Mental Health Nursing unit V

1. Presented by:
Mr. P. Vethadhas M.Sc (N),
Assistant Professor,
Dept.of Mental Health Nursing.

3. Anxiolytics
These are also called as minor tranquilizers. Most of
them belong to the benzodiazepine group of drugs.

4. Classification
1. Barbiturates: Example, phenobarbital, pentobarbital,
secobarbital and thiopentone.
2. Non-barbiturate non-benzodiazepine anti-anxiety
agents: Example, Meprobamate glutethimide, ethanol,
diphenhydramine and methaqualon.

5. Classification
3. Benzodiazepines: Presently benzodiazepines are the drugs of first
choice in the treatment of anxiety, and for the treatment of insomnia.
• Very short-acting: Example, Triazolam, Midazolam.
• Short-acting: Example, Oxazepam (Serepax), Lorazepam (Ativan,
Trapex, Larpose), Alprazolam (Restyl, Trika, Alzolam, Quiet, Anxit)
• Long-acting: Example, Chlordiazepoxide (Librium), Diazepam
(Valium, Calmpose), Clonazepam (Lonazep), Flurazepam (Nindral),
Nitrazepam (Dormin).

6. Indications for Benzodiazepines
Anxiety disorders
Insomnia
Depression
Panic disorder and social phobia
Obsessive-compulsive disorder

7. Indications for Benzodiazepines
Post-traumatic stress disorder
Bipolar I disorder
Other psychiatric indications include alcohol withdrawal,
substance-induced and psychotic agitation

8. Dosage
Alprazolam: 0.5- 6 PO
Oxazepam: 15-120 PO
Lorazepam: 2-6 PO/ IV /IM
Diazepam: 2-10 PO/ IM/ slow IV
Clonazepam: 0.5-20 PO/ IM
Chlordiazepoxide: 15-100 PO ; 50-100 slow IV
Nitrazepam: 5-20 PO

9. 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.

10. Side Effects
Nausea, Vomiting
Weakness
Vertigo
Blurring of vision
Body aches
Epigastric pain
Diarrhea

11. Side Effects
Impotence
Sedation
Increased reaction time
Ataxia
Dry mouth
Retrograde amnesia, Impairment of driving skills
Dependence and withdrawal symptoms (the drug should be withdrawn
slowly, as a result)

12. Nurse's Responsibility in the
Administration of Benzodiazepines
• Administer with food to minimize gastric irritation.
• Advise the patient to take medication exactly as directed. Abrupt
withdrawal may cause insomnia, irritability and sometimes even
seizures.
• Explain about adverse effects and advise him to avoid activities that
require alertness.
• Caution the patient to avoid alcohol or any other CNS depressants
along with benzodiazepines ; also instruct him not to take any over-the-
counter (OTC)medications.

13. Nurse's Responsibility in the
Administration of Benzodiazepines
• If IM administration is preferred give deep IM.
• For IV administration do not mix with any other drug.
• Give slow IV as respiratory or cardiac arrest can occur;
monitor vital signs during IV administration.
• Prevent extravasations since it can cause phlebitis and
venous thrombosis.