ANTIANXIETY DRUGS

INTRODUCTION

The anxiolytic drugs are also called as minor tranquilizers and anti-anxiety drugs. In
practice, treatment of anxiety has largely turned from traditional antianxiety agents, anxiolytics, to
antidepressant therapies. In current use, the benzodiazepines, the best known class of anxiolytics,
have been largely supplanted by serotonin-specific reuptake inhibitors (SSRIs, including
citalopram, fluoxetine, fluvoxamine, and others), which have a milder side effect profile and less
risk of dependency. However, traditional anxiolytics remain useful for patients who need a rapid
onset of action, or whose frequency of exposure to anxiety-provoking stimuli is low enough to
eliminate the need for continued treatment. While SSRIs may require three to five weeks to show
any effects, and must be taken continuously, benzodiazepines may produce a response within 30
minutes, and may be dosed on as-needed basis.

DEFINITION
Antianxiety drugs are medicines that calm and relax people with excessive anxiety,
nervousness, or tension, or for short-term control of social phobia disorder or specific phobia
disorder.

INDICATIONS

1. Management of anxiety disorder for short term relief of anxiety symptoms.

2. Acute alcoholic withdrawal
3. Skeletal muscle spasm - relief of muscles plasticity
4. Convulsive disorders (Seizures)
5. As an anticonvulsants Preoperative sedation.

CONTRAINDICATIONS
Antianxiety drugs are persons with known hypersensitivity to any of the drugs in the
classification and following condition.
1. Acute narrow angle glaucoma
2. Untreated open angle glaucoma
3. During or within 14 days of MAO inhibitors therapy.
4. Depressed or psychotic patients in the absence of anxiety.
5. First trimester of pregnancy and lactation.
6. Shock or coma
7. Acute alcoholic intoxication.

ACTION
Anxiolytics depress the sub cortical levels of CNS particularly, the limbic system and reticular formation.

They penetrate the effects of powerful inhibitory neurotransmitter GABA (Gamma amino butyric acid)
on the brain producing a cumulative effect.

The drug is derived to produce the desired effects through interaction with serotonin, dopamine and other
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neurotransmitter receptors.

CLASSIFICATION
1. BARBITURATES: Barbiturates can be divided into 4 main types.
a) Long Acting: Duration of action is more than 8 hours, Example is Phenobarbital.
b) Intermediate Acting: Duration of action is 5-8 hours examples are amobarbital
and pentobarbital.
c) Short Acting: Duration of action is 1-5 hours. Example is secobarbital.
d) Ultra- short- Acting: - Duration of action is less than 1hour examples are
thiopentone and methohexital. The barbiturates are no longer used commonly as
anti-anxiety agents. They produce multiple side- effects like excessive sedation,
respiratory and circulatory depression, hepatic enzyme induction, dependence,
withdrawal symptoms, rebound increase in REM sleep on withdrawal and potential
for use in suicide.

2. NON-BARBITURATE, NON-BENZODIAZEPINE ANTI-ANXIETY AGENTS:

These can be further divided into following categories.
a) Carbamates: Examples are meprobamate, tybamake and carisoprodol, not used
commonly due to potential for abuse and dependence.
b) Piperidinediones: Example is glutethimide. This too is not used now, due to
dependence potential.
c) Alcohols: Examples include ethanol, chloral hydrate and ethchlorynol these drugs
are highly dependence producing.
d) Quinazoline Derivatives: Examples is methaqualone. Methaquolone had become a
street drug. I.e. a drug of abuse, before it was discontinued as an anti-anxiety agent
and a hypnotic.
e) Anti-Histamines: Examples are diphenhydramine, hydroxyzine and pro-netgazube,
Diphenhydramine is usually combined with methaqualone or diazepam. They may
be used as an anti anxiety agent is minimal and probably not effective.
f) Cyclic Ethers: Antipshchotics (eg. Thioridazine) and antidepressants
g) Beta-(B) Blockers: - Example is propranolol. This is particularly effective in
treatment of peripheral somatic manifestations of anxiety. It is also the drug of first
choice for treatment of anticipatory anxiety and situational anxiety.

 Propranolol can be used either alone or along with benzodiazepines.

