Antianxiety drug

The antianxiety dragp are discussed in this chapter. Antidepressant dragp and antipsychotic drugs are discussed in Chapters 31 and 32, respectively. 

Antianxiety drugp include the benzodiazepines and the nonbenzodiazepines. Examples of the benzodiazepines 

Antianxiety drugp are used in the management of anxiety disorders and short-term treatment of the symptoms of anxiety. Long-term use of these dru is usually not recommended because prolonged therapy can result in drug dependence and serious withdrawal symptoms. 

Some of these drugp may have additional uses as sedatives, muscle relaxants, anticonvulsants, and in the treatment of alcohol withdrawal. For example, clo-razepate (Tranxene) and diazepam (Valium) are used as anticonvulsants (see Chap. 28). Additional uses of the individual antianxiety drugp are given in the Summary Drug Table Antianxiety Drugp. 

SUM MARY DRUG TABLE ANTI ANXIETY DRUGS 

By definition, a psychotherapeutic drug or a psychotropic drug is one tliat is used to treat disorders of die inind. The tyi es of psycliotlierapeutic drugs used to treat mental ilhiess include  

Anxiety is a feeling of apprehension, worry, or uneasiness that may or may not be based on reality. Anxiety may be seen in many types of situations, ranging from the anxiety that may accompany one s employment to tiie acute anxiety that may be seen during withdrawal from alcohol. Although a certain amount of anxiety is normal, excess anxiety interferes with day-to-day functioning and can cause undue stress in the lives of certain individuals. Dru used to treat anxiety are called anti anxiety drugs. Anotiier term tiiat refers to the antianxiety dru is anxiolytics. 

The mechanism of action of the benzodiazepines was discussed previously in this chapter. The antianxiety properties of these drugs involve a mechanism similar or identical to their sedative-hypnotic effects (i.e., potentiating GABAergic transmission).37 Benzo- 

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Tranquilizers (also called antianxiety drugs) are used to treat a variety of psychiatric disorders which go along with anxiety (anxiety disorders). Serotonin-reuptake inhibitors and the benzodiazepines are the most commonly employed drugs for the treatment of common clinical anxiety disorders. 

The exact mode of action of diazepam (Valium), an antianxiety drug (see Chap. 30), in die relief of painful musculoskeletal conditions is unknown. The drug does have a sedative action, which may account for some of its ability to relieve muscle spasm and pain. 

Although the use of barbiturates and miscellaneous sedatives and hypnotics for sedation has largely been replaced by the antianxiety drugs (see Chap. 30), they occasionally may be used to provide sedation before certain types of procedures such as cardiac catheterization or the administration of a local or general anesthesia Sedative doses usually given during daytime hours, may be used to treat anxiety and apprehension. Fhtients with chronic disease may require sedation, not only to reduce anxiety, but also as an adjunct in the treatment of their disease... 

Discuss important preadministration and ongoing assessment activities the nurse should perform on the patient taking antianxiety drugs. 

Discuss ways to promote an optimal response to therapy, how to mange common adverse reactions, and important points to keep in mind when educating patients about the use of antianxiety drugs. 

Discuss the uses, general drug actions, general adverse reactions, contraindications, precautions, and interactions associated with the administration of the antianxiety drugs. 

When discontinuing use of an antianxiety drug in patients who have used these drugs for prolonged periods , the physician will prescribe a decrease of dosage gradually for a period of 4 to 8 weeks to avoid the possbility of withdrawal symptoms. 

Some antianxiety drug, such as buspirone (BuSpar), seem to have less abuse potential and less effect on motor ability and cognition than that of Hie other anfianxiety drug. 

The antianxiety drug s are contraindicated in patients with known hypersensitivity, psychoses, acute narrow-angle glaucoma, and shock. These drugp are also contraindicated in patients in a coma or with acute alcoholic intoxication with depression of vital signs. 

Buspirone causes less additive CNS depression than do the other antianxiety drugs. However, it is recommended that concurrent use with a CNS depressant be avoided. Buspirone may increase serum digoxin levels, which increases the risk of digitalis toxicity. 

A patient receiving an antianxiety drug may be treated in the hospital or in an outpatient setting. Before starting therapy for the hospitalized patient, the nurse obtains a complete medical history, including mental status and anxiety level. In the case of mild anxiety, patients may (but sometimes may not) give a reliable history of their illness. 

In addition, if possible, die nurse obtains a history of any past drug or alcohol abuse. Individuals with a history of previous abuse are more likely to abuse odier drug s, such as the antianxiety drug s. Some patients, such as diose with mild anxiety or depression, do not necessarily require inpatient care. These patients are usually seen at periodic intervals in die primary health care provider s office or in a psychiatric outpatient setting. The preadministration assessments of the outpatient are the same as diose for the hospitalized patient. 

The patient is monitored for adverse reactions. The sedation and drowsiness that sometimes occur with the use of an antianxiety drug may decrease as therapy continues. Prolonged tiierapy (> 3-4 months) may lead to dependence. 

Benzodiazepine withdrawal may occur when use of the antianxiety drugs is abruptly discontinued after 3 to 4 months of therapy. Occasionally, withdrawal symptoms may occur after as little as 4 to 6 weeks of therapy. Symptoms of benzodiazepine withdrawal include increased anxiety, concentration difficultiesi, tremor, and sensory disturbances, such as paresthesias photophobia, hypersomnia, and metallic taste. To help prevent withdrawal symptoms, the nurse must make sure the dosage of the benzodiazepine is gradually decreased over a period of time, usually 4 to 6 weeks... 

Educating the Patient and Family The nurse evaluates the patient s ability to assume responsibility for taking drug at home. The nurse explains any adverse reactions that may occur with a specific antianxiety drug and encourages die patient or family members to contact the primary health care provider immediately if a serious drug reaction occurs. 

Which antianxiety drug must be taken regjularly and is not effective on a PRN basis ... 

Narcotic or antianxiety drug—to decrease anxiety and apprehension immediately before surgery. The patient who is calm and relaxed can be anesthetized more quickly, usually requires a smaller dose of an induction drug, may require less anesthesia during surgery, and may have a smoother anesthesia recovery period (awakening from anesthesia). 

Preanesthetic drugs may be omitted in those 60 years or older because many of the medical disorders for which these drugsare contraindicated are seen in older individuals For example, atropine and glycopyrrolate, drugs that can be used to decrease secretions of the upper respiratory tract, are contraindicated in certain medical disorders such as prostatic hypertrophy, glaucoma, and myocardial ischemia. Other preanesthetic drugs that depress the central nervous astern (CN, such as narcotics barbiturates and antianxiety drugs with or without antiemetic properties may be contraindicated in the older individual. 

The preanesthetic drug is usually selected by the anesthesiologist and may consist of one or more drug (Table 35-2). A narcotic (see Chap. 19), antianxiety drug (see Chap. 30), or barbiturate (see Chap. 26) may be given to... 

Section B shows some Hofmann rearrangements. Entry 9, using basic conditions with bromine, provided an inexpensive route to an intermediate for a commercial synthesis of an herbicide. Entry 10, which uses the Pb(OAc)4 conditions (see p. 949), was utilized in an enantiospecific synthesis of the naturally occurring analagesic (-)-epibatidine. Entry 11 uses phenyliodonium diacetate as the reagent. The product is the result of cyclization of the intermediate isocyanate and was used in an enantioselective synthesis of the antianxiety drug (tf)-fluoxetine. 

Similarly, it is apparent that chlorpromazine does not prevent the LSD sequence of effects and, when given during the LSD experience, may mask perception of some of the changes but not the course of the march of events. Indeed, because of the effects of chlorpromazine per se, most clinicians treating bad trips have learned, if medications are to be used, to employ sedative antianxiety drugs, such as valium. Animal experiments tell us that remarkably small doses of chlorpromazine can be strikingly effective in blocking the effects of LSD on fixed ratio performance (30 Mg/kg), and there was some early hint that less of a 5-HT elevation occurred with chlorpromazine pretreatment in rat brain (22). 

C. Prakash, V. Soliman, Metabolism and Excretion of a Novel Antianxiety Drug Candidate, CP-93,393, in Long Evans Rats , Drug Metab. Dispos. 1997, 25, 1288-1297. 

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