Psychopharmacology: Anxiolytics,Sedatives and Hypnotics

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ANXIOLYTICS , SEDATIVES & HYPNOTICS
·         Hypnotic :- a drug which produces sleep resembling natural sleep
·         Sedative:- Drug that reduces excitement, calms the patient & is commonly used as an anxiolytic.
·         Sedatives in therapeutic doses are anxiolytic agents
·         Most sedatives in larger doses produce hypnosis.( trans like state in which subject becomes passive and highly suggestible.)   Sedative-Hypnotic both depress the CNS.
·         Hypnotics in higher doses produce General anaesthesia.
Classification
1. Barbiturates
           Long acting :  > 8hrs: Phenobarbitone,Mephobarbitone
           Intermediate acting: 5-8hrs (amobarbital)
  Short acting : 1-5 hrs Butobarbitone,Secobarbitone,Pentobarbitone
           Ultra short acting: < 1hr. Thiopentone,Methohexitone,Hexobarbitone
2.Benzodiazepines
·         Hypnotic: diazepam, flurazepam, nitrazepam, flunitrazepam, temazepam, triazolam, midazolam
·         Antianxiety:Diazepam,Chlordiazepoxide,Oxazepam,Lorazepam,Alprazolam
·         Anticonvulsant:Clonazepam,Clobazam
3.Newer nonbenzodiazepine hypnotics  Zopiclone,Zolpidem
Indications
·         Anxiety disorders
·         Alcohol withdrawal
·         Convulsive disorder
·         Status epileptics
·         Pre operative sedation
·         Insomnia
·         Depression
·         Panic disorder
·         Social phobia
·         OCD
·         PTSD
·         Bipolar I disorder
·         Substance abuse
·         Psychotic agitation
Contra indications
·         Hyper sensitivity
·         Other CNS depressant
·         Pregnancy and lactation
·         Shock and coma
·         Hepatic and renal problem
 Dosage (mg/day)
·         Alprazolam: 0.5-6 PO
·         Oxazepam: 15-120 PO
·         Lorazepam: 2-6 PO/ IV/ 1M
·         Diazepam: 2-10 PO/ 1M/ Slow IV
·         Clonazepam: 0.5-20 PO/ 1M
·         Chlordiazepoxide: 15-100 PO, 50-100 slow IV  
·         Nitrazepam: 5-20 PO
 Action
           Benzodiazepines bind to specific sites on GABA receptors and increase the GABA level.
Since GABA is an inhibitory neuro transmitter, it has a calming effect on central nervous system, thus reducing anxiety.
Nurses role 
·         Monitor for drowsiness, confusion, lethargy, risk for injury, panic anxiety.  
·         Monitor vital signs and for respiratory depression, hypotension
·         Not to drive dangerous machine.      
·         Do not stop taking drug abruptly.
·         Lorazepam and oxazepam are best benzodiazepines for older adults.
·         Paradoxical excitement -client will develop symptoms opposite of the medication desired effect
·         Administer with food to minimize gastric irritation 
·         Advice the patient to take medication exactly as directed
·         Explain about adverse effects and advice him to avoid activities that require alertness   Caution the patient to avoid alcohol or any other CNS depressants along with benzodiazepines
·         Give deep IM if IM administration is preferred

·         For IV administration do not mix with any other drug, give slow IV 

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notes.nursium.com: Psychopharmacology: Anxiolytics,Sedatives and Hypnotics
Psychopharmacology: Anxiolytics,Sedatives and Hypnotics
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