 The role of B-blockers in the treatment of psychic manifestation of anxiety is
still investigational.
 Propranolol is contraindicated in patients of bronchial asthma and cardiac
conditions. It should be used with cautions in patient of age 40 and above.
 The dosages are 40- 240 mg/ day is divided doses.

3. BENZODIAZEPINES:
Since the discovery of chlordiazepoxide in 1957 by sternback, benzodiazepines have
replaced other anti-anxiety drugs. Presently, benzodiazepines are the drugs of first choice
in treatmentof anxiety and for the treatment of insomnia.

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 The benzodiazepines can be classified according to their elimination half lives.
 Narcoanalysis or abreactiors IV diazepam)
 Treatment resistant schizophrenia (experimental use in high doses)
 Psychosomatic disorders. :-

Whenever administered, benzodiazepines should not e ordinarily used for more than 6 weeks at
one time. Otherwise the risk of dependence is high and tolerance occurs.
Mechanism of Actions:
The exact mechanism of action of benzodiazepines is not clear. The recent discovery
(1977) of benzodiazepine receptors has shed some light on the mode of action.

INDICATION:
The indications for use of benzodiazepines are as follows:
Generalized anxiety disorder, adjustment disorder with anxious mood.
Panic disorder, agoraphobia, and school phobia particularly alprazolam and clonazepam)
Agitated depression (added to antidepressants for first 1-2 weeks) alprazolam probably has
antidepressants effects.
Insomnia.
Stage 4 NREM sleep disorder like enuresis, somnambulism (diazepam reduces duration of
stage NREM step)
Nightmares (diazepam also reduces REM sleep duration )
Premedication in anesthesia (intravenous lorazepam, midazolam, or diazepam).
Anticonvulsant use (drugs of choice for status epilepticus myoclonic seizures and certain
infantile spasmis)
To produce skeletal muscle relaxation (eg in tetanus, cerebral palsy)
Treatment of alcohol and other drug withdrawal syndromes.
For minor surgical, endoscopic or obstetric procedures.
Acute mania (clonazepam, either alone or with lithium)
Antipsychotic – induced akathisia
Emergency management of acute psychoses (IV lorazepam along with parenteral
antipsychoties). E.g. Doxepine) are sometimes used for treatment of severe intractable
anxiety. However, they are not the drugs of first choice and should be used with discretion
when all other drugs have failed to benefit.

PROBABLE MECHANISM OF ACTION OF BENZODIAZEPINES

There are, presently, two known benzodiazepine (BDZ) receptors
B.D.Z. Receptors I which, with GABA (Gamma- AminoButyric – Acid) receptor and is
probably involved in mediation of sleep.
BDZ Receptor II, which is alone, is probably involved in cognition and motor control. Thus
benzodiazepines probably act by enhancing GABA transmission in brain. Benzodiazepine
receptor antagonists (eg. Flumazenil) are anxiety provoking agents Flumazenil has a half life
of 60 minutes and administered in a parenteral dose of 0.2 mg-10. Mg IV given over 1-2
minutes in the treatment of benzodiazepine toxicity.

SIDE EFFECTS:
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 The side effect of benzodiazepine include nausea, vomiting weakness , epigastria pain, diarrhea,
vertigo, blurring of vision, body aches, urinary incontinence (rare), impotence, sedation,
latitude increased reaction time, ataxia (in high doses), dry mouth, retrograde amnesia (rare),
impairment of driving skills, severe effects when and chlordiazepoxide), disinhibited behavior
(particularly with diazepam), dependence and withdrawal symptoms con stopping the drug.)
Cross tolerance occurs with barbiturates, methaqualone and ethyl alcohol.
Worsening of depression and pre- existing psychosis with the use of benzodiazepines has been
reported.
Since withdrawal symptoms occur, the drug should be withdrawn slowly.

