anxiolytics

1. Introduction
• Anxiety It is an emotional state, unpleasant in nature,
associated with uneasiness (a fear that seems to arise from a
unknown source), discomfort and concern or fear about some
defined or undefined future threat.
• Some degree of anxiety is a part of normal life. Treatment is
needed when it is disproportionate to the situation and
excessive.

2. Anxiety
• Some psychotics and depressed patients
also exhibit pathological anxiety.
• The physical symptoms of severe anxiety are
similar to those of fear (such as tachycardia,
sweating, trembling, and palpitations) and
involve sympathetic activation.

3. Types of anxiety
✘ GAD.
✘ PTSD.
✘ PHOBIAS.
✘ OCD.

4. Definition (Anti Anxiety)
✘ A class of drugs used to clam down the person,
by reducing the anxiety.
✘ These drugs also induce sedations (Hypnotic
Property).
✘ Also known as Anxiolytics, Minor tranquilizers.

5. Classification
A. Long
lasting-
Act more than
8 hr.
(Phenobarbital)
B.
Intermediate-
Act up to 5-8
hr.
(Amitobarbital)
C. Short
Acting-
up to 1- 5 hr.
(Secobarbital)
D. Ultra short-
Less than 1 hr.
Barbiturates
1. Carbamites-
(Metrobmate) Have
dependance & Abuse.
2. Peperidinendinones-
Glutethemide. Now days
baned because of
dependance.
3. Alcohol- Ethanol.
4. Quinazoline
Derivatives-
Methaqualone
5. Antihistamin-
Dyphenaylhydramine.
6. Beta Blockers- helpful
in situaltional and
anticipatory anxiety.
Propanolol is common
drug
NON
Barbiturates
1. Very Short
Acting-
Midazolam
2. Short
Acting-
Alprazolam.
3. Long
Acting-
Chlordizapoxi
de
Benzo
diazepams

6. Indications of Benzodiazepines
✘ GAD, Adjustmental
problem with anxious
mood.
✘ Panic disorder- Agro
phobia, school phobia.
✘ Agitated depression
(Along with
Antidepressants).
✘ Insomnia.
✘ Convulsion.
✘ Pre anesthetics.
✘ Minor surgeries.
✘ Acute mania.
✘ Antipsychotic induced
akathesia.
✘ EMR treatment for acute
psychosis.

7. Mechanism of action

8. Cont…
No receptors
• Cl- channel are closed,
receptors are inactive no
transmission.
Receptor binding
GABA
• Binding of GABA open the chloride channel
opening which Lead to hyper polarization.
Receptor binding
GABA &
Benzodiazepines
• Binding of GABA by BZN, resulting in greater entry
of chloride ions
• Entry of Cl– hyperpolarizes the cell, making it more
difficult to depolarize, & therefore reduces neural
excitability.
• Facilitate tha GABA release leads to relive from
anxiety and pt. feel calm.

9. Effect of BZN on GABA
✘ BZN acts on GABA-a alpha Sub unit.
✘ This acts leads to a variety of effect.
✘ Such as-
 Sedation.
 Anxiolytics.
 Muscle relaxation.
 Potentiate alcohol effect.

10. ✘ Anxiolytics- By binding GABA at amygdala BZN
causes Anti Anxiety effect (Alpha-2).
✘ Hypnotic Effect- BZN produce sleep by binding
GABA- A receptor at VLPO, causing
sleepiness(Alpha-1).
Effect

11. Side effects
✘ Nausea vomiting.
✘ Weakness.
✘ Epigastric pain.
✘ Diarrhea.
✘ Blurred vision.
✘ Urinary incontinence.
✘ Sedation.
✘ Retrograde amnesia.
✘ Impaired driving skill.
✘ Dependence and
withdrawal syndrome.

12. Nursing consideration
Assessment and intervention for-
✘ Cognitive function.
✘ Accidental prevention.
✘ Dependence and withdrawal.
✘ Hydration and oral hygiene.

13. Barbiturates
✘ Acts on alpha and beta receptors.
✘ It enhances the duration of GABA receptor activity by
opening the channel for long time. (whereas BZN
increases the frequency & can act only in the presence of
GABA).
✘ It also decreases the activity of excitatory neuron such as
acetylcholine, Glutamate.

14. ✘ Barbiturates also acts directly same as GABA,
thus this drug can open the channel directly.
✘ This action leads to CNS Depression.
✘ This action leads to narrow therapeutic index.

15. Side Effect
✘ Headache.
✘ Dizziness.
✘ Light Sedation.
✘ Memory Impairment.
✘ Overdose can leads to coma. (Used in physician
induced suicide, euthanasia).

16. Non- Barbiturates.
✘ Synthetic drug which act same as BZN, but
structurally different.
✘ Newer drug in the class.
✘ Action are similar as BZN except theses drug do
not have anti anxiety property (thus the person
experience sleep only.)
✘ E.g are Zolapidine, Zoleplon, Ezapilon.

17. Side Effect
✘ Cognitive Impairment.
✘ Memory loss.
✘ Narcolepsy.
✘ Impaired motor function.