ANTIANXIETY DRUGS

Generic Name: Chlordiazepoxide

Generic Name: Alprazolam Brand Name: Librium
Brand Name: Xanax DRUG CLASSIFICATION
DRUG CLASSIFICATION Therapeutic Class: Anxiolytic
Therapeutic Class: Anxiolytic Pharmacologic Class: Benzodiazepine
Pharmacologic Class: Benzodiazepine INDICATION
INDICATION  Mild to moderate anxiety
 Anxiety  Withdrawal symptoms of acute alcoholism
 Panic disorders  Preoperative apprehension and anxiety
MECHANISM OF ACTION MECHANISM OF ACTION
Unknown. Probably potentiates the effects of GABA, depresses the CNS, and A benzodiazepine that may potentiate the effects of GABA, depress the
suppresses the spread of seizure activity CNS, and suppress the spread of seizure activity
SIDE EFFECTS/ADVERSE REACTIONS SIDE EFFECTS/ADVERSE REACTIONS
CNS: sedation, somnolence, difficulty speaking impaired coordination memory CNS: drowsiness, lethargy, ataxia, confusion, extrapyramidal reactions,
impairment, fatigue, depression suicide, mental impairment, ataxia, paresthesia, minor changes in EEG patterns
dyskinesia, hypoesthesia, lethargy, vertigo, malaise, tremor, nervousness, CV: edema
restlessness, agitation, nightmare, syncope, akathisia, mania GI: nausea, constipation
CV: palpitations, chest pain, hypotension GU: menstrual irregularities
EENT: allergic rhinitis, blurred vision, nasal congestion Hema: agranulocytosis
GI: diarrhea, dry mouth, constipation, nausea, increased or decreased appetite, Hepa: jaundice
anorexia, vomiting, dyspepsia, abdominal pain Skin: swelling and pain at injection site, skin eruptions
GU: dysmenorrhea, sexual dysfunction, premenstrual syndrome, difficulty urinating Other: altered libido
Meta: increased or decreased weight NURSING RESPONSIBILITIES
Musculo: arthralgia, myalgia, arm or leg pain, back pain, muscle rigidity, muscle  In patients receiving repeated or prolonged therapy, monitor
cramps, muscle twitch hepatic, renal, and hematopoietic function periodically
Respi: upper respiratory tract infection, dyspnea, hyperventilation  Watch for paradoxical reaction in psychiatric patients and
Skin: pruritus, increased sweating, dermatitis hyperactive, aggressive children
Other: influenza, injury, emergence of anxiety between doses, dependence,  Use of this drug may lead to abuse and addiction. Don’t
NURSING RESPONSIBILITIES withdraw drug abruptly after long-term use because withdrawal
 The optimum duration of therapy is unknown symptoms may occur
 Don’t withdraw drug abruptly, withdrawal symptoms, including  Warn patient to avoid hazardous activities that require alertness
seizures, may occur. Gradually reduce dosage. Abuse or and coordination until effects of drug are known
addiction is possible  Tell patient to avoid use of alcohol while taking drug
 Monitor hepatic, renal, and hematopoietic function periodically  Warn patient drug may my cause psychological and physical
in patients receiving repeated or prolonged therapy dependence. Tell patient not to increase dose or abruptly stop the
 Closely monitor addiction-prone patients drug because withdrawal symptoms may occur
 Warn patient to avoid hazardous activities that require alertness  Warn women to avoid use during pregnancy
and good coordination until effects of drug are known CONTRAINDICATIONS AND CAUSES
 Tell patient to avoid use of alcohol while taking drug  Contraindicated in patients hypersensitive to drug and in pregnant
 Advise patient that smoking may decrease drug’s effectiveness women, especially in first trimester
 Warn patient not to stop drug abruptly because withdrawal  Use cautiously in elderly patients and in patients with mental
symptoms or seizures may occur depression, history of substance abuse, porphyria, or hepatic or renal
 Tell patient to swallow extended-release tablets whole disease
 Warn women to avoid use during pregnancy and breast-feeding
CONTRAINDICATIONS AND CAUSES
 Contraindicated to patients hypersensitive to drug or other
benzodiazepines and in those with acute angle-closure glaucoma.