4. NEWER DRUGS :
a) BUSPIRONE
Buspirone is a new-anxiety drug which is not a benzodiazepine. It is a
azaspirodecane-dione (azaspirone) derivate and is a 5- HT1A, partial against and a
selective DA auto receptor antagonist. It also inhibits the spontaneous firing of 5- HT
neurons. It is not seen to act on benzodiazepine receptors. It is anxioselective with no
sedative action, no anticonrulsant or muscle- relaseant properties.
It is administered in a dose of 15-30 mg / day in a thrice daily schedule due to a
short half. As it has slower and more gradual onset of action, it usually takes about two
weeks before the anti-anxiety effects of buspirone are evident. It is not useful in the
treatment of panic disorder. The side effects include dizziness, headache, lightheadness
and diarrhea.
As it is anxio-selective and lacks any risk of dependence, it may replace the
benzodia zepines as the drug of choice in generalized anxiety disorders.

b) ZOPICIONE
Belongs to a new class of non benzodiazepine drugs, the cyclopyrrolones,
Cyelophrrolone derivatives also act on the GABA receptors, but at a site distinct from that
if the benzodiazepines.
Zopiclone has a short duration of action as well as shorter onset. After oral
administration, it is absorbed rapidly with peak plasma concentration occurring in about 60
minute. The elimination half life is 4-6 hours.
The usual dose of zopiclone is 3.75-7.5 mg at bed time lower dose in elderly
patients and in patients in severe hepatie failure. The side effects bitter taste, drug mouth,
drosiness nausea and headache. Its safety in children and in pregnancy and lactation is not
proven. It is clinically superior to benzodiazepines in subjective awakening qudility, well
being and attention span in the morning.

c) ZOLPIDEM
Zolpidem is an imidazopyridine derivative which is being marketed as a hypnotic. It
is administered in a dose of 5-10 mg for hypnotic use. It has a half life of 2-3 hours
therefore it is useful in the treatment of difficulty in initiation of sleep (initial insomnia).
The side effect includes drowsiness, dizziness, headache, depression, nausea, dry
mouth and myalgia. It should not used for more than 2 weeks at one time. Its safety in
children and in pregnancy and lactation is not proven.
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d) ZALPELON:
Zelpelon is a pyrazolo- pyrimidine derivative which is being marketed as a
hypnotic, although a non-benzodiazepine drug, it acts on the omega-1 benzodiazepine
receptor located on the alpha sub-unit of the GABA –A receptor complete (causing
sedation) with very little effect on omega-2 and omega-3 receptors.
It is administered in a dose of 5-10 mg for hypnotic use; it has a half life of one
hour with a rapid onset of effect. Therefore it is useful in treatment of difficulty in
initiation of sleep (initial insomnia).
It can be taken again at night if there is more than 4 hours of sleep time remaining.
Because of the very short half life, there is virtually no hangover in the morning. The side
effect includes headache, drowsiness, dizziness, nausea and myalyia. It should not be used
for more than 2 weeks at one time. Its safety in children and in pregnancy and lactation is
not proven.

5. OTHER DRUGS
The other newer, hyposedative and antianxiety drugs include suridone (a
cyclopyzolone derivative, a hypnotic) bretazenil and imidazenil (partial bengodiazepine
agonists’ anxiolytic without sedation, rapid onset of action abecarnil (is car olive partial
against atbenzodiazepine receptor, anxiolytic and anticonrusant) and alpidem (anxiolytic)

RECOMMENDED DOSAGE
Pre-surgical dosing of midazolam varies with the route of administration, the age
and physical condition of the patient, and the other drugs to be used. For patients under the
age of 60, who have not received narcotic analgesics, a dose of 2–3 mg is normally
adequate, but some elderly patients may respond to a dose as low as 1 mg. The usual dose
of lorazepam is up to 4 mg, administered by intramuscular injection at least two hours prior
to surgery. If the drug is given intravenously, a dose of up to 2 mg may be given 15–20
minutes before surgery.

Benzodiazepines should be administered 30–60 minutes before exposure to the

anticipated stress. Dosage should be individualized to minimize sedation. The normal dose
of alprazolam is 0.25–0.5 mg. The usual dose of lorazepam is 2–3 mg. Doses may be
repeated if necessary.
Buspirone is initially dosed at 5 mg three times a day. The dosage should be
increased 5 mg/day, at intervals of two to three days, as needed. A dosage of 60 mg/day
should not be exceeded. Two to three weeks may be required before a satisfactory response
is observed.
SIDE EFFECTS
 CNS - Sedation vertigo, weakness ataxia, depressed motor performance,
confusion.
 Ocular - Double or blurred vision.
 Skin - Urticaria, rash, Photosensitivity.
 GI - Change in weight, dry mouth, constipation
 CNS - when used in combination with antidepressants may lead to death.
 CVS - Tachycardia to cardiovascular collapse
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 A) Barbiturates
CLASS OR TRADE MECHANISM OF
S.N. DOSES SIDE EFFECTS NURSING RESPONSIBILITY
GENERIC NAME NAME ACTION
1. PHENOBARBITAL Barbita,  Elixir-20 Sedative and hypnotic  Somnolence,  Barbiturates do not have analgesic
Luniral mg/5 ml effects of barbiturates appear  Nightmares, an action, and they may be
 Injection-60 to be due primarily to  Bradycardia, expected to produce restlessness
Solfoton when given to patients in pain.
mg/ml interference with impulse  Rash,
 Hypoventilation,  Large doses over extended time
 Tablet - 15 transmission of cerebral may cause vitamin B12 deficiency.
 Edema,
mg, 30 mg, cortex by inhibition of  Advice patients taking barbiturates
 Urticaria,
32 mg,60 reticular activating system at home not to keep drug on bed
 Thrombosis,
mg, 62 mg, side table or in a readily accessible
 Constipation,
100 mg place.
 Steven Johnson syndrome, etc.

2. PENTOBARBITAL Nembutal  Adult- Oral Short- acting barbiturate  With rapid IV respiratory  Do not use parenteral solutions that
120-200 mg with actions, contra depression laryngospasm, appear cloudy or in which a
IM 150-200 bronchospasm, apnea, precipitate has formed.
mg indications, precautions, and  IV route should be used only when
adverse reactions as for hypotension. other routes are not feasible.
 Child- Oral other barbiturates potent  May be given by direct IV
30-120 mg IM undiluted or diluted with sterile
respiratory depressant.
2-6 mg/kg water.
(max 100 mg)  IV administration should be slow;
rate should not exceed 50 mg/ min.
 During IV administration monitor
TPR/BP
 IM injection should be made deep
into large muscle mass.
3. METHOHEXITAL Brevital  Adult – IV Rapid, ultra short acting Respiratory distress, nausea  Patient should be recumbent during
(THIOPENTAL) Sodium 5-12 ml of barbiturate anaesthetic dyspnoea and abnormal muscle drug administration, fall in B.P. may
occur in susceptible patients
1% solution agent. More potent than movements receiving drug in upright position.
(50-120 mg) thiopental but has less  Methohexital is stable in sterile
at a rate of cumulative effect and water for injection at room
temperature for at least 6 week.
1ml (5 mg) of shorter duration of action,  Hiccups are not uncommon,
5 min, then 2- and recovery is more rapid. particularly with rapid injection,
4 ml (20-40 they sometimes persist after
mg) 4-7 min anaesthesia.
 Facilities for assisting respiration
and administration of oxygen should
be ready.

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 B) Non-barbiturate non-benzodiazepine, anti-anxiety drugs
S.N. CLASS OR GENERIC TRADE DOSES MECHANISM OF SIDE EFFECTS NURSING RESPONSIBILITY
NAME NAME ACTION
1. MEPROBANATE Equanil, Adult: Propanediol carbamate Urticaria,  Meprobamate may be administered
(CARBAMATES) Meprospan, PO-1.2-1.6 g/d derivative structurally and Eosinophilia, with food to minimize gastric
Miltown in 3 – 4 divided pharmacologically related to Peripheral edema, distress.
doses. carisoprodol. CNS Oliguria  Hypnotic doses may cause increased
depressant actions similar to Drowsiness, motor activity during sleep. Side rails
Child: those of barbiturates. Acts Palpitation, are advisable.
PO-100-200 mg on multiple sites in CNS and Aplastic  Psychic or physical dependence may
b.i.d. or t.i.d. appears to block Anemia and circulatory occur with long term use of high
corticothalamic impulses. collapse doses.
 Warn patient that tolerance to
alcohol will be cowered.
 Avoid driving a car until drug
response has been determined
2. PIPERIDINEDIONS Doriglute Adult: Pharmacologic actions  Respiratory depression  If administered for insomnia,
(GLUTETHIMIDE) PO 500 mg-1 similar to those of  Coma glutethimide should be given4 hr or
gm 1 hr before barbiturates can induce  Exfoliating dermatitis more before the usual time of arising
anaesthesia hypnosis without producing  Dry mouth to avoid residual day time effects.
reliable analgesic,  Nausea  Keep physician informed of patient’s
antitussive or anticonvulsant  Cyanosis response to drug smallest effective
action.  Impaired memory dosage should be used for the shorted
 Tremors and sudden apnea. period of time compatible with
patients needs.
 Advise patient to report onset of rash
or any other unusual symptoms.
 Warn patient about possible
adversereaction when glutethimide is
combined with alcohol or other CNS
depressants.
 Prolonged use of moderate to high
doses of glutethimidecan produce
tolerance and psychologic and
physical dependence.

