Anxiolytics and antabuse ppt ,,,, ,,,,,,,,,,,,,,,,,,,,,

1. ANXIOLYTICS
&ANTABUSE DRUGS

2. INRODUCTION
o Anxiolytics or Antianxiety agents are used to treat overt anxiety
and somatic complaints . Barbiturates were effective in
decreasing anxiety , but they were additives in and lethal in
overdose. Anti anxiety drugs are also called anxiolytics and minor
tranquilizer.
o Antabuse drugs or disulfiram is a medicine used in the treatment
of patients with alcohol misuse. This effect is used in the
treatment of patients with alcohol problems . Its chemical name is
Tetraethyithiuram disulfide.

3. ANXIOLYTICS DRUGS

4. DEFINITON
Anxiety is a state which occurs in all human beings at
sometime or the other. It is also a cardinal symptom of
many psychiatric conditions . The drugs used to relieve
anxiety are called ANTIANXIETY OR ANXIOLYTICS
AGENTS . Antianxiety drugs relieve moderate to severe
anxiety and tension.

5. USES
Antianxiety agents are used to relieve mild, moderate
and severe anxiety associated with : emotional
disorders physical disorders and excessive
environmental stress neuroses.
For control of alcohol withdrawals symptoms.
To control convulsions
To produce skeletal muscle relaxation.

6. MODE OF ACTION
 Non – barbiturate benzodiazepines act as CNS depressants . It is
believed that these drugs increase or help the inhibitory
neurotransmitter action of gama – aminobutyric acid (GABA).This
GABA mediates both presynaptic and postsynaptic inhibition in
all areas of CNS. So, there is inhibition or control on the cortical
and limbic system of the brain , which is responsible for emotions
such as rage and anxiety.

7. Classification
Drugs that are classified into 3 that are:
1. Barbiturates
2. Non- barbiturates , non- benzodiazepines anti anxiety agents
3. Benzodiazepines

8. 1.barbiturates
Barbiturates exert an anxiolytic effect linked to the sedation they
cause . The risk of abuse and addiction is high . Many experts
consider these drugs obsolete for treating anxiety but valuable
for the short term treatment of severe insomnia , though only
after benzodiazepines or non benzodiazepines have failed.

9. Barbiturates : Example, Phenobarbital,
pentobarbital ,secobarbital and thiopentone.
CONTI…
.

10. 2.Non – Barbiturates , non –
benzodiazepines Antianxiety agents
 Example, meprobamate glutethimide ,
ethanol, Diphenhydramine and
methaqualone.

11. 3. Benzodiazepines
Sometimes called “benzos ”, presently
benzodiazepines are the drugs of first choice
in the treatment of anxiety , and for the treat ,
ent of insomnia.
 Very short acting : eg, Triazolam, Midazolam.
 Short acting : eg , Oxazepam ( serepax),
Lorazepam (Ativan, trapex ).
 Long acting : eg, Cnlordiazepoxide (
Librium),Diazepam (vallium, calmpose).

12. CONTI…
Benzodiazepines are highly effective in treating anxiety
and insomnia due to the sleep inducing , sedative and
muscle relaxing properties . While considering safe for
short – treatment , long term or illict use can lead to
the tolerance , addiction, and with drawal symptoms
upon cessation or rapid reduction in use.

13. INDICATIONS FOR
BENZODIAZEPINES
 Anxiety disorders
 Insomnia
 Depression
 Panic disorder and social phobia
 Bipolar disorder
 Post traumatic stress disorder

14. SIDE EFFECTS
 Nausea
 Vomiting
 Weakness
 Vertigo
 Blurring of vision
 Sedation

15. MECHANISM OF
ACTION
 Benzodiazepines bind to specific sites on the
GABA receptors and increase GABA level .
Since GABA is an inhibitory neurotransmitter, it
has a calming effect on the central nervous
system , thus reducing anxiety.

