug-drug interactions
  • Adjust dose for liver impairment
  • Schedule IV controlled substance 
Term
ramelteon (Rozerem)
Definition
  • Melatonin receptor agonist
  • Improves sleep induction
  • Short onset (30 minutes)
  • Ok for long-term use: does not produce tolerance or dependence
Term
Sedative-hypnotic
Definition
  • Drugs that are sedative (relaxing) at low doses and hypnotic (sleep inducing) at high dose
  • Barbituates
Term
Types of anxiety disorders
Definition

In order of highest to lowest cause of anxiety:

  1. Phobias
  2. PTSD
  3. GAD
  4. OCD
  5. Panic disorder

Others:

  • Situational anxiety
  • Social anxiety disorder

 

Term
Limbic system & Reticular activating system (RAS)
Definition
Two regions of the brain strongly associated with anxiety, expression of emotions, and restlessness
Term
Anxiolytic
Definition
  • Drug having ability to relieve anxiety
  • Ex: antidepressants, CNS depressants, seizure drugs, emotional and mood disorder drugs, antihypertensives, antidysrhythmics
Term
Short-term or behavioral insomnia
Definition
Caused by stress of hectic lifestyle or inability to resolve day-to-day conflicts within home or work environment
Term
Long-term insomnia
Definition
Caused by depression, manic diorder, chronic pain
Term
Electroencephalogram (EEG)
Definition

Used to diagnose sleep disorders, seizure activity, depression, dementia

Measures brain waves (alpha, beta, delta, theta)

Term
nonrapic eyemovement sleep (NREM)
Definition
  • 4 stages
  • Go through I to IV and then in reverse
  • Can be identified on EEG
Term
Rapid eye movement (REM)
Definition
  • Happens at then end of a NREM cycle
  • When dreaming happens
  • Brain wave pattern (on EEG) similar to drowsy but awake 
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