Overview
This lecture reviews medication therapy for anxiety, covering major drug classes, mechanisms of action, side effects, and essential nursing considerations.
Anxiety Disorder Background
- Anxiety disorders are common mental health conditions affecting millions globally.
- Effective treatment often involves medications that modulate neurotransmitter activity to restore emotional balance.
- Understanding medication mechanisms and nursing implications ensures safe administration and proper patient education.
Benzodiazepines
- Benzodiazepines are central nervous system (CNS) depressants providing rapid relief from anxiety.
- Common examples: diazepam, alprazolam (look for "-pam" or "-lam" endings).
- Enhance GABA (gamma-aminobutyric acid), the brain's main inhibitory neurotransmitter, causing calming effects.
- Used for acute anxiety, panic attacks, insomnia, muscle spasms, and seizure control.
- Risks: sedation, dizziness, impaired coordination, memory issues, high dependence potential, withdrawal symptoms.
- Combining with alcohol or other CNS depressants can cause respiratory depression.
- Nurses must monitor for sedation and fall risk, especially in elderly; educate on dependence and gradual tapering.
Non-Benzodiazepines
- Non-benzodiazepines, such as buspirone, are safer alternatives for long-term anxiety management.
- Act on serotonin and dopamine receptors without causing sedation or dependence.
- No significant cognitive impairment, dependence, or withdrawal risk.
- Drawback: delayed onset (2–4 weeks) make them unsuitable for acute anxiety.
- Must be taken consistently (not as-needed); patients should be educated on adherence and delayed effect.
Serotonin Reuptake Inhibitors (SRIs)
- SRIs are used for long-term anxiety management; include SSRIs (e.g., fluoxetine) and SNRIs (e.g., venlafaxine).
- Increase serotonin levels to stabilize mood and lower anxiety.
- SNRIs also increase norepinephrine, aiding focus and energy.
- Chosen based on patient symptoms (e.g., SSRIs for anxiety alone, SNRIs if low focus/energy present).
- Lower dependence risk than benzodiazepines.
- Side effects: nausea, weight gain, sexual dysfunction, sleep disturbances, and risk of serotonin syndrome.
- Serotonin syndrome signs: agitation, confusion, sweating, tremors, hyperreflexia.
- Require 4–6 weeks for full effect; educate patients on adherence and that side effects often improve.
Key Terms & Definitions
- GABA (Gamma-Aminobutyric Acid) — main inhibitory neurotransmitter in the brain.
- SSRIs (Selective Serotonin Reuptake Inhibitors) — increase serotonin by blocking reuptake.
- SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors) — increase both serotonin and norepinephrine.
- Serotonin Syndrome — dangerous excess of serotonin causing agitation, confusion, tremors, and more.
- Dependence — the risk of addiction or withdrawal from certain medications.
Action Items / Next Steps
- Review textbook: Focus on Nursing Pharmacology, page 343 (anxiolytics overview), page 346 (drug dosage/indications), page 351 (barbiturates).
- Study summary tables for drug classes, dosages, and special considerations.
- Review signs and management of serotonin syndrome.