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3. PROMETHAZINE Prozine, Adult Aliphatic derivative  Drowsiness  Absorption is inhibited by antacids;
(ANTIHISTAMINIC) Sparine PO/IM 10- 200 chlorpromazine has weak  Orthostatic hypotension therefore administer promazine 1 hr
mg antipsychotic activity and  Blurred before or 1 hr after antacid
extra pyramidal effects  Vision  Oral route should be used whenever
Adolescent occur less frequently.  Epileptic seizures possible.
PO/IM 10-25  Leucopenia,  Warn patient that dizziness or
mg  Aganulocytosis. faintness may occur on arising.
 Advice making all position changes
slowly, particularly from recumbent
to upright position.
 Warn patient to avoid alcohol during
therapy.
 Give oral drug well diluted in acid
fruit juice or milk to reduce irritation
of GI tract and mask odour and taste.
 Rapid withdrawal after prolonged
use may produce delirium tremens
and hallucination.
4. CYCLIC ETHERS Paracetal- Adult Cyclic ether formed by  Irritation of mucous  Monitor patient closely for
(PARALDEHYDE) dehyde PO 10-30 ml polymerization of  Membrane hypotension and respiratory
acetaldehyde. Potent CNS  Nausea depression.
Child depressant with sedative and  Ataxia  Bronchial secretions may be
PO 0.3 ml/kg hypnotic actions similar to  Erythematic skin rash increased. Suctioning may be
those of alcohol,  Toxic hepatitis necessary
barbiturates and chloral  Respiratory depression  Patient breath will have a
hydrate.  Dilation and failure of characteristic odour for several
right heart hours.
 Cardiovascular collapse  If the Patient is also receiving
antacid or anti-diarrheal medication
schedule the phenothiazine to be
take at least 1 hr before or 1 hr after
the other medication.

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5. OTHERS Mellaril, Adult Phenothiazine with actions  Sedation  If patient has been exposed to
ANTIPSYCHOTIC Novoridazine PO50-100 mg uses limitations and  Dizziness extremes in heat or has had an
(THIORIDAZINE) interactions similar to those  Lethargy elevated temperature for several
Child of chlorpromazine. Rarely  Paralytic ileus hours, be alert to the signs of heat
PO> 2 yrs, produces extra pyramidal  Amenorrhea, stroke, red, dry, hot skin, and full
0.5-3 mg/ kg/d effects. Has weak anti  Urinary retention bounding pulse dyspnea.
emetic but strong  Extra pyramidal syndrome.  Counsel patient to take drug as
anticholinergic and alpha- prescribed and not to alter dosing
adrenergic agonist activity regimen or stop medication without
and potent sedative actions. consulting physician.
 Thioridazine may color urine pink
red to reddish brown.
 Avoid rapid injection , which may
cause respiratory depression