 Use cautiously in patients with hepatic, renal, or pulmonary disease or
history of substance abuse
 Generic Name: Clonazepam
Brand Name: Klonopin
DRUG CLASSIFICATION
Therapeutic Class: Anticonvulsant
Pharmacologic Class: Benzodiazepine
INDICATION
 Lennox-Gastaut syndrome, atypical absence seizures,
akinetic and myoclonic seizures
 Restless legs syndrome
MECHANISM OF ACTION
Unknown. Probably acts by facilitating the effects of the inhibitory
neurotransmitter GABA
SIDE EFFECTS/ADVERSE REACTIONS
CNS: drowsiness, agitation, ataxia, behavioral disturbances, confusion,
depression, slurred speech, tremor
CV: palpitations
EENT: abnormal eye movements, nystagmus
GI: anorexia, change in appetite, constipation, diarrhea, gastritis,
nausea, sore gums
GU: dysuria, enuresis, nocturia, urine retention
Hema: leukopenia, thrombocytopenia, eosinophilia
Respi: respiratory depression, chest congestion, shortness of breath
Skin: rash
NURSING RESPONSIBILITIES
 Closely monitor all patients for changes in behavior that may
indicate worsening of suicidal thought or behavior or depression
 Don’t stop drug abruptly because this may worsen seizures. Call
prescriber at once if adverse reactions develop
 Assess elderly patient’s response closely. Elderly patients are
more sensitive to drug’s CNS effects
 Monitor patient for oversedation
 To reduce inconvenience of somnolence when drug is used for
panic disorder, giving one dose at bedtime may be desirable
 Advise patient to avoid driving and other hazardous activities that
require mental alertness until drug’s CNS effects are known
 Instruct parent to monitor child’s school performance because
drug may interfere with attentiveness
 Warn patient and parents not to stop drug abruptly because
seizures may occur
 Advise patient that drug isn’t for use during pregnancy or breast-
feeding
CONTRAINDICATIONS AND CAUSES
 Contraindicated in patients hypersensitive to benzodiazepines and in
those with significant hepatic disease or acute angle-closure glaucoma
 Use cautiously in patients with mixed-type seizures because drug may
cause generalized tonic-clonic seizures
 Use cautiously in children and in patients with chronic respiratory
disease, open-angle glaucoma, or a history of drug or alcohol addiction
 Use cautiously in elderly patients. Drug may accumulate due to
potential decrease in hepatic and renal function
Generic Name: Diazepam
Brand Name: Valium
DRUG CLASSIFICATION
Therapeutic Class: Anxiolytic
Pharmacologic Class: Benzodiazepine
INDICATION
 Anxiety
 Muscle spams
 Adjunct treatment for seizure disorders
 Status epilepticus, severe recurrent seizures
 Patients on stable regimens of antiepileptic drugs who
need diazepam intermittently to control bouts if
increased seizure activity
MECHANISM OF ACTION
A benzodiazepine that probably potentiates the effects of GABA,
depresses the CNS, and suppresses the spread of seizure activity
SIDE EFFECTS/ADVERSE REACTIONS
CNS: drowsiness, dysarthria, slurred speech, tremor, transient amnesia,
fatigue, ataxia, headache, insomnia, paradoxical anxiety, hallucination,
minor changes in EEG patterns, pain
CV: CV collapse, bradycardia, hypotension
EENT: diplopia, blurred vision, nystagmus
GI: nausea, constipation, diarrhea with rectal form
GU: incontinence, urine retention
Hema: neutropenia
Hepa: jaundice
Respi: respiratory depression, apnea
Skin: rash, phlebitis at injection site
Other: altered libido, physical or psychological dependence
NURSING RESPONSIBILITIES
 Monitor periodic hepatic, renal and hematopoietic function studies in
patients receiving repeated or prolonged therapy
 Monitor elderly patients for dizziness, ataxia, and mental status
changes. Patients are at an increased risk of falls
 Warn patient to avoid hazardous activities that require alertness and
good coordination until eff3ects of drugs are known
 Notify patient that smoking may decrease drug’s effectiveness
 Warn patient not to abruptly stop drug because withdrawal symptoms
may occur
 Warn women to avoid use during pregnancy
 Instruct patient’s caregiver on the proper use of Diastat rectal gel
CONTRAINDICATIONS AND CAUSES
 Contraindicated in patients hypersensitive to drug or soy protein;
in patients experiencing shock, com, or acute alcohol
intoxication; in pregnant women, especially in first trimester; and
in infants younger than age 6
 Contraindicated in patients with acute angle-closure glaucoma
 Use cautiously in patients with liver or renal impairment,
depression, history of substance abuse, or chronic open-angle
