Psychopharmacol

ogy
Anti-Anxiety Drugs
 The ANXIOLYTICS AND
HYPNOTICS
 These drugs are used to change
the individual’s responses to the
environment.
 The ANXIOLYTICS AND
HYPNOTICS
 The medications that can prevent
the feelings of tension and fear are
called ANXIOLYTICS.
 Anti-anxiety drugs
 The ANXIOLYTICS AND
HYPNOTICS
 The drugs that can calm
individuals making them unaware
of the environment are called
SEDATIVES.
 The ANXIOLYTICS AND
HYPNOTICS
 The drugs that can induce sleep
are called HYPNOTICS.
 The ANXIOLYTICS AND
HYPNOTICS
 The drugs in this class are the
 BENZODIAZEPINES
 BARBITURATES
 Use of The Drugs
Clinical indications for the use of the
anxiolytics, sedatives and hypnotics
 1. Prevention of anxiety

 2. Formation of sedative state

 3. Induction of sleep
 The BENZODIAZEPINES
The benzodiazepines are the most
frequently used anxiolytic drugs.

These agents prevent anxiety states

without causing much sedation, with
less physical dependence than other
agents.
 The BENZODIAZEPINES
The following are the benzodiazepines
 Alprazolam (Xanax)
 Chlordiazepoxide (Librium)
 clonazepam
 clorazepate
 Diazepam (Valium)
 estazolam
 flurazepam
 lorazepam
 midazolam
 oxazepam
 quazepam
 temazepam
 triazolam
 The BENZODIAZEPINES
Special uses
Diazepam Status epilepticus
(Valium)
Chlordiazepoxide Alcohol
(Librium) withdrawal
Alprazolam Panic attack
(Xanax)
 The BENZODIAZEPINES

The Mechanism of Action of the Benzodiazepines

 These agents act on the Limbic

system and the RAS (reticular
activating system) to make the
GABA ( Gamma-aminobutyric acid)
more effective causing interference
with neuron firing.
 The BENZODIAZEPINES
The Mechanism of Action of the Benzodiazepines

 The GABA is an inhibitory

neurotransmitter.
 This will result to an
anxiolytic effect at lower
doses than required for
sedation/hypnosis.
 The BENZODIAZEPINES

These agents are indicated for the

treatment of
2. anxiety disorders
3. alcohol withdrawal
4. hyperexcitability, and agitation
5. pre-operative relief of anxiety and
tension and in induction of
balanced anesthesia.
 The BENZODIAZEPINES
Pharmacodynamics: The adverse
effects
 CNS effects= sedation,
drowsiness, depression, lethargy,
blurred vision
 GIT= dry mouth, constipation,
nausea, vomiting
 CVS= Hypotension or
hypertension, arrhythmias,
palpitations, and respiratory
difficulties.
 Hematologic= blood dyscrasias
and anemia
 The BENZODIAZEPINES
Nursing Considerations:
 Maintain patients on bed for
at least 3 hours after drug
administration.
 Instruct to avoid hazardous
activities like driving and
machine operation.
 Instruct to avoid consuming
ALCOHOL while taking the
drug.
 The BENZODIAZEPINES
Nursing Considerations:
 Provide comfort measures to
help patients tolerate drug
effects-
 instruct to urinate before
taking drug
 give high fiber foods
 use side-rails and assistance
with ambulation.
 Have available FLUMAZENIL
as an antidote for
benzodiazepine overdose.
 The BARBITURATES
 These are also anxiolytics and
hypnotics with a greater
likelihood of producing sedation,
with increase risk of addiction
and dependence.
 The BARBITURATES
The following are the barbiturates
 amobarbital
 aprobarbital
 butabarbital
 mephobarbital
 pentobarbital
 Phenobarbital
 secobarbital
 The BARBITURATES
The Mechanism of Action of the
Barbiturates
 They depress the motor output from
the brain.
 The results of their MOA are
sedation, hypnosis and anesthesia,
and if extreme, coma.
 The BARBITURATES
Clinical indications of the
Barbiturates
• Relief of anxiety manifestations
• For sedation
• For patients with insomnia
• For pre-anesthesia
• seizures/epilepsy
• The rapid acting barbiturates
are also used for the treatment
of acute manic reactions and
status epilepticus
 The BARBITURATES
Pharmacodynamics: The Adverse
effects
 CNS= CNS depression, somnolence,
vertigo, lethargy, ataxia,
paradoxical excitement, anxiety and
hallucinations.
 GIT= nausea, vomiting,
constipation/diarrhea and epigastric
pain
 CVS= bradycardia, Hypotension and
syncope.
 Respi= serious hypoventilation,
respiratory depression and
 The BARBITURATES
Nursing Considerations
 Provide stand-by life support
facilities in cases of severe
respiratory depression or
hypersensitivity reaction.
 Taper the drug gradually after
long-term therapy to avoid
withdrawal syndrome.
 Provide comfort measures
including small frequent meals,
access to bathroom facilities,
high-fiber foods, environmental
control, safety precaution and
 The CNS stimulants
These are drugs used to treat
certain disorders
2. exogenous obesity

3. attention-deficit hyperactivity
disorders (ADHD)
4. narcolepsy
 The CNS stimulants
What is unusual is the
ability of the CNS
stimulants to CALM
hyperactive children, which
allows them to focus on
one activity for a longer
period.
 The CNS stimulants
The following are the CNS
stimulants:
1. Methylphenidate (Ritalin)=
most commonly used for ADHD
2. Dextroamphetamine= a CNS
stimulant that is used for short
tem therapy for obesity.
3. Modafinil= used for narcolepsy
4. Pemoline= used for ADHD
 The CNS stimulants
The Mechanism of Action

These agents act as to stimulate

the cortical and reticular
activating system (RAS) of the
brain.
This is by releasing
neurotransmitters from the nerve
cells leading to increased
stimulation of the post-synaptic
neurons.
 The CNS stimulants
 The paradoxical effect of calming
hyperexcitability through CNS
stimulation seen in ADHD is
believed to be related to the
increased stimulation of an
IMMATURE Reticular Activating
System leading to the ability to
be more selective in response to
incoming stimuli.
 The CNS stimulants
Pharmacodynamics: Adverse effects of the
CNS stimulants
 CNS= nervousness, insomnia, dizziness,
headache, and blurred vision
 GIT= anorexia, nausea and weight loss

 CVS= hypertension, tachycardia

arrhythmias, and angina
 Others= rashes, physical/psychological
dependence.
 The CNS stimulants
Implementation
 The nurse must ensure that the drug is only
given to the indicated conditions
 Administer the drug before 6 pm to
reduce the effect of insomnia
 BEST given AFTER meals to prevent the
effect of anorexia
 Consult with school personnel to monitor the
patient under therapy
 Provide safety measures such as side-rails
and assisted ambulation
 The CNS stimulants
Evaluation
Evaluate the effectiveness of the drug:
3. Calming effect in the patient with
ADHD
4. Alertness for patients with narcolepsy