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 C) Benzodiazepines
S.N. CLASS OR GENERIC TRADE DOSES MECHANISM OF SIDE EFFECTS NURSING RESPONSIBILITY
NAME NAME ACTION
1. MIDAZOLAM Versed Adult Mechanism of action  Retrograde amnesia  Monitor vital signs for entire
HYDROCHLORIDE IM 0.08 mg/kg unclear intensifies activity  Diplopia recovery period.
Child of gamma-amino benzoic  Laryngospasm  Patient may feel drowsy, weak or
PR 0.03 mg/kg acid, a major inhibitory  Respiratory arrest tired for 1-2 day after drug has been
neurotransmitter of the  Chills given watch patient not to drive a
brain, by interfering with its  Swelling card or perform other tasks requiring
reuptake and promoting its  Burning alertness and coordination until
accumulation at neuronal  Excessive sedation effects of midazolam disappear.
synapses.  Provide written instruction with
verbal teaching to assure future
understanding and complaints.
 In the obese patient, half life is
prolonged; therefore duration of
effect is prolonged. Monitor vital
signs entire recovery period.
2. ANTIDEPRESSANT Adapin, Adult: Dibenzoxepin tricyclic  Aganulocytosis  Capsule may be emptied and
(DOXEPINE) Sinequan, PO 30- 150 antidepressant. Decreases  Edema contents swallowed with fluid or
Zonalon mg/d number of awakenings form  Drowsiness mixed with food.
sleep, and increase stage 4  Orthostatic hypotension,  If a patient uses excessive amounts
sleeps. Relief of nocturnal  Palpitation of alcohol, potentiating of Doxepine
enuresis is perhaps due to  Constipation effects may increase the danger of
Anticholinergic activity and  Tinnitus overdose or suicide attempt.
to nervous system  Be alert to changes in I & O ratio
stimulation. and check patient for constipation
and abdominal distension.
 Teach the necessity to maintain
established dosage regimen and to
avoid changes of intervals, doubling
reducing, or skipping doses.

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3. BETA BLOCKERS Apoproprancol, Adult Blocks cardiac effects of  Fever  Advice patient to e consistent with
(PROPRANOLOL) inderal PO 40 mg beta adrenergic stimulation,  Erythematous regard to taking propranolol with
Child as a result reduces heart rate,  Sleep disturbance food or on an empty stomach to
PO 1mg/kg/d Myocardial irritability and  Respiratory distress minimize radiation in absorption.
force of contraction,  Confusion  Blood pressure monitoring until drug
depresses automatically of  Drug induce psychosis effectiveness is demonstrated will be
sinus node and ectopic  Bradycardia necessary
pacemaker and decreases  Tinnitus  I & O ratio and daily weight are
AVand intraventricular  Heartburn significant indexes for detecting
conduction velocity.  Myotonia fluid retention and developing heart
 Healing loss failure.
 Aganulocytosis  Advise to stop smoking because
 Laryngospasm smoking increases hepatic
 Weight gain metabolism.
 Arthralgia  Advice patient to report to physician
if any complication occurs.
4. LORAZEPAM Ativan Adult: Effects are mediated by the  Drowsiness  Supervise ambulation of elderly
PO 2-6 mg/day inhibitory neurotransmitter  Sedation patient for at least 8 hr after
IM 2-4 mg, GABA. Action sites  Dizziness lorazepam injection to prevent
(0.5 mg/kg) thalamic, hypothalamic and  Depression falling and injury.
limbic levels of CNS,  Sleeps disturbance  When higher oral dosage is required
limitations and limbic levels  Confusion the evening dose should be increased
of CNS.  Hypotension before the day time doses.
Limitations and interaction  Abdominal discomfort  Closely supervise patient who
similar to those of exhibits depression with anxiety,
Chlorodiazepoxide. particularly when there is apparent
improvement in mood.
 Inform patient about retrograde
amnesia. Full recall and recognition
may not return for about 8 hours.
 Advise patient to refrain from any
hazardous activity, including
dangerous sports and driving car.
 Advise patient to avoid large volume
intake of coffee

