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Drugs for Anxiety and Insomnia

Drugs for Anxiety and Insomnia. Factors that Contribute to Anxiety. Stressful environment events Abnormal fear of a specific situation or object Reexperiencing a traumatic life event. Nonpharmacological Therapies to Cope with Anxiety. Behavioral therapy Biofeedback techniques Meditation.

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Drugs for Anxiety and Insomnia

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  1. Drugs for Anxiety and Insomnia

  2. Factors that Contribute to Anxiety • Stressful environment events • Abnormal fear of a specific situation or object • Reexperiencing a traumatic life event

  3. Nonpharmacological Therapies to Cope with Anxiety • Behavioral therapy • Biofeedback techniques • Meditation

  4. CNS Agents Used to Treat Anxiety and Sleep Disorders • Antidepressants • Benzodiazepines • Barbiturates • Nonbarbiturates and nonbenzodiazepines

  5. Three Types of Antidepressants • Selective serotonin-reuptake inhibitors (SSRIs) • Tricyclic antidepressants (TCAs) • Monoamine oxidase inhibitors (MAOIs)

  6. Benzodiazepines • Short-term treatment of anxiety and sleep disorders • Excessive amounts do not produce • Respiratory depression • Coma

  7. Barbiturates - Schedule II Drugs • Rarely used for anxiety or sleep disorders • Significant side effects • High risk of psychological and physiological dependence

  8. Nonbenzodiazepines and Nonbarbiturates • Anxiety disorders • Antiseizure medication - valproate (Depakote) • CNS depressant - buspirone (Buspar) • Beta blockers - atenolol (Inderal), propanolol (Tenormin) • Insomnia • Nonbenzodiazepine CNS depressants - zalepon (Sonata), zolpidem (Ambien) • Antihistamines - diphenhydramine (Benadryl), hydroxyzine (Vistaril)

  9. CNS Depressants • Slow neuronal activity in the brain • Low doses cause relaxation to sedation • High doses cause sleep to anesthesia

  10. Antidepressants • Tricyclic antidepressants - TCAs • Amitriptyline (Elavil) - depression • Imipramine (Tofranil) - depression, generalized anxiety • Monoamine oxidase inhibitors - MAOIs • Phenelzine (Nardil) - social anxiety, depression • Tranylcypromine (Parnate) - depression

  11. Antidepressants (cont’d) • Selective serotonin reuptake inhibitors - SSRIs • Fluoxetine (Prozac) - depression, panic, social anxiety • Paroxetine (Paxil) - depression, panic, social anxiety • Atypical antidepressants • Trazodone (Desyrel) - depression, generalized anxiety • Venlafaxine (Effexor) - depression, social anxiety, generalized anxiety

  12. Benzodiazepines • Panic disorders • Alprazolam (Xanax) - generalized anxiety, phobias, social anxiety • Anxiety • Diazepam (Valium) - panic • Oxazepam (Serax) - phobias • Insomnia • Estazolam (Prosom) • Flurazepam (Dalmane) • Triazolam (Halcion)

  13. Barbiturates for Sedation and Insomnia • Short acting • Pentobarbital sodium (Nembutal) • Secobarbital (Seconal) • Intermediate acting • Amobarbital (Amytal) • Butabarbital sodium (Butisol) • Long acting • Mephobarbital (Mebaral) • Phenobarbital (Luminal)

  14. Nonbenzodiazepines, Nonbarbiturates, CNS Depressants • Antiseizure medication • Valproate (Depakote) - panic • CNS depressants (mild tranquilizers) • Buspirone (BuSpar) - generalized anxiety, OCD • Beta blockers • Atenolol (Tenormin) - performance anxiety, social anxiety • Nonbenzodiazepines • Zaleplon (Sonata) - insomnia • Zolpidem (Ambien)

