By definition, a psychotherapeutic drug or a psychotropic drug is one that is used to treat
disorders of the mind. The types of psychotherapeutic drugs used to
treat mental illness include:
• Antianxiety drugs (tranquilizers);
• Antidepressant drugs; and
• Antipsychotic drugs.
Anxiety is a feeling of apprehension, worry, or uneasiness that may or may not be based on reality.Anxiety may be seen in many types of situations, ranging from the anxiety that may accompany one’s employment to the acute anxiety that may be seen during withdrawal from alcohol. Although a certain amount of anxiety is normal, excess anxiety interferes with day-to-day functioning and can cause undue stress in the lives of certain individuals.
Drugs used to treat anxiety are called antianxiety drugs. Another term that refers to the
antianxiety drugs is anxiolytics.
Antianxiety drugs include the benzodiazepines and the nonbenzodiazepines. Examples of the
benzodiazepines include alprazolam (Xanax), chlordiazepoxide (Librium),
clorazepate (Tranxene), diazepam (Valium), lorazepam (Ativan), and oxazepam (Serax).
All benzodiazepines are classified as Schedule IV in the Controlled Substances
Act by the Drug Enforcement Agency (DEA) regulations (see Chap. 1). Nonbenzodiazepines
useful as antianxiety drugs are buspirone (BuSpar), hydroxyzine (Atarax), and
zolpidem (Ambien).
ACTIONS
The exact mechanism of action of the antianxiety drugs is not fully understood. However,
it is believed that the benzodiazepines exert their tranquilizing effect by potentiating the effects
of gamma-aminobutyric acid (GABA),
an inhibitory transmitter, by binding to the specific benzodiazepine receptor sites.
Nonbenzodiazepines exert their action in various ways. For example, buspirone is
thought to act on the brain’s dopamine and serotonin receptors. Hydroxyzine (Atarax)
produces its antianxiety effect by acting on the hypothalamus and brain stem
reticular formation.
USES
Antianxiety drugs are used in the management of anxiety disorders and short-term treatment
of the symptoms of anxiety. Long-term use of these drugs is usually not
recommended because prolonged therapy can result in drug dependence and serious withdrawal
symptoms.
Some of these drugs may have additional uses as sedatives, muscle relaxants, anticonvulsants,
and in the treatment of alcohol withdrawal. For example, clorazepate (Tranxene) and
diazepam (Valium) are used as anticonvulsants
ADVERSE REACTIONS
Transient, mild drowsiness is commonly seen during the first few days of treatment with
antianxiety drugs.
Discontinuation of therapy because of the undesirable effects of the antianxiety agent is rare.
Depending on the severity of anxiety or other circumstances, it may be desirable to allow some
degree of sedation to occur during early therapy. Other adverse reactions include
lethargy, apathy, fatigue, disorientation, anger, restlessness, constipation, diarrhea, dry mouth, nausea,
visual disturbances, and incontinence. Some adverse reactions may be seen only when higher dosages are
used.
Dependence
Long-term use of antianxiety drugs may result in physical drug dependence (addiction) and
tolerance (increasingly larger dosages required to obtain the desired effect).
Withdrawal syndrome has occurred after as little as 4 to 6 weeks of therapy with a benzodiazepine. Withdrawal syndrome is more likely to occur when the benzodiazepine is taken for 3 months or
more and is abruptly discontinued. The antianxiety drugs must never be discontinued
abruptly because withdrawal symptoms,
which can be extremely severe, may occur. The onset of withdrawal symptoms is usually
within 1 to 10 days after discontinuing the drug, with the duration of withdrawal
symptoms from 5 days to 1 month. Some antianxiety drugs, such as buspirone (BuSpar),
seem to have less abuse potential and less effect on motor ability and cognition than that
of the other antianxiety drugs.
CONTRAINDICATIONS
The antianxiety drugs are contraindicated in patients with known hypersensitivity, psychoses,
acute narrow-angle glaucoma, and shock. These drugs are also contraindicated in patients in
a coma or with acute alcoholic intoxication with depression of vital signs.
The benzodiazepines are Pregnancy Category D drugs,and the drug metabolite freely crosses
the placenta. Use of these drugs during pregnancy is contraindicated
because of the risk of birth defects or neonatal with drawal syndrome manifested by irritability
tremors and respiratory problems. The benzodiazepines are contraindicated during labor because
of reports of floppy infant syndrome manifested by sucking difficulties,
lethargy, and hypotonia. Lactating women should also
avoid the benzodiazepines because of the effect on the
infant, who becomes lethargic and loses weight.
PRECAUTIONS
Antianxiety drugs are used cautiously in patients withimpaired liver or kidney function and in elderly anddebilitated patients. The metabolism of the benzodiazepines is slowed in the liver, increasing the risk of benzodiazepine toxicity. Lorazepam and oxazepam are the only benzodiazepines whose elimination is not significantly affected by liver metabolism. Two nonbenzodiazepines are Pregnancy Category B drugs (buspirone and zolpidem); hydroxyzine is a Pregnancy
Category C drug. No adequate studies have been performed in pregnant women. These drugs should be used during pregnancy only when clearly needed and when the potential good would outweigh any harm to the fetus.
INTERACTIONS
Central nervous system (CNS) depressants such as alcohol, narcotic analgesics, tricyclic
antidepressants, and the antipsychotic drugs, increase the sedative effects of the antianxiety drugs.
Combination of any of these drugs with the antianxiety drugs is dangerous and can cause serious
respiratory depression and profound sedation. Ingestion of alcