MMIN

CLINICAL TEACHING on
ANXIOLYTICS &
HYPNOSEDATIVES

By:- Diksha Malhotra

Bsc Nursing 4th year
2017009
HISTORY OF BARBITURATES,
BDZs & Z-drugs
* Sedatives ( before development of
barbiturates):- since antiquity alcohol beverages
and potions containing Laudanam & various
herbals have been used to induce sleep.
- Morphine was used for quick management of
aggressive patients. In 1800 mostly wide used
sedative in Asylums.
* In 1857, Bromide was introduced as Sedative &
soon after as hypnotic.
 CONTINUE...

* In 1864 Barbiturates were introduced:-

Barbiturates were widely diverted from medical
use on the street in the 60s where they were
called as ‘downers’ & sold under different variety
names.
Barbiturates have Low therapeutic index & were
often used in for suicides.
* In 1990s these are replaced by
Benzodiazepines:- 1961 introduction of
chlordiazepoxide by Stern Back was invented.
 OTHER Z- DRUGS ...

* Methaqualone and Meprobamate were used in

the 60s that is ‘ Non Barbiturate Transquilizer’.
In 1951:- Methaqualone was synthesized in India
as Antimalarial.
In 1965:- The most commonly prescribed
Sedative in Britain.
In 1972:- The 6th best selling sedative in USA
discontinued in 1985. Now Z-drugs are to be
replaced by BDZs to treat symptoms i.e,
Insomnia and Anxiety.
 CLASSIFICATION OF SEDATIVE
HYPNOTICS / ANXIOLYTICS......
1) Benzodizepines:-
a) Short acting:- Oxazepam , Midazolam
b) Immediate acting:- Alprazolam , Lorazepam ,
Nitrazepam.
c) Long acting:- Diazepam , Clonazepam ,
Flurazepam and Chlordiazepoxide.
2) Barbiturates:-
a) Ultra Acting:- Thiopentone
b) Short acting:- Pentobarbitone
c) Long acting:- Phenobarbitone
 CONTINUE..

3) Micellanous agents:-
a) Anxiolytics:- Antidepressants like
TCAs,SSRIs,MAOIs and Dopaminergic
antidepreesants.
b) Hypnotics:- Z Drugs like Methaqualone and
Antihistaminics like Doxepin.
DIFFERENCE B/W ANXIOLYTICS &
HYPNOSEDATIVES..
* Anxiety is an unpleasant state of tension ,
apprehension or uneasiness that arises from
either a known or unknown source.
* Anxiolytics drugs are the agent which reduces
the worriness manifested as the psychic
awareness of anxiety which is accompanied with
increased vigilance , motor tension and
hyperactivity.
* whereas sedatives that don’t induce sleep or
reduce excitment calms the patient. Sedative in
therapeutic dose are anxiolytics.
 CONTINUE..

* Most sedatives in higher doses produce

hypnosis. Site of action is on the Limbic system
which regulates thought and mental function.
* Whereas Hypnotics are the drugs which
produces sleep resembling natural sleep.
They’re used for inintiation of sleep. Hypnotics
in higher doses produces action of general
anesthesia. Site of action is Midbrain Ascending
RAS which maintains wakfulness.
 BENZODIAZEPINES..
* Anxiolytics and Hypnosedatives are also called
as minor transquilizers. Most of them belong to
the benzodiazepines group of drugs.
# INDICATIONS:-
* Anxiety disorders
* Insomnia
* Depression
* Panic disorders & Social phobias
* PTSD and Bipolar disorder
* OCDs , Substance abuse and in Alcohol
withdrawl .
 DOSAGE AND ROUTE...

a) Alprazolam:- 0.5-6 PO
b) Oxazepam:- 15-120 PO
c) Lorazepam:- 2-6 PO/IV/IM
d) Diazepam:- 2-10 PO/IM/Slow IV
e) Clonazepam:- 0.5-20 PO/IM
f) Chlordiazepoxide:- 15-100 PO; 50-100 slow IV
g) Nitrazepam:- 5-20 PO
 MECHANISM OF ACTION..

* Benzodiazepines bind to specific sites on

the GABA receptors and increase GABA level.
* Since GABA is an inhibitory
neurotransmitter, it has calming effect on the
cebtral nervous system , thus reducing
anxiety.
 SIDE EFFECTS ..

1) Nausea and vomiting

2) Weakness , Vertigo
3) Blurring of vision , Epigastric pain
4) Ataxia , Retrograde Amnesia
5) Dry mouth
6) Diarrhoea
7) Impairment driving skills
 NURSE‘S RESPONSIBITY...
* Administer with food to minimize gastric
irritation.
* Advise the patieht to take medication exactly as
directed. Abrupt withdrawl may cause insomnia ,
irritability and sometimes even seizures.
* Explain about the adverse effects and advise
him to avoid activities that requires alertness.
* Caution the patient to avoid alcohol along with
BDZs.
* If IM is preferred give deep IM; if IV then don’t
mix with any other drug, give slow IV check resp
or cardiac activity.
 BIBLIOGRAPHY...

* Textbook of Mental Health and

Psychiatric Nursing published by
Jaypee publisher by R. Sreevani
edition 4th page no. 133-134