  15. Drugs for Emotional and Mood Disorders

  16. Categories of Mood Disorders • Depression • Bipolar disorder

  17. Antidepressants Combat Depression • Enhance mood • Boost neurotransmitters • Norepinephrine • Serotonin • Four primary classes • Tricyclic antidepressants (TCAs) • Selective serotonin reuptake inhibitors (SSRIs) • Monoamine oxidase inhibitors (MAOIs) • Atypical antidepressants

  18. Several Drugs May Be Used to Manage Bipolar Disorder • Mood stabilizers to manage manic phase • Some antiseizure drugs to stabilize mood • TCAs and atypical antidepressants used during depressive stage • Benzodiazepines during manic phase to moderate manic symptoms • Antipsychotic agents used for extreme agitation, delusions, or hallucinations

  19. To Manage Attention Deficit-Hyperactivity Disorder (ADHD) • CNS stimulants are drug of choice • Non-CNS stimulants less effective • Atypical antidepressants and TCAs • Second choice drugs • When CNS stimulants fail • When CNS stimulants are contraindicated

  20. Symptoms of ADHD • Easy distractability • Failure to receive or follow instructions properly • Inability to focus on one task at a time and tendency to jump from one activity to another • Difficulty remembering

  21. Symptoms of ADHD (cont’d) • Frequent loss or misplacing of personal items • Excessive talking and interrupting other children in a group • Inability to sit still when asked repeatedly • Impulsiveness • Sleep disturbances

  22. Atypical Antidepressants • Action - inhibit the reuptake of serotonin and affect the activity of norepinephrine and dopamine • Primary use - depression • Examples • Bupropion (Wellbutrin) • Nefazodone (Serzone)

  23. CNS Stimulants - Schedule II Controlled Substance • Action - stimulate specific areas of CNS that heighten awareness and increase focus • Primary use - ADHA • Adverse effects • Insomnia • Nervousness anorexia • Weight loss • Examples • Methylphenidate (Ritalin) • Pemoline (Cykert)

  24. Nonstimulants • Action - inhibit reuptake of norepinephrine • Primary use - ADHD • Adverse effects • Headache • Insomnia • Upper abdominal pain • Decreased appetite • Cough • Example - atomoxetine (Strattera)

  25. Drugs for Psychoses and Degenerative Diseases of the Nervous System

  26. Imbalance of Neurotransmitters in Specific Areas of the Brain • Too much dopamine produced • Stimulates dopamine type 2 (D2) receptors on the postsynaptic neurons

  27. Parkinsonism Symptoms • Tremor • Muscle rigidity • Stooped posture • Shuffling gait

  28. Most Common Degenerative Diseases of the CNS • Alzheimer’s disease • Amyotrophic lateral sclerosis (ALS) • Huntington’s chorea • Multiple sclerosis (MS) • Parkinson’s disease

  29. Parkinson’s Disease Pharmacological Management • Agents do not cure the disease • Increase ability to perform normal daily activities • Reduce symptoms of the disease • Know the side effects of the agents

  30. Alzheimer’s Disease Pharmacological Management • Do not cure the disease • Slow progression of disease in mild to moderate stages (not severe stage) • Limited effectiveness in improving • Functions in activities of daily living • Behavior • Cognition • Know the side effects of the different agents

  31. Multiple Sclerosis Pharmacological Management • Do not cure the disease • Reduce inflammation during exacerbations • Prevent attacks on the nervous system • Relieve symptoms • Know the side effects of different agents

  32. Drugs for Parkinson’s Disease • Dopaminergic agents • Example - levodopa (Larodopa) • Action - increase dopamine levels in the corpus striatum • Primary use - Parkinson’s disease • Adverse effects - involuntary movements, headache, insomnia, nausea, vomiting, orthostatic hypotension

  33. Drugs for Parkinson’s Disease (cont’d) • Anticholinergics • Example - benzotropine (Cogentin) • Action - acts on CNS • Primary use - Parkinson’s disease • Adverse effects - dry mouth, blurred vision, tachycardia, urinary retention, constipation