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5. ALPRAZOLAM Xanax Adult: CNS depressant. Mode of  Drowsiness  Alprazolam may be administered
PO 0.25-0.5 action known but appears to  Sedation without regards to meals
mg on the limbic, thalamic and  Fatigue  Drowsiness and sedation are more
hypothalamic levels of CNS  Tremors common side effects so monitor
Psychotherapeutic agent  Tachycardia especially the elderly
related to  ECG changes  Advice patients to avoid driving and
Chlorodiazepoxide, appears  Dyspnea inform physician if any complication
to act on both limbic  Restlessness occurs
subcortical levels of CNS.  Syncope  Abrupt discontinuation of drug may
Reportedly superior in  Depression cause withdrawal symptoms.
antianxiety and  Blurred vision Nausea, vomiting, sweating, tremors
anticonvulsant activity. and convulsion.
Shorter REM and stage 4  Tablet may be crushed before
sleep but increases total administration and taken with fluids
sleep time. or mixed with food.
 Abrupt discontinuation of diazepam
should generally be avoided.
6. DIAZEPAM Apodiazepam, Adult: Anxiolytic with actions,  Drowsiness,  Always rotate injection sites.
E-Pam, IM / IV 5- uses and interactions  Cardiovascular collapse  Monitor I/O ratio, including bowel
Meval, 10mg qualitatively similar to those  Laryngospason elimination.
Valium, of lorazepam but with fewer  Hepatic dysfunction  Heavy smokers may need a higher
Vivol. Child unwanted side effects, e.g.  Tremor dose than the nonsmoker because
IM / IV sedation.  Slurred speech. smoking increases metabolism of
< 5 yrs., 0.2- diazepam.
0.5 mg  The patient should be advised that
if she becomes pregnant during
therapy or intends to become
pregnant she should communicate
with her physician regarding
desirability of discontinuing drug.
 Advise patient not to change dose
or dose intervals.

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7. CLONAZEPAM Novoclopate, Adult First generation agent in a  Drowsiness  Antacids delay absorption of drug if
Tranxene PO 15 mg /d new class of anxiolytics.  ataxia patient has gastric distress, advice
h.s. Action is under but appears  xerostomia taking drug with food or milk.
to be focused mainly on the  blood dyscrasias  Drowsiness, a common side effect, is
brain dopamine system.  GI disturbances move likely to occur at initiation of
 Diplopia therapy and with dose increments on
 Headache successive days.
 Mental confusion  Counsel patient to take drug as
prescribed and not to change dose or
abruptly stop taking the drug without
physician’s approval.
 Caution patient to avoid driving and
other potentially hazardous activities
until reaction to drug is known.
 Administer with food to decrease
first pass metabolism

49
 D) NEWER DRUGS
S.N. CLASS OR GENERIC TRADE DOSES MECHANISM OF SIDE EFFECTS NURSING RESPONSIBILITY
NAME NAME ACTION
1. BASTIONED Buspar Adult – PO Buspirone has against  Dizziness  Buspirone may displace digoxin
(AZASPIRONE) 10-15 mg /d effects on presynaptic  Headache from its serum binding.
dopamine receptors and also  Drowsiness  Assure patient that these effects
a high affinity for serotonin  Tremors subside during continued therapy
receptors.  Dream disturbances with or without dosage adjustment.
 Numbness  Caution patient about driving or
 Nausea working with dangerous equipment
 Hair loss until reaction to the drug is known.
 Dry skin  Drug will be discontinued during
 Constipation pregnancy.
 Arthralgia.

2. ZOLPIDEM Ambien Adult: PO 5- Non benzodiazepine  Headache on awakening  Zolpidem should be administered
(IMIDAZOPYRIMIDINE) 10 mg h.s. hypnotic. Does not have  Drowsiness or fatigue immediately before bedtime.
muscle relaxant or anti-  Depression  For more rapid sleep onset, do not
conversant effects.  Anxiety administer with or immediately after
 Dizziness a meal.
 Double vision  Patients who exhibit signs and
 Anterograde amnesia symptoms of depression because
 Dyspepsia Zolpidem may increase level of
 Myalgia depression.

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PRECAUTIONS

Precautions and warnings apply to the use of ant-anxiety agents for use over long periods of
time. They are unlikely to occur in patients who have only received a single dose prior to surgery.
Benzodiazepines should not be used in patients with psychosis, acute narrow-angle glaucoma or liver
disease. The drugs can act as respiratory depressants and should be avoided in patients with
respiratory conditions. Benzodiazepines are potentially addictive and should not be administered to
patient with substance abuse disorders. Because benzodiazepines are sedatives, they should be
avoided in patients who must remain alert. Their use for periods over four months has not been
documented. These drugs are should not be used during the second and third trimester of pregnancy,
although use during the first trimester appears to be safe. They should not be taken while breast
feeding. Specialized references for use in children should be consulted.
Buspirone is metabolized by the liver and excreted by the kidney and should be used with care
in patients with hepatic or renal disease. The drug is classified as schedule B during pregnancy, but
should not be taken during breastfeeding. Its use in children under the age of 18 years has not been
studied.

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