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Download Chapter 14 Media Directory Common Causes of Anxiety
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Chapter 14 Drugs for Anxiety and Insomnia Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed. Michael Patrick Adams, Leland Norman Holland, Jr., and Paula Manuel Bostwick Slide 29 Zolpidem Animation Copyright ©2008 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Major Types of Anxiety Disorders • • • • • • Media Directory Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed. Michael Patrick Adams, Leland Norman Holland, Jr., and Paula Manuel Bostwick Figure 14.1 A model of anxiety in which stressful events or a changing mental condition can produce unfavorable symptoms, some of which may be controlled by medication. Situational anxiety Generalized anxiety disorder (GAD) Panic disorder Phobias Obsessive-compulsive disorder Post-traumatic stress disorder Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed. Michael Patrick Adams, Leland Norman Holland, Jr., and Paula Manuel Bostwick Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed. Michael Patrick Adams, Leland Norman Holland, Jr., and Paula Manuel Bostwick Copyright ©2008 by Pearson Education, Inc. Phobias Post-traumatic stress Generalized anxiety Obsessive-compulsive feelings Panic disorders Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed. Michael Patrick Adams, Leland Norman Holland, Jr., and Paula Manuel Bostwick Copyright ©2008 by Pearson Education, Inc. Copyright ©2008 by Pearson Education, Inc. Nonpharmacologic Therapies to Cope with Anxiety Common Causes of Anxiety • • • • • Copyright ©2008 by Pearson Education, Inc. • • • • Cognitive behavioral therapy Counseling Biofeedback techniques Meditation Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed. Michael Patrick Adams, Leland Norman Holland, Jr., and Paula Manuel Bostwick Copyright ©2008 by Pearson Education, Inc. Nonpharmacologic Therapies to Cope with Anxiety May Help To • Change the way one thinks • Eliminate the cause of anxiety Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed. Michael Patrick Adams, Leland Norman Holland, Jr., and Paula Manuel Bostwick • Located in middle of brain • Responsible for emotional responses, learning, memory • Signals pass to hypothalamus Copyright ©2008 by Pearson Education, Inc. Hypothalamus – Responsible for unconscious responses – Connects with reticular formation Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed. Michael Patrick Adams, Leland Norman Holland, Jr., and Paula Manuel Bostwick Copyright ©2008 by Pearson Education, Inc. Reticular Activating System (RAS) • Projects from brainstem to thalamus • Responsible for sleeping and wakefulness • Signals from hypothalamus to higher brain centers Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed. Michael Patrick Adams, Leland Norman Holland, Jr., and Paula Manuel Bostwick Limbic System Copyright ©2008 by Pearson Education, Inc. Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed. Michael Patrick Adams, Leland Norman Holland, Jr., and Paula Manuel Bostwick Copyright ©2008 by Pearson Education, Inc. Reticular Formation • Network of neurons along length of brainstem • Stimulation causes heightened awareness and arousal • Inhibition causes general drowsiness and sleep Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed. Michael Patrick Adams, Leland Norman Holland, Jr., and Paula Manuel Bostwick Copyright ©2008 by Pearson Education, Inc. Classes of Medications Used to Treat Anxiety and Sleep Disorders • Antidepressants • Benzodiazepines • Barbiturates Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed. Michael Patrick Adams, Leland Norman Holland, Jr., and Paula Manuel Bostwick Copyright ©2008 by Pearson Education, Inc. Antidepressants • Reduce panic, obsessive-compulsive behavior, and phobia symptoms Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed. Michael Patrick Adams, Leland Norman Holland, Jr., and Paula Manuel Bostwick Copyright ©2008 by Pearson Education, Inc. Barbiturates • Low doses reduce anxiety • Moderate doses promote sleep Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed. Michael Patrick Adams, Leland Norman Holland, Jr., and Paula Manuel Bostwick Copyright ©2008 by Pearson Education, Inc. Assess Client’s Need for Antianxiety or Insomnia Drugs • • • • Assess intensity and duration of symptoms Identify precipitating factors Identify