glaucoma. Use cautiously in elderly and debilitated patients
 Generic Name: Lorazepam
Brand Name: Ativan
DRUG CLASSIFICATION
Therapeutic Class: Anxiolytic
Pharmacologic Class: Benzodiazepine
INDICATION
 Anxiety
 Insomnia from anxiety
 Status epilepticus
MECHANISM OF ACTION
May potentiate the effects of GABA, depress the CNS, and suppress the
spread of seizure activity
SIDE EFFECTS/ADVERSE REACTIONS
CNS: drowsiness, sedation, amnesia, insomnia, agitation, dizziness,
weakness, unsteadiness, disorientation, depression, headache
CV: hypotension
EENT: visual disturbances, nasal congestion
GI: abdominal discomfort, nausea, change in appetite
NURSING RESPONSIBILITIES
 Monitor hepatic, renal, and hematopoietic function periodically in
patients receiving repeated or prolonged therapy
 Use of this drug may lead to abuse and addiction. Don’t stop drug
abruptly after long-term use because withdrawal symptoms may occur
 Warn patient to avoid hazardous activities that require alertness and
good coordination until effects of drug are known
 Tell patient to avoid use of alcohol while taking drug
 Notify patient that smoking may decrease drug’s effectiveness
 Warn patient not to stop drug abruptly because withdrawal symptoms
may occur
 Advise women to avoid becoming pregnant while taking drug
CONTRAINDICATIONS AND CAUSES
 Contraindicated in patients hypersensitive to drug, other
benzodiazepines, or the vehicle used in parenteral dosage form;
in patients with acute angle-closure glaucoma; and in pregnant
women, especially in the first trimester
 Use cautiously in patients with pulmonary, renal, or hepatic
impairment, or history of substance abuse
 Use cautiously in elderly, acutely ill, or debilitated patients
Generic Name: Oxazepam
Brand Name: Serax
DRUG CLASSIFICATION
Therapeutic Class: Anxiolytic
Pharmacologic Class: Benzodiazepine
INDICATION
 Alcohol withdrawal, severe anxiety
 Severe anxiety syndromes; agitation; anxiety associated
with depression
 Anxiety, tension, irritability, agitation
MECHANISM OF ACTION
May stimulate GABA receptors in the ascending reticular activating
system
SIDE EFFECTS/ADVERSE REACTIONS
CNS: drowsiness, lethargy, dizziness, vertigo, headache, syncope,
tremor, slurred speech, changes in EEG patterns
CV: edema
GI: nausea
Hepa: hepatic dysfunction
Skin: rash
Other: altered libido
NURSING RESPONSIBILITIES
 Monitor hepatic, renal, and hematopoietic function periodically in
patients receiving repeated or prolonged therapy
 Use of this drug may lead to abuse and addiction. Don’t stop drug
abruptly because withdrawal symptoms may occur
 Warn patient to avoid hazardous activities that require alertness or good
coordination until effect of drug are known
 Tell patient avoid use of alcohol while taking drug
 Notify patient that smoking may decrease drug’s effectiveness
 Warn patient not to stop drug abruptly because withdrawal symptoms
may occur
 Warn women of childbearing age to avoid use during pregnancy
CONTRAINDICATIONS AND CAUSES
 Contraindicated in patients hypersensitive to drug; in pregnant
women, especially in the first trimester; and in those with
psychoses
 Use cautiously in elderly patients and in those with history of
substance abuse or in whom a decrease in blood pressure might
led to cardiac problems
 Generic Name: Temazepam
Brand Name: Restoril
DRUG CLASSIFICATION
Therapeutic Class: Hypnotic
Pharmacologic Class: Benzodiazepine
INDICATION
 Short-term treatment (7-10 days) of insomnia
MECHANISM OF ACTION
Probably acts on the limbic system, thalamus, and hypothalamus of the
CNS to produce hypnotic effects
SIDE EFFECTS/ADVERSE REACTIONS
CNS: complex sleep-related behaviors, drowsiness, dizziness, lethargy,
disturbed coordination, daytime sedation, confusion, nightmares,
vertigo, euphoria, weakness, headache, fatigue, nervousness, anxiety,
depression, minor changes in EEG patterns
EENT: blurred vision
GI: diarrhea, nausea, dry mouth
Other anaphylaxis, angioedema, physical and psychological
dependence
NURSING RESPONSIBILITIES
 Monitor patient closely. Anaphylaxis and angioedema may occur as
early as the first dose
 Assess mental status before starting therapy and reduce doses in elderly
patient’s; these patients may be more sensitive to drug’s adverse CNS
effects
 Take precautions to prevent hoarding by patients who are depressed,
suicidal, or drug-dependent or who have history of drug abuse
 Don’t stop drug abruptly as this may cause withdrawal
symptoms. To discontinue drug, follow a gradual dosage-tapering