  34. Drugs for Alzheimer’s Disease • Acetylcholinesterase inhibitors • Example - donepezil (Aricept) • Action - inhibits acetylcholinesterase which intensifies effects of acetylcholine at cholinergic receptors in order to improve function in activities of daily living, behavior, cognition • Primary use - early stages of Alzheimer's disease • Adverse effects - nausea, vomiting, diarrhea

  35. Drugs for Multiple Sclerosis • Immunostimulants • Example - interforon beta la (Avonex) • Action - decrease overall relapse rate • Primary use - RRMS • Adverse effects - redness, pain, swelling, itching or lump at injection site, joint pain, muscle aches

  36. Drugs for Multiple Sclerosis (cont’d) • Miscellaneous drugs for symptoms • Modafinil (Provigil) and amantadine (Symmeterel) - fatigue, memory loss, progressive weakness • Gabapentin (Neurontin) - depression, sensitivity to pain • Methylprednisolone (Solu-Medrol) - acute inflammation of CNS

  37. Drugs for Pain Control

  38. Successful Pain Management Depends on • Accurate assessment of pain experienced • Potential disorders causing the pain • Selecting the correct therapy

  39. Endogenous Opioids Are Neurotransmitters Released by Descending Neurons • Examples - endorphins, dynorphins, enkephalins • Block the release of substance P in the spinal cord • Pain impulses do not reach the brain

  40. Acute Opioid Intoxication • Medical emergency • Respiratory depression

  41. Naloxone (Narcan) - Opioid Antagonist - Reverses Respiratory Depression and Other Acute Symptoms

  42. Opioid (Narcotic) Analgesics for Pain Management • Opioid agonists • Example - morphine • Mechanisms of action - bind to both mu and kappa receptors and produce analgesia, decrease GI motility, euphoria, miosis, sedation • Primary uses - treat severe pain • Adverse reactions - respiratory depression, sedation, nausea and vomiting, and physical and psychological dependence

  43. Opioid (Narcotic) Analgesics for Pain Management (cont’d) • Opioid antagonists • Example - naloxone (Narcan) • Mechanisms of action - inhibit both mu and kappa receptors preventing the effects of opioid agonists • Primary uses - opioid overdose, opioid depression • Adverse effect - drowsiness

  44. Opioid (Narcotic) Analgesics for Pain Management (cont’d) • Opioids with mixed agonist-antagonist activity • Example - pentazocine (Talwin) • Mechanisms of action - activate kappa receptors and block mu receptors to produce analgesia, decrease GI motility, miosis, sedation • Primary uses - treat moderate to severe pain • Adverse effects - less intense than opioid agonists

  45. Nonopioid Analgesics • Nonsteroidal anti-inflammatory drugs (NSAIDs) • Examples - aspirin and other salicylates, ibuprofen and ibuprofen-like drugs, selective COX-2 inhibitors • Mechanisms of action - aspirin and ibuprofen inhibit both COX-1 and COX-2 enzymes which inhibit prostaglandins which inhibit pain and inflammation; selective COX-2 inhibit only COX-2 enzyme, which produces the prostaglandins that cause pain and inflammation • Primary uses - treat mild to moderate pain, inflammation, fever • Adverse effects - GI irritation and bleeding

  46. Nonopioid Analgesics (cont’d) • Acetaminophen • Example - acetaminophen (Tylenol) • Mechanisms of action - inhibit prostaglandin production, then block transmission of pain impulse peripherally, inhibits prostaglandins in hypothalamus • Primary uses - treat mild to moderate pain and fever • Adverse effects - very few with recommended doses

  47. Nonopioid Analgesics (cont’d) • Centrally acting drugs • Examples - clonidine (Catapres), tramadol (Ultram) • Mechanisms of action - prevents transmission of pain impulses in the spinal cord • Primary uses - management of pain • Adverse effects - drowsiness, hypotension, nausea

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