coping mechanisms Assess for sleep disorder Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed. Michael Patrick Adams, Leland Norman Holland, Jr., and Paula Manuel Bostwick Copyright ©2008 by Pearson Education, Inc. Benzodiazepines • Some treat short-term insomnia • Others treat generalized anxiety disorders Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed. Michael Patrick Adams, Leland Norman Holland, Jr., and Paula Manuel Bostwick Copyright ©2008 by Pearson Education, Inc. Monitor Client’s Condition and Provide Education • Obtain vital signs, medical and drug history • Discuss lifestyle and dietary habits • What precipitated the feelings of anxiety? Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed. Michael Patrick Adams, Leland Norman Holland, Jr., and Paula Manuel Bostwick Copyright ©2008 by Pearson Education, Inc. Obtain Drug History • Hypersensitivity • Use of alcohol and other CNS depressants • Drug abuse and dependence Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed. Michael Patrick Adams, Leland Norman Holland, Jr., and Paula Manuel Bostwick Copyright ©2008 by Pearson Education, Inc. Use Cautiously for Certain Clients • Those who are elderly • Those with suicidal potential • Those with impaired renal or liver function Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed. Michael Patrick Adams, Leland Norman Holland, Jr., and Paula Manuel Bostwick Copyright ©2008 by Pearson Education, Inc. Normal Sleep Patterns Involve NREM and REM • • • • Occur every 90 minutes NREM sleep—four stages REM sleep follows NREM sleep During REM sleep, dreaming occurs Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed. Michael Patrick Adams, Leland Norman Holland, Jr., and Paula Manuel Bostwick Copyright ©2008 by Pearson Education, Inc. Benzodiazepines Bind To GABA ReceptorChloride Channel Molecule • Intensify effects of GABA • Examples: Xanax, Librium, Tranxene Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed. Michael Patrick Adams, Leland Norman Holland, Jr., and Paula Manuel Bostwick Copyright ©2008 by Pearson Education, Inc. Benzodiazepine and Nonbenzodiazepine • Assess for common side effects of CNS depression • Assess neurological status, level of consciousness • Monitor vital signs, observe respiratory patterns particularly during sleep • Monitor patient’s intake of stimulants, such as caffeine and nicotine • Monitor affect and emotional status Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed. Michael Patrick Adams, Leland Norman Holland, Jr., and Paula Manuel Bostwick Copyright ©2008 by Pearson Education, Inc. Stress Causes Mind to Be Too Active • Interrupts normal sleep patterns Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed. Michael Patrick Adams, Leland Norman Holland, Jr., and Paula Manuel Bostwick Copyright ©2008 by Pearson Education, Inc. Barbiturates Bind to GABA ReceptorChloride Channel Molecule • Intensifies effect of GABA in brain • Examples: Nembutal, Seconal, Amytal Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed. Michael Patrick Adams, Leland Norman Holland, Jr., and Paula Manuel Bostwick Copyright ©2008 by Pearson Education, Inc. Nonbenzodiazepines, nonbarbiturates (CNS depressants) • Mechanism of action: binds to GABA receptor Benzodiazepines • Prototype drug: lorazepam (Ativan) • Mechanism of action: binds to GABA – Preserves sleep stages III and IV – Offers minor effects of REM sleep • Examples: Buspar, Noctec, Placidyl receptor-chloride channel molecule, which intensifies GABA effects • Primary use: for anxiety disorders and insomnia • Adverse effects: drowsiness, dizziness, respiratory depression Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed. Michael Patrick Adams, Leland Norman Holland, Jr., and Paula Manuel Bostwick Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed. Michael Patrick Adams, Leland Norman Holland, Jr., and Paula Manuel Bostwick Copyright ©2008 by Pearson Education, Inc. Nonbenzodiazepines, Nonbarbiturate (CNS depressant) Barbiturates • Prototype drug: diazepam (Valium) • Mechanism of action: – Binds with GABA receptor-chloride channel molecules, intensifying effects of GABA – Inhibits brain impulses from passing through limbic and reticular activating systems • Prototype: zolpidem (Ambien) • Mechanism of action: binds to GABA receptors • Primary use: as hypnotic • Adverse effects: mild nausea, dizziness, • Primary use: as sedative and hypnotic • Adverse effects: tolerance, respiratory diarrhea, daytime drowsiness, amnesia, sleepwalking, ingesting carbohydrates while sleepwalking depression, psychological and physical dependence Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed. Michael Patrick Adams, Leland Norman Holland, Jr., and Paula Manuel Bostwick Copyright ©2008 by Pearson Education, Inc. Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed. Michael Patrick Adams, Leland Norman Holland, Jr., and Paula Manuel Bostwick Copyright ©2008 by Pearson Education, Inc. Zolpidem Animation Copyright ©2008 by Pearson Education, Inc. Drugs for Anxiety and Insomnia • • • • • Assessment Potential nursing diagnoses Reason for drug Monitoring vital signs Cautions and contraindications Click here to view an animation on the topic of zolpidem. Back to Directory Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed. Michael Patrick Adams, Leland Norman Holland, Jr., and Paula Manuel Bostwick Copyright ©2008 by Pearson Education, Inc. Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed. Michael Patrick Adams, Leland Norman Holland, Jr., and Paula Manuel Bostwick Copyright ©2008 by Pearson Education, Inc. Drugs for Anxiety and Insomnia (continued) • Possible drug interactions • Nursing Diagnosis – Completing health history – Drug history – Evaluation of lab reports Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed. Michael Patrick Adams, Leland Norman Holland, Jr., and Paula Manuel Bostwick – Risk for injury – Knowledge deficient, related to drug therapy – Ineffective individual coping Copyright ©2008 by Pearson Education, Inc. Drugs for Anxiety and Insomnia – Planning: client will Copyright ©2008 by Pearson Education, Inc. Drugs for Anxiety and Insomnia (continued) • Evaluation – Effectiveness of drug therapy – Evaluate the achievement of goals and expected outcomes Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed. Michael Patrick Adams, Leland Norman Holland, Jr., and Paula Manuel Bostwick Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed. Michael Patrick Adams, Leland Norman Holland, Jr., and Paula Manuel Bostwick Copyright ©2008 by Pearson Education, Inc. Drugs for Anxiety and Insomnia (continued) • Implementation • Exhibit decrease in symptoms of anxiety and insomnia • Demonstrate an understanding of the drug’s activity • Accurately describe drug side effects and precautions • Demonstrate proper administration technique Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed. Michael Patrick Adams, Leland Norman Holland, Jr., and Paula Manuel Bostwick Drugs for Anxiety and Insomnia (continued) Copyright ©2008 by Pearson Education, Inc. – Interventions and rationales – Administration of drug – Observing for adverse effects – Client education and discharge planning Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed. Michael Patrick Adams, Leland Norman Holland, Jr., and Paula Manuel Bostwick Copyright ©2008 by Pearson Education, Inc. Antidepressants for treatment of panic disorders Table 14.2 Antidepressants Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed. Michael Patrick Adams, Leland Norman Holland, Jr., and Paula Manuel Bostwick Copyright ©2008 by Pearson Education, Inc. Antidepressants as anxiolytics Table 14.3 Antidepressants as Anxiolytics Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed. Michael Patrick Adams, Leland Norman Holland, Jr., and Paula Manuel Bostwick Copyright ©2008 by Pearson Education, Inc. Barbiturates for sedation and insomnia Table 14.5 Barbiturates Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed. Michael Patrick Adams, Leland Norman Holland, Jr., and Paula Manuel Bostwick Table 14.4 Benzodiazepines for Anxiety Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed. Michael Patrick Adams, Leland Norman Holland, Jr., and Paula Manuel Bostwick Copyright ©2008 by Pearson Education, Inc. Miscellaneous drugs for anxiety and insomnia Table 14.6 Miscellaneous Drugs Copyright ©2008 by Pearson Education, Inc. Miscellaneous drugs for anxiety and insomnia Table 14.6b Miscellaneous Drugs Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed. Michael Patrick Adams, Leland Norman Holland, Jr., and Paula Manuel Bostwick Benzodiazepines for anxiety and insomnia Copyright ©2008 by Pearson Education, Inc. Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed. Michael Patrick Adams, Leland Norman Holland, Jr., and Paula Manuel Bostwick Copyright ©2008 by Pearson Education, Inc.
