Anxiety is a normal human emotion, similar to fear.

It is unpleasant feeling of apprehension or nervousness caused by the perception of potential or actual danger that threatens persons security. MILD ANXIETY - is a state of heightened awareness of the surroundings and seen in response to day to day circumstances

MILD ANXIETY - is a state of heightened awareness

of the surroundings and seen in response to day to day circumstances. This type of anxiety can be beneficial to the motivator for individual to take action in reasonable and adaptive manner. It is sometimes said that people rise to the ocassion.

Anxiety Disorders happened when the patients

response to stressful situations are abnormal or irrational and impair normal daily functioning. It is the most commonly mental disorder in the practice.
Usually begin before the age of 30 More common in women

1.Generalized Anxiety Disorder is described as excessive and unrealistic worry about two or more life circumstances for 6 months or more. 2. Panic Disorder is recognized as a separate disease and not a more severe form of chronic generalized anxiety disorder. It begins as a series of acute or unprovoked anxiety (panic) attacks involving intense, terrifying fear.

3. Phobias are irrational fear of a specific object, activity, or situation.

Social Phobia a fear of certain social situations which the person is exposed to scrutiny by others and fears of doing something embarrassing. Simple Phobia an irrational fear of specific object or situation such as heights (acrophobia), closed spaces (claustrophobia) or phobias to animal like spider, snakes and mice.

4. Obsessive-Compulsive disorder the most disabling of the anxiety disorders, although it is responsive to treatment. Its primary features is recurrent obsessions and compulsions that cause significant distress.

BENZODIAZEPINES - most commonly used. ACTION It has similar action as CNS depressants but individual drugs within benzodiazepine family act more selectively as specific sites, which allow for a variety of uses. It reduce anxiety by stimulating the action of an inhibitory neurotransmitter called gammaaminobutryic acid (GABA) improving symptoms of sleep disturbance, tremor and muscle tension.

In patients with reduce hepatic function or in older adults alprazolam, lorazepam or oxazepam may be most appropriate because they have a relatively short duration of action and no active metabolites. the other benzodiazepines ha active metabolites that significantly prolong the duration of action and may accumulate to the point of excessive side effects with chronic administration however some patients who cannot tolerate oral administration because of nausea and vomiting. Chlordiazepoxide, diazepam or lorazepam may be administered IM.

GENERIC NAME ALPRAZOLAM Diazepam

BRAND NAME Xanax Nirvam Valium

USES Used for treating anxiety and panic disorder Used for short-term relief of symptoms related to anxiety disorders. Used for treating anxiety disorder Used for treating alcohol withdrawal, partial seizures in people with epilepsy, and anxiety Used for treating alcohol withdrawal and anxiety Used for treating alcohol withdrawal and anxiety

Lorazepam Clorazepate

Ativan Tranxene

Chlordiazepoxide

Librium

Oxazepam

Serax

Therapeutic outcomes
Decrease the level of anxiety to a manageable level (e.g. coping is improved, physical signs of anxiety such as look of anxiety tremor and pacing are reduced.)

Nursing responsibilities: Premedication assessment 1. Record baseline data on level of anxiety present. 2. Record baseline vital signs, particularly BP, in sitting and supine position. 3. Check for history of blood dyscrasias or hepatic disease 4. Determine whether the individual is pregnant or breast feeding.

Inform the patient that rapidly discontinuing benzodiazepines after long term use may result in symptoms similar to alcohol withdrawal
Common symptoms include restlessness, worsening of anxiety and insomia tremor, muscle tension increased HR and auditory hypersensitivity.

Prevention consist of gradual withdrawal of benzodiazepines over 4 weeks.

 Drowsiness Hangover

Sedation

Lethargy

 Excessive

Use or Abuse Blood Dyscrasias Hepatoxicity

*GENERIC NAME: Buspirone *BRAND NAME: Buspar Actions

Buspirone is an anti anxiety agent which are chemically unrelated to barbiturates, benzodiazepines or other anxiolytic agents. It is a partial serotonin and dopamine agonist and interacts in several ways with nerve system in the midbrain therefore it is sometimes called Midbrain Modulator. It does not affect the GABA receptor. Its advantage over other anxiety agents is that is does not alter psychomotor functioning.

Uses Use in the treatment of anxiety disorders and for short term relief of the symptoms of anxiety.
Therapeutic Outcomes To decrease the level of anxiety to a manageable level (e.g. coping is improved, physical signs of anxiety such as look of anxiety tremor and pacing are reduced.)

PREMEDICATION ASSESSMENT Record base line date on the level of anxiety. Schedule assessments periodically throughout therapy for development of slurred speech or dizziness, which are signs of excessive dosing.

 Sedation

Lethargy

Slurred

Speech Dizziness

*GENERIC NAME: Fluvoxamine *BRAND NAME: Luvox Action

Fluvoxamine inhibits the reuptake of serotonin at nerve endings, thus prolonging serotonin activity.

Uses
It is used in the treatment of obsessive compulsive disorder when obsessions or compulsions cause marked distress, are time consuming or interfere substantially with social or occupational responsibility.

*GENERIC NAME: Hydroxyzine *BRAND NAME: Vistaril Action

Uses

It is a antihistamine. It acts within the CNS to produce sedation, antiemetic, anticholinergic, antihistaminic, antianxiety, and antispasmodic activity, making it somewhat multi purpose agent.

Hydroxyzine is used as a mild tranquilizer in psychiatyric conditions characterized by anxiety, tension, and agitation. It is also occasionally used as preoperative or post operative sedative to control vomiting diminish anxiety, and reduce the amount of narcotics needed for analgesia. It is also be used as an antipruritic agent to relieve the itching associated with allergic reactions

Premedication assessment 1. Perform baseline assessment on anxiety symptoms. 2. Determine level of anxiety before and after surgical intervention; record and intervene appropriately. 3. For nausea and vomiting, administer when nausea first start. 4. For allergic reactions, before administering dose; repeat before administration of subsequent doses to determine effectiveness. 5. Monitor for level of sedation present, slurred speech, or dizziness; report to health care provider if excessive before administering repeat doses.

 Blurred

Vision Constipation Dryness of Mucosa of the Mouth, Nose, and Throat. Sedation

Slurred

Speech Dizziness

*GENERIC NAME: Meprobamate *BRAND NAME: Equanil, Miltown Action

Meprobamate acts on multiple sites within the CNS to produce mild sedation, antianxiety, and muscle relaxation. Mechanism of action is unknown.

Uses
It is used as an antianxiety agent and mild skeletal muscle relaxant for the short-term relief, (less than 4 months) of anxiety and tension. It is of little use in the treatment of psychoses.

Premedication assessment
1. Record baseline data on the level of anxiety present. 2. Schedule assessments periodically throughout the therapy for development of slurred speech, dizziness which are signs of excessive dosing.

Sedation

Slurred Speech Dizziness Excessive Use or Abuse Orthostatic Hypotention Paradoxical Excitement Dysrhythmias Hives, Pruritus, Rash