16. Nurses responsibility in the
administration of
benzodiazepines
Administer with food to minimize gastric irritation.
Explain about adverse effects and advise him to avoid
activities that requires alertness.
If IM administration is preferred give deep IM.
Advice the patient to take medication exactly as directed.
Abrupt withdrawal may cause insomnia ,irritability and
sometimes even seizures.

17. NURSES ROLE IN ANTI
ANXIETY DRUGS
 Assessment of the patient , if the patients complains of
sleep disturbance the causative factor should be
identified.
 Look for side effects , record and report immediately.
 Give I/M injection deep into muscles to prevent irritation.
 Instruct the patient not to take any stimulants like coffee ,
alcohol as they aiter the effects of drugs.

18. CONTI…
while administering the drugs daily should be given at bed time
to promote a normal sleep pattern , so that day time activites
are not affected.
 Appropriate nursing measures to induce sleep should be taken
such as calm and quiet environment, a cup of hot milk , good
back care , allowing the patient to read magazines , sitting with
the patient for sometime for reassurance purpose.

19. ANTABUSE DRUGS

20. DEFINITION
Disufiram is used to ensure abistence in the treatment
of alcohol dependence. Its main effect is to produce a
rapid and violently unpleasant reaction in a person
who ingests even a small amount of alcohol while
taking disulfiram.

21. Mechanism of action
Disuifirm is an aldehyde dehydrogenase inhibitor that interfers
with the metabolism of alcohol and produces a marked increase
in blood acetal dehyde levels. The accumulation of acetaldehyde
(to a level of 10 times more than that which occurs in the normal
metabolism of alcohol) produces a wide array of unpleasant
reactions called the disulfirm ethanol reaction (DER) ,
characterized by nausea, vomiting,hypotension, sweating ,
dyspnea, blurred vision and a sense of impending doom
associated with severe anxiety.

22.  Side effects
The side effects of disulfirm in the absence of alcohol
consumption that are:
 Fatigue
 Dermatitis
 Impotence
 Optic neuritis
 Mental changes
 Acute polyneuropathy

23.  CONTINUED…
Hepatic damage
With alcohol consumption the intensity of the
disulfirm alcohol reactions varies with each
patient .In extreme cases it is marked by
convulsions , respiratory depression ,
cardiovascular collapse , myocardial infaraction
and death.

24. Contra indications
 Pulmonary and cardiovascular disease.
 Disulfirm should be used with caution in patients with
nephritis , brain damage, hypothyroidism
,diabetes,hepatic disease, seizures, poly drug
dependance or an abnormal electroencephalogram.
 Patients at high risk of of alcohol ingestion.

25. DOSAGE
Disulfirm is supplied in tablets of 250 and 500 mg .
The usual intial dose is 500 mg/day orally for the first
two weeks, followed by a maintance dosage of 250
mg/day. The dosage should not exceed 500mg/ day.

26. NURSES RESPONSIBITILTY
 An informed consent should be taken before starting
treatment.
 Ensure that at least 12 hours have elapsed since the last
ingestion of alcohol before administering the drug.
 Patient must be instructed that ingestion of even the smallest
amount of alcohol brings on a disulfiram ethanol reaction with
all its unpleasant effects ; he should therefore be strictly
warmed not to take any alcohol whatever.

27. Continued…
 Caution patient against taking CNS depressants or
any OTC (over the counter) medications during
disulfiram therapy.
 Instruct patient to avoid driving or other activities
requiring alertness until response to drug is
unknown.
 Patients should be warned that the disulfiram alcohol
reaction may continue for as long as 1to 2 weeks
after the last dose of disulfiram.

28. CONCLUSION
 Anxiolytic – hypnotics agents are used to alter an individual’s
responses to environmental stimuli. These agents are referred
to as anxiolytics (prevent feelings of tension or fear),sedatives
(help patient feel calm and unaware of their environment),
and hypnotics (help patients sleep).
 The drug disufirm is used in conjunction with other alcohol
dependency treatment methods . The chemotherapeutic
purpose of the drug is to assist the client to control or not to
act on the impulse to drink.

29. THANK YOU