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.
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
· Hypnotic: diazepam, flurazepam, nitrazepam, flunitrazepam, temazepam, triazolam, midazolam
3.Newer nonbenzodiazepine hypnotics Zopiclone,Zolpidem
· Anxiety disorders
· Alcohol withdrawal
· Convulsive disorder
· Status epileptics
· Pre operative sedation
· Panic disorder
· Social phobia
· Bipolar I disorder
· Substance abuse
· Psychotic agitation
· Hyper sensitivity
· Other CNS depressant
· Pregnancy and lactation
· Shock and coma
· Hepatic and renal problem
· 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
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.
· 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