schedule
 Warn patient that drug my cause allergic reactions, facial
swelling, and complex sleep-related behaviors, such as driving,
eating, and making phone calls while asleep. Advise patient to
report these adverse effects
 Tell patient to avoid alcohol during therapy
 Caution patient to avoid performing activities that require mental
alertness or physical coordination
 Warn patient not to stop drug abruptly if taken for 1 month or
longer
 Tell patient that onset of drug’s effects may take as long as 2 to 2
¼ hours
CONTRAINDICATIONS AND CAUSES
 Contraindicated in pregnant patients and those hypersensitive to
drug or other benzodiazepines
 Use cautiously in patients with chronic pulmonary insufficiency,
impaired hepatic or renal function, severe or latent depression,
suicidal tendencies, and history of drug abuse
Generic Name: Triazolam
Brand Name: Halcion
DRUG CLASSIFICATION
Therapeutic Class: Hypnotic
Pharmacologic Class: Benzodiazepine
INDICATION
 Sort-term treatment (7 to 10 days) of insomnia
MECHANISM OF ACTION
Unknown. Probably acts on the limbic system, thalamus, and
hypothalamus of the CNS to produce hypnotic effects
SIDE EFFECTS/ADVERSE REACTIONS
CNS: complex sleep-related behaviors, drowsiness, amnesia, ataxia,
depression, dizziness, headache, lack of coordination, mental confusion,
nervousness, physical or psychological dependence, rebound insomnia
GI: nausea, vomiting
Other: anaphylaxis, angioedema
NURSING RESPONSIBILITIES
 Monitor patient closely. Anaphylaxis and angioedema may occur
as early as the first dose
 Assess mental status before starting therapy and reduce doses in elderly
patient’s; these patients may be more sensitive to drug’s adverse CNS
effects
 Take precautions to prevent hoarding by patients who are depressed,
suicidal, or drug-dependent or who have history of drug abuse
 Don’t stop drug abruptly as this may cause withdrawal
symptoms. To discontinue drug, follow a gradual dosage-tapering
schedule
 Warn patient that drug my cause allergic reactions, facial
swelling, and complex sleep-related behaviors, such as driving,
eating, and making phone calls while asleep. Advise patient to
report these adverse effects
 Tell patient to avoid alcohol during therapy
 Caution patient to avoid performing activities that require mental
alertness or physical coordination
 Warn patient not to stop drug abruptly if taken for 1 month or
longer
CONTRAINDICATIONS AND CAUSES
 Contraindicated in pregnant patients and those hypersensitive to
benzodiazepines
 Use cautiously in patients with impaired hepatic or renal
function, chronic pulmonary insufficiency, sleep apnea, mental
depression, suicidal tendencies, or history of drug abuse
 Use cautiously in breast-feeding women
NONBENZODIAZEPINE
MEDICATION
Generic Name: Buspirone
Brand Name: BuSpar
DRUG CLASSIFICATION
Therapeutic Class: Anxiolytic
Pharmacologic Class: Azaspirodecanedione derivative
INDICATION
 Anxiety disorders
 Traumatic brain injury
MECHANISM OF ACTION
May inhibit neuronal firing and reduce serotonin turnover in cortical,
amygdaloid, and septohippocampal tissue
SIDE EFFECTS/ADVERSE REACTIONS
CNS: dizziness, drowsiness, headache, nervousness, insomnia, light-
headedness, fatigue, numbness, excitement, confusion, depression,
anger, decreased concentration
CV: tachycardia, nonspecific chest pain
EENT: blurred vision
GI: dry mouth, nausea, diarrhea, abdominal distress
NURSING RESPONSIBILITIES
 Monitor patient closely for adverse CNS reactions. Drug is less
sedating than other anxiolytics, but CNS effects may be
unpredictable



Before starting therapy, don’t stop a previous benzodiazepine
regimen abruptly because a withdrawal reaction may occur
Drug shows no potential for abuse and isn’t classified as a
ANTIANXIETY
controlled substance
 Teach patient to recognize and immediately report symptoms of
serotonin toxicity
 Warn patient to avoid hazardous activities that require alertness
and good coordination until effects of drug are known
 Remind patient that drug effects may not be noticeable for
several weeks
 Warn patient not to abruptly stop a benzodiazepine because of
risk of withdrawal symptoms
 Tell patient to avoid use of alcohol during therapy
Advise patient to take consistently, that is, always with or always without food
CONTRAINDICATIONS AND CAUSES
 Contraindicated in patients hypersensitive to drug and within 14 days of
MAO inhibitor therapy
 Drug isn’t recommended for patients with severe hepatic or renal
impairment