Medication antianxiety

Problem 6.3 Diazepam, marketed as an antianxiety medication under the name Valium, has three rings, eight double bonds, and the formula C]6H/CIN20. How many hydrogens does diazepam have (Calculate the answer don t count hydrogens in the structure.)... 

Patients with GAD may be managed with psychotherapy, pharmacotherapy, or both. The treatment plan should be individualized based on the patients symptom severity, comordid illnesses, medical status, age, and preference. Patients with severe symptoms resulting in functional impairment should receive antianxiety medication. 

Reich, M.R., Ohad, D.G., Overall, K.L. and Dunham, A.E. (2000) Electrocardiographic assessment of antianxiety medication in dogs and correlation with serum drug concentration [published erratum appears in Journal of American Veterinary Medical Association 2000 216 (12) 1936[. Journal of the American Veterinary Medical Association, 216, 1571-1575. 

There are three reports (Hsu and Starzinsi, 1986 Woolston, 1999 Craven and Murphy, 2000) on a total of six bipolar adolescents treated with CBZ—three with acute mania, two of whom responded (Hsu and Starzinski, 1986). As in studies of adults, antipsychotic and/or antianxiety medications were frequently used adjunctively in subjects of these reports. Gabapentin, topiramate, and lamotrigine have been minimally studied for the treatment of acute mania in youth. Davanzo and McCracken review these limited data in Chapter 25 in this volume. 

Buspirone is a relatively new antianxiety medication that acts as an agonist of d-HTi receptors. A number of open trials of buspirone in children and adolescents have shown significant improvements in anxiety and... 

Treatment of GAD can be undertaken using a number of pharmacological agents. Benzodiazepines have been found to be superior to placebo in several studies and all benzodiazepines appear to be equally effective. However, side effects include sedation, psvchomotor impairment, amnesia and tolerance (Chapter 1). Recent clinical data indicate that SSRIs and SNRIs are effective in the treatment of acute GAD symptoms. Venlafaxine, paroxetine and imipramine have been shown to be effective antianxiety medications in placebo-controlled studies. Case studies also indicate the usefulness of clomipramine, nefazodone, mirtazapine, fluoxetine and fluvoxamine in GAD. Buspirone, a 5-HTla receptor partial agonist, has been shown to be effective in several placebo-controlled, double-blind trials (Roy-Byme and Cowley, 2002). Buspirone has a later onset of action than both benzodiazepines and SSRIs but with the advantage of being non-addictive and non-sedating. 

Meprobamate was developed early in the history of antianxiety medication (1954). Its addictive potential led to experimentation with other types of compounds. 

The sedative-hypnotics, which include all prescription sleep medications and nearly all antianxiety medications, are sometimes prescribed for other conditions, such as preventing or alleviating epileptic seizures. Ben-... 

GABA (gamma- aminobutyric acid) Inhibitory. Secreted by neurons in the cerebral cortex, subcortical area, and spinal cord. Anxiety states, also involved in chemical dependency. Diffusely affected by many medications. Many antianxiety medications work on GABA receptor sites, especially in the frontal lobe of the brain. Alcohol, benzodiazepines, and barbiturates all affect GABA receptors, as do other drugs. 

Benzodiazepines, which have a GABA-enhancing effect, have long been the standard treatment for GAD, bnt as discussed earlier, there are the problems of side effects and addictive potential. An antianxiety medication, bnspirone, has been effective in some studies and is FDA-approved for the treatment of GAD (but not for other anxiety disorders snch as... 

As with any other endeavor, learning to cope with stress takes some effort and your capabilities will increase with practice. The coping suggestions that I ll give you in the balance of this chapter can have a very real, physical effect on your brain and your emotional status. And they can help you to control your blood pressure, just as surely as prescription antianxiety medications can. Both... 

Typical memory loss secondary to cancer treatment is short term and is usually attributable to pretreatment antianxiety medications. Based on these reports, you feel confident in moving ahead with therapy and exploring Patricia s anxiety and memory loss from a nonorganic focus. 

The atypical antianxiety medication buspirone has been used with some success with GAD patients. This medication offers the benefits of reduced rumination and worry, but without the problems of sedation and potential drug dependence seen with benzodiazepines. Buspirone is not addictive and thus provides a treatment option for GAD patients with substance abuse risk. 

Treatment with antianxiety medications (benzodiazepines) is risky with borderline patients. These patients are certainly at risk for tranquilizer abuse. In addition, clinical experience, as well as research, shows that benzodiazepines can contribute to emotional dyscontrol and increased suicidality with borderline patients (Cowdry and Gardner 1988). 

Other substances of abuse—including caffeine, cannabis, inhalants, and nicotine—are not covered here since they are less important clinically. Caffeine intoxication can lead to anxiety or confusion. Inhalants can cause an organic psychosis and are very neurotoxic—leading to permanent neurological deficit. Nicotine dependence can be treated with a nicotine gum or patch (in conjundion with cognitive-behavioral treatment). Sedative abuse and dependence is discussed in chapter 16, on antianxiety medications. 

Antianxiety medications, especially benzodiazepines, can provide relief of anxiety regardless of the cause situational stress, hyperthyroidism, or manic excitement (see figure 16-D). Of course, it is crucial to recognize and treat the underlying disorder. The use of benzodiazepines should be avoided until other measures have been tried (such as psychotherapy, relaxation training) or if anxiety is severe. 

Typically, antianxiety medications with short half-lives (see figure 16-A) are more likely to produce withdrawal symptoms (since the medications are more rapidly eliminated from the system). However, clearly, withdrawal can occur with all minor tranquilizers and sedative-hypnotics (with the exception of buspirone and possibly Zolpidem, which are chemical compounds unrelated to the benzodiazepines). 

It may be instructive to describe one of the cases seen by Spector. A 35-year-old woman, called Ms. 0., was presented for treatment three days after smoking AMP. She felt anxious, was tremulous, was salivating excessively and sweating, and had a racing heartbeat. All of this followed closely the actual AMP smoking. Several hours later she exhibited psychomotor retardation, secluded herself, reported she could not think well and lost all motivation, and described paranoid thoughts. Ms. D. also described hallucinations in which she saw blood on the walls. After three days many of these complaints disappeared, with the exception of the anxiety and tremulousness. She was treated with an antianxiety medication, and the discomfort cleared within several days. 

These medications can work quickly to address the anxiety symptoms that frequently lead to panic. These antianxiety medications woric by helping to calm the parts of the brain that have become overly excited in anxious individuals (Dulcan, 1999). Furthermore, using a medication in this category can help in getting the client to agree to psychosocial intervention efforts. 

Assess needs for antianxiety medications and arrange for prescription if needed. 

Anxiety is a symptom of many psychiatric disorders and an almost inevitable component of many medical and surgical conditions. Symptoms of anxiety commonly are associated with depression and especially with dysthymic disorder (chronic depression of moderate severity), panic disorder, agoraphobia and other specific phobias, obsessive-compulsive disorder, eating disorders, and many personality disorders. Sometimes, no treatable primary illness is found, or if one is found and treated, it may be desirable to deal directly with the anxiety at the same time. In such situations, antianxiety medications are frequently and appropriately used. 

The long-term-care facility nurse is caring for a client diagnosed with a cerebrovascular accident (CVA) 6 months ago who has residual cognitive deficits. The HCP has ordered alprazolam (Xanax), an antianxiety medication, to be administered at bedtime. Which intervention should the nurse initiate for this client ... 

An antianxiety medication to control anxiety during treatments. 

The male client diagnosed with a brain tumor tells the clinic nurse that he has been having seizures more frequently. The client is taking the anticonvulsant phenytoin (Dilantin), the narcotic morphine sulfate (Roxanol), the analgesic acetaminophen (Tylenol), and the antianxiety medication alprazolam (Xanax). Which question about the client s medications should the nurse ask next ... 

The therapy sessions take from 5 to 10 minutes and do require the client to lie still, but usually antianxiety medications are not needed. 

Encourage the client to have the HCP prescribe an antianxiety medication. 

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