Anxiety and Drugs

• Increases

  • HR
  • BP
  • Resp
  • Muscle tension
• Sympathetic nervous system activation

  • Tremor
  • Sweating
  • Polyuria
  • Diarrhea
• Mild Anxiety

  • Everyday problem solving kind of anxiety
  • Light discomfort
  • Mild tension relieving behaviors
  • Nail biting, tapping, etc)
• Moderate Anxiety

  • Clear thinking hampered
  • Problem solving not optimal

  Sympathetic Nervous system:

  • Tension
  • Pouding heart
  • Increase pulse and respirations
• Severe Anxiety

  • Focus on one detail
  • Learning becomes difficult
  • Difficulty concentrating
  • Headache, Nausea, Dizzy
  • Hyperventilation
  • Sense of impeding doom / dread
• Panic

  • Disturbed behavior - running, shouting, screaming or pacing
  • Behavior becomes erratic - uncordinated and impulsive
• Anxiety Pathophysiology

  • Chemical imbalances in brain which cause inappropiate response to stress mood or excitement
  • may produce lower levels of dopamine or serotonin
• Anxiety Presentations

  • Unexpected sudden, and recurrent
  • Generate intense feeling of fear
  • Important to rule out other illness
• Physical Cues

  • Cold sweaty hands
  • Dry mouth
  • Heart palpitation and shortness of breath
  • Nausea
  • Pallor
  • Increase blood sugar
• Mental Symptoms

  • Feeling panic
  • Nightmares
  • Repeated thoughts
  • Flashbacks
  • Uncontrolled obsesive thoughts
• Behavioral Symptoms:

  • Inability to be still or calm
  • Ritualistic behaviors such as washing hands repeatedly
  • Trouble sleeping
• Types of Anxiety

  • Generalized anxiety disorder
  • Panic disorder
  • Phobic disorder
  • OCD
  • PTSD
• Generalized anxiety disorder

  • Excessive anxiety and worry about life
  • Unrealistic anxiety
  • Generalized/persistent
  • Common among children and adolescents

  Treatment

  • SSRIs
  • SNRIs
  • Benzodiazepine
• Panic Disorder

  • Severe acute exacerbation
  • S/S: Palpations, tachycardia, sweating, shaking or trembling
  • Trt: SSRIs, SNRIs, Benzodiazepine
• Phobic Disorders

  • Persistent and irrational fear of definable situations
  • S/S: pounding heart, dry mouth, Increase BP, sweaty, dizzy etc.
  • Trt: Benzodiazepine, SSRIs, MAOI, TCA
• Obsessive Compulsive Disorder

  • Recurrent persisten thoughts urges, or images
  • Rituals
  • TRT: SSRI and TCA
• PTSD

  • "Brusing" of CNS - longer the trauma
  • TRT: SSRIs and SNRIs
• Diazepam, Alprazolam, Larazepam

  • Anxiolytic
  • Benzodiazepine
  • SE: drowzzy, hangover, bradycardia, hypotension, constipation, diarrhea
  • NC: Instruct patient about dizziness and changing position, can cause dependency
• Buspirone

  • Anxiolytic
  • Binds to seratonin and dopamine
  • Treats Generalized Anxiety Disorder
  • SE: Dizzy, nausea, headache, sedation, little to no risk for suicide
  • NC: effects develop slowly, muscle relaxant, adminster with food
  • Drug-Drug: Increase burspirone levels by erythromycin, ketoconazole and grapefruit juice
• Propranolol, Atenolol, and Metoprolol

  • Beta blocker
  • Anxiolytic
  • Blocks release of adrenaline and other stress hormones
  • Treats preformance anxiety and social anxiety
  • SE: Dizzy, nausea, dry mouth or eyes, fatigue sleep changes, hypotensions
  • NC: monitor BP and HR
• St Johns Wart

  • Herbal
  • Antidepressant
  • Treats OCD and depression
  • SE: Dizzy, restlessness, nausea, vomiting, diarrhea, dry mouth, GI distess
  • NC: contraindicated in pregnancy