1. Drugs Used in Mental Health Antianxiety Drugs

2. Anxiety – a feeling of apprehension, worry, or uneasiness that may or may not e based on reality Anxiolytics – another name for antianxiety medications

3. Antianxiety Drugs Block neurotransmitter receptor sites preventing anxious feelings from reaching brain Also prevents body’s physical reaction to anxiety

4. Antianxiety Drugs Common Uses Anxiety disorders and panic attacks Preanesthetic sedation and muscle relaxants Convulsions or seizures - diazepam (Valium) Alcohol withdrawal

5. Antianxiety Drugs Benzodiazepines –diazepam (Valium) half life : 36-200 hr –clonazepam (Klonopin) half life : 18-50 hr –chlordiazepoxide (Librium) half life : 5-25 hr –alprazolam (Xanax) half life : 6-12 hr –lorazepam (Ativan) half life : 10-20 hr

6. Antianxiety Drugs Nonbenzodiazepines –doxepin (Sinequan) half life : 28-52 hr –buspirone HCl (BuSpar) half life : 2-3 hr * buspirone (BuSpar) drug of choice with elderly because it does not cause excessive drowsiness and poses less fall risk

7. Antianxiety Drugs Side Effects / Adverse Reactions Drowsiness / sedation Lightheadedness / dizziness Headache, visual disturbances Lethargy, apathy, fatigue Confusion, restlessness, agitation GI disturbances, dry mouth

8. Antianxiety Drugs Benzodiazepine Toxicity –Results from overdose –Sedation, respiratory depression, coma, death –Antidote: flumazenil (Romazicon) Parenteral Alert –IM, IV route may lead to apnea and cardiac arrest –Use care with elderly, debilitated, respiratory compromised

9. Antianxiety Drugs High Risk for Physical Dependence Long term use Tolerance Physical dependence Withdrawal symptoms After 3 months of use, do NOT discontinue abruptly

10. Antianxiety Drugs Withdrawal Symptoms Increased symptoms of anxiety Fatigue, hypersomnia Metallic taste, nausea, sweating Headache, difficulty concentrating Cramps, tremors Hallucinations, convulsions

11. Contraindications Psychoses Acute narrow angle glaucoma Pregnancy –Floppy infant syndrome Lactation –Infant becomes lethargic and loses weight Significant hypotension / bradycardia

12. Precautions Use cautiously with elderly –Initial Low Dose: excreted more slowly, high risk for toxic levels –Exception: lorazepam (Ativan), safe for elderly at usual ranges Use cautiously in patients with –Impaired liver function –Impaired kidney function –Overall debilitation Avoid alcohol

13. Interactions Use cautiously with elderly –Initial Low Dose: excreted more slowly, high risk for toxic levels –Exception: lorazepam (Ativan), safe for elderly at usual ranges Use cautiously in patients with –Impaired liver function –Impaired kidney function –Overall debilitation Avoid alcohol

14. Nursing Process Assessment Nursing Diagnoses Planning Implementation Evaluation

15. Assessment Vital Signs Allergies Labs General appearance General comfort Route of Administration

16. Nursing Diagnoses Risk for injury Impaired comfort Ineffective individual coping

17. Planning What will the patient require? What is the expected outcome? What adverse reactions might occur?

18. Implementation Route of administration Drug interactions Concurrent CNS depression Safety concerns Mouth care, hard candies, sugarless gum for dry mouth Fluids and fiber to prevent constipation

19. Evaluation Is the patient –Less anxious? subjective evaluations objective evaluations –More comfortable? –Experiencing any adverse reactions? –Developing tolerance / addiction?

20. Patient Teaching Take as directed Do not discontinue abruptly Avoid hazardous activity Advise physician of all OTC medications and supplements Do not drink alcohol

21. Hypnotics Hypnotic – drug that induces drowsiness or sleep

22. Hypnotics Common Uses Insomnia Convulsions - Valium Adjuncts for anesthesia –Preanesthesia –Conscious sedation

23. Hypnotics Benzodiazepines –flurazepam (Dalmane) half life : 40-250 hr temazepam (Restoril) half life : 8-20 hr –triazolam (Halcion) half life: half life : 2-3 hr Nonbenzodiazepines –Zolpidem tartrate (Ambien) half life : 2-3 hr

24. Hypnotics Barbituates –pentobarbital (Nembutal) half life : 15-48 hr –secobarbital (Seconal) half life : 15-40 hr

25. Hypnotics Side Effects / Adverse Reactions CNS depression Lightheadedness / dizziness Headache Tolerance, addiction Rebound insomnia, hangover GI disturbances, dry mouth

26. Contraindications Respiratory problems History of substance abuse Pregnancy / lactation

27. Precautions Use cautiously with elderly –Elderly –Debilitated –Mental health concerns Use cautiously in patients with –Impaired liver function –Impaired kidney function –Overall debilitation Avoid alcohol

28. Interactions Increased CNS depression with –Alcohol ( Alcohol + Barbituates = Coma, Death ) –Opiod (narcotic) analgesics –Antihistamines –Antidepressants –Anxiolytics, antipsychotics –Cimetidine (Tagamet)

29. Nursing Process Assessment Nursing Diagnoses Planning Implementation Evaluation

30. Assessment Factors interfering with sleep –Reduce environmental stimuli –Administer pain medication if needed Administer at hour of sleep –Not too early –Not too late

31. Nursing Diagnoses Risk for injury Ineffective breathing pattern Ineffective individual coping

32. Planning What will the patient require? What is the expected outcome? What adverse reactions might occur?

33. Implementation Supportive care Reduce caffeine intake Provide safety

34. Evaluation Is the sleep pattern improved? –Rested in the morning? subjective evaluations objective evaluations –Experiencing any adverse reactions? –Developing tolerance / addiction?