ANXIOLYTICS
, SEDATIVES & HYPNOTICS
·
Hypnotic :- a drug which produces sleep
resembling natural sleep
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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
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Anxiety disorders
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Alcohol withdrawal
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Convulsive disorder
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Status epileptics
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Pre operative sedation
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Insomnia
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Depression
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Panic disorder
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Social phobia
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OCD
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PTSD
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Bipolar I disorder
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Substance abuse
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Psychotic agitation
Contra
indications
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Hyper sensitivity
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Other CNS depressant
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Pregnancy and lactation
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Shock and coma
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Hepatic and renal problem
Dosage (mg/day)
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Alprazolam: 0.5-6 PO
·
Oxazepam: 15-120 PO
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Lorazepam: 2-6 PO/ IV/ 1M
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Diazepam: 2-10 PO/ 1M/ Slow IV
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Clonazepam: 0.5-20 PO/ 1M
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Chlordiazepoxide: 15-100 PO, 50-100 slow IV
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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.
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Monitor vital signs and for respiratory
depression, hypotension
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Not to drive dangerous machine.
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Do not stop taking drug abruptly.
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Lorazepam and oxazepam are best benzodiazepines
for older adults.
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Paradoxical excitement -client will develop
symptoms opposite of the medication desired effect
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Administer with food to minimize gastric
irritation
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Advice the patient to take medication exactly as
directed
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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
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For IV administration do not mix with any other
drug, give slow IV
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