we'll discuss now medication therapy for anxiety uh a little bit of background about the condition um anxiety disorders more than one um are among the most common mental health conditions and they're affecting U Millions worldwide of therefore effective treatment uh will need medication that will modulate the neurotransmitter activity and by doing that will help to reduce the excessive neural excitability and restore the emotional balance now understanding this mechanisms um and the medication involved in the process and their nursing implications is very important for a safe Administration and as well patient education so let's look into the classes into the groups of medications that are um used in uh Medic in treating uh anxiety we'll start with Beno aspin which um if you remember from the beginning of this module they are CNS depressants uh what they do they have um as an end result a rapid relief but they have a risk of dependence um examples of those medications will be diazapam Alprazolam please remember benzo zipin group of uh medications and in M Pam or lamb at the end of the word so how do they work they enhance the effects of the U Gaba um neurotransmitter and um this is the brain's uh primary inhibitory neurotransmitter that is leading to a calming and sedative um type of in effect in terms of um uses primarily um benzo aspin will be prescribed for acute episodes of uh anxiety for panic disorder insomnia muscle spasm and seizure control um there are some risks and side effects associated with them so um they can cause sedation dizziness um impaired coordination and memor issue uh they have a high potential for dependency and they have withdrawal symptoms if you for a long term when combined with alcohol and opioids or other CNS depressants they can cause thep spiratory uh depression so in terms of nursing considerations when we are prescribing benzoins we need to monitor for Sedation and fall risk especially in our elderly patients and we need to educate patients on the risk of dependency and the importance of a gradual tapering when discontinued a second class of medication used for anxiety will will be non benzoin so if we have benodin we have a grou another group of medication that are classified as non benzoin is kind of not belonging to this group uh which is a safer alternative especially for long-term use um if needed in anxiety for example um one of those medication is uh bu spiron and the way that this medication is working is um acting on serotonin and dopamine receptors um and is reducing anxiety without having that um side effect of sedation or uh dependence in terms of benefits it will not going to cause any significant cognitive impairment and they have no risk of physical dependence or withdrawal symptoms uh they seem better right as an option however they have some drawbacks um they have a very delayed um onset of action it takes between two and four weeks um to see a full effect so the patients are taking the medication for at least two weeks before they will see a little bit of uh benefit from the medication this makes it really unsuitable for acute anxiety episode and unfortunately most of our clients will come with those kind of acute anxiety episodes uh in terms of nursing um considerations we need to educate patients that uh buiron is not a PRN medication um they must take it consistently for benefits it's not as needed PRN meeting is needed um but it needs to be consistently taken for benefits they need to reinforce adance despite the um delayed onet um it may take we need to be very clear that it may take between two and four weeks before they will see any um Improvement and the third group of medication that we can use for anxiety are the serotonine reuptake inhibitor um the sris um that are used for long-term anxiety uh Management in this um category we have the selective one selective serotonine reuptake Inhibitors uh you see on the slide sris this is the group that has two subgroups um one of the subgroups is called SSRI uh selective serotonine reuptake Inhibitors um fluox sentin and Calin those are the most common uh medication used um and we have the serotonin nor epinephrine rapake Inhibitors they are um you will see them in literature as SN r i serotonine nor epinephrine retic Inhibitors uh venlafaxin and D oxentine um in terms of how they work they will increase the serotonin levels in the brain and because of that they will stabilize the mood when the mood is stabilized the anxiety is reduced um now I was telling you that we have the selective serotonine Inhibitors and we have the serotonine nor epinephrine now um norepinephrine uh component is uh helping with focus and energy levels uh so we will prescribe the medication depending on what our our patients um uh symptoms are um if they have only elements of anxiety an SSRI will be enough if they do have lack of focus and low levels of energy uh we will prescribe the one that has the component of of nor epinephrine in in them as well in terms of benefits they um have a lower risk of dependence compared to benzo asip pins uh they are effective for generalized um anxiety disorder for panic disorder and social anxiety disorder they do have some side effects however so uh please keep in mind there is no medication um out there that will have only benefits and have will have no side effects so there will be something with pretty much anything that um we are using as medication so a side effects for uh non-bo asip Pines we have nausea weight changes um that usually is uh on the side of weight gain uh sexual dysfunction and sleep disturbances there is a risk of interaction um and that is called the serotonine syndrome risk when combined with monoamine oxidize Inhibitors with thj um John sart and other serotonin drugs only because it's to we end up having having too much serotonin in the same patient for nursing considerations um we need to monitor for serotonine syndrome that uh will be characterized by agitation confusion sweating Tremors hyper reflexia um all those kind of very obvious signs and symptoms we need to educate patients um that um serotonine um reuptake uh Inhibitors will need to be taken for four to 6 weeks so so again this is a medication that has a very late and um slow onset uh it takes up to six weeks for full therapeutic effect and we need to encourage adherance and inform them that side effects often um improve over time as a final thought um if I need to summarize uh benzos fast relief but habit forming bepon the non- benzo slower but safer while sris will be the long-term control but require patience um now if you need more information this can be find in uh can be found in tuer car's focus on nursing pharmacologic book at page uh 343 um if you want to read about um anxiolytics across lifespan how do they work in different um age groups um elderly uh children as opposed to adults um there are some very good summarizing table of most used drugs in each of those uh classes um in table um 20.1 um on page 346 uh it summarizes dosages routes most common usual indication and some special consideration for benzos uh and on page uh 351 for barbiturates