1. Chapter 16 Drugs Used for Anxiety Disorders Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

2. Slide 2 Chapter 16 Lesson 16.1 Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

3. Slide 3 Objectives Define key words associated with anxiety states Describe the essential components of a baseline assessment of a patient’s mental status Develop a teaching plan for patient education of people taking antianxiety medications Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

4. Slide 4 Anxiety Disorders Generalized anxiety disorder Panic disorder Phobias Obsessive-compulsive disorder (OCD) Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

5. Slide 5 Treatment for Generalized Anxiety Disorders Psychotherapy Specific benzodiazepines SSRIs (escitalopram [Lexapro], paroxetine [Paxil]) Azaspirones (buspirone [BuSpar]) Extended-release venlafaxine Beta-adrenergic blocking agents (to some extent) Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

6. Slide 6 Treatment for Panic Disorders Behavioral therapy Benzodiazepines (alprazolam [Xanax], clonazepam) SSRIs (sertraline [Zoloft], paroxetine [Paxil], fluoxetine [Prozac]) Tricyclic antidepressants Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

7. Slide 7 Treatment for Phobias Avoidance Behavioral therapy Benzodiazepines Beta-adrenergic blockers (propranolol [Inderal], atenolol [Tenormin]) Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

8. Slide 8 Treatment for Obsessive-Compulsive Disorders Behavioral and psychosocial therapy Paroxetine (Paxil) Sertraline (Zoloft) Fluoxetine (Prozac) Fluvoxamine (Luvox) Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

9. Slide 9 Assessment of Mental Status Components of a baseline assessment  History of behavior  Basic mental status  Mood/affect  Clarity of thought  Psychomotor functions  Obsessions or compulsions  Sleep pattern  Dietary history Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

10. Patient Education for Anxiety Disorders Individualize based on assessment data Explore coping mechanisms used to respond to stressors Involve patient and family in goal setting Discuss medication information and how it benefits the patient Slide 10 Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

11. Slide 11 Chapter 16 Lesson 16.2 Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

12. Slide 12 Objectives Describe signs and symptoms the patient will display when a positive therapeutic outcome is being seen for the treatment of a high anxiety state Cite the adverse effects of hydroxyzine therapy and identify those effects requiring close monitoring when used preoperatively Discuss psychological and physiologic drug dependence Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

13. Slide 13 Drug Class: Benzodiazepines Actions  CNS depressants; reduce anxiety by stimulating the neurotransmitter GABA Uses  Treat anxiety associated with alcohol withdrawal and medical illnesses Common adverse effects  Drowsiness, hangover, sedation, lethargy Serious adverse effects  Excessive use or abuse; blood dyscrasias; hepatotoxicity Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

14. Slide 14 Drug Class: Azaspirones Drug: buspirone (BuSpar) Actions  Partial serotonin and dopamine agonist Uses  Short-term relief of symptoms of anxiety Common adverse effects  Sedation, lethargy Serious adverse effects  Slurred speech, dizziness Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

15. Slide 15 Miscellaneous Antianxiety Agents Drug: hydroxyzine (Vistaril, Atarax) Action  Antihistamine Uses  Mild tranquilizer for anxiety, tension, agitation; sedation; relaxation before surgery; controlled itching in allergic reactions Common adverse effects  Blurred vision; constipation; dryness of mucosa of the mouth, throat, and nose; sedation Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

16. Slide 16 Miscellaneous Antianxiety Agents (cont’d) Drug: meprobamate (Miltown) Action  Act on multiple sites in the CNS; mechanism of action unknown Uses  Antianxiety, skeletal muscle relaxant Common adverse effects  Sedation Serious adverse effects  Slurred speech, dizziness; excessive use or abuse Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.