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Medications affecting the nervous system - Anxiety Disorders

الكلية كلية التمريض     القسم قسم العلوم الطبية الاساسية     المرحلة 3
أستاذ المادة عمار عباس شعلان الحميري       27/12/2015 13:04:39
Medications affecting the nervous system
Anxiety Disorders
Overview
The major medications used to treat anxiety disorders include:
Benzodiazepine sedative hypnotic anxiolytics such as diazepam (Valium)
Atypical anxiolytic/nonbarbiturate anxiolytics such as buspirone (BuSpar)
Selective Serotonin Reuptake Inhibitors (SSRI antidepressants) such as paroxetine (Paxil)
Other classifications that may be used include:
Antidepressants, such as
Amitriptyline (Elavil), a tricyclic antidepressant (TCA)
Phenelzine (Nardil), a monoamine oxidase inhibitor (MAOI)
Venlafaxine (Effexor), a serotonin-norepinephrine reuptake inhibitor.
Sertraline (Zoloft), a selective serotonin reuptake inhibitor.
CNS stimulants, such as methylphenidate (Ritalin, Concerta)
Antihistamines, such as hydroxyzine (Vistaril)
Beta blockers, such as propranolol (Inderal)
Anticonvulsants, such as gabapentin (Neurontin)
Sedative Hypnotic Anxiolytic – Benzodiazepine
diazepam (Valium)
Other Medications:
Alprazolam (Xanax)
Lorazepam (Ativan)
Chlordiazepoxide (Librium)
Clorazepate (Tranxene)
Oxazepam (Serax)
Clonazepam (Klonopin)
Purpose
Expected Pharmacological Action
Diazepam enhances the inhibitory effects of gamma-aminobutyric acid (GABA) in the central nervous system (CNS). Relief from anxiety occurs rapidly following administration.
Therapeutic Uses
Generalized anxiety disorder (GAD) and panic disorder.
Other uses for benzodiazepines include:
Seizure disorders
Insomnia
Muscle spasm
Alcohol withdrawal (for prevention and treatment of acute symptoms)
Induction of anesthesia
Complications
Contraindications/Precautions
Diazepam is a Pregnancy Risk Category D medication.
Diazepam is contraindicated in clients with sleep apnea and/or respiratory depression.
Use diazepam cautiously in clients with substance abuse and liver disease.
Interactions
Nursing Administration
Advise clients to take the medication as prescribed and to avoid abrupt discontinuation of treatment to prevent withdrawal symptoms.
When discontinuing benzodiazepines that have been taken regularly for long periods and in higher doses, taper the dose over several weeks.
Administer the medication with meals or snacks if GI upset occurs.
Advise clients to swallow sustained-release tablets and to avoid chewing or crushing the tablets.
Inform clients about the possible development of dependency during and after treatment and to notify the provider if symptoms occur.
Atypical Anxiolytic/Nonbarbiturate Anxiolytic
Buspirone (BuSpar)
Purpose
Expected Pharmacological Action
The exact antianxiety mechanism of this medication is unknown. This medication binds to serotonin and dopamine receptors. Abuse is much less likely than with other anxiolytics, and use of buspirone does not result in sedation or potentiate the effects of other CNS depressants.
Therapeutic Uses
Panic disorder, obsessive-compulsive disorder, social anxiety disorder, and posttraumatic stress disorder
Complications
Contraindications/Precautions
Buspirone is Pregnancy Risk Category B.
Buspirone is not recommended for use by nursing mothers.
Use buspirone cautiously in older adult clients and clients with liver and/or renal dysfunction.
Buspirone is contraindicated for concurrent use with MAOI antidepressants or for 14 days after MAOIs are discontinued. Hypertensive crisis may result.
Interactions
Nursing Administration
Advise clients to take the medication with meals to prevent gastric irritation.
Advise clients that effects do not occur immediately. It may take a week to notice the first therapeutic effects and several more weeks for the full benefit. Medication should be taken on a regular basis and not PRN.
Instruct clients that tolerance, dependence, or withdrawal symptoms are not an issue with this medication.
SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRI ANTIDEPRESSANTS)
Select Prototype Medication: Paroxetine
Other Medications:
Sertraline
Escitalopram (Lexapro)
Fluoxetine (Prozac)
Fluvoxamine (Luvox)
Expected Pharmacological Action
Paroxetine selectively inhibits serotonin reuptake, allowing more serotonin to stay at the junction of the neurons.
It does not block uptake of dopamine or norepinephrine.
Paroxetine produces CNS stimulation, which can cause insomnia.
The medication has a long effective half-life. A timeframe of about 4 weeks is necessary to produce therapeutic medication levels.
Therapeutic Uses
Generalized anxiety disorder (GAD)
Panic disorder
Obsessive-compulsive disorder (OCD)
Social anxiety disorder
Posttraumatic stress disorder (PTSD)
Depressive disorders
Complications

Contraindications/Precautions
Paroxetine is a Pregnancy Risk Category D medication.
Paroxetine is contraindicated in clients taking MAOIs or a TCA.
Clients taking paroxetine should avoid alcohol.
Use paroxetine cautiously in clients with liver and renal dysfunction, seizure disorders, or a history of GI bleeding.
Interactions
Nursing Administration
Advise clients that medications may be taken with food. Sleep disturbances may be minimized by taking medication in the morning.
Instruct clients to take the medication on a daily basis to establish therapeutic plasma levels.
Assist with medication regimen adherence by informing clients that therapeutic effects may not be experienced for 1 to 3 weeks.
Nursing Evaluation of Medication Effectiveness
Effectiveness may be evidenced by:
Maintaining normal sleep pattern
Verbalizing feeling less anxious and more relaxed
Greater ability to participate in social and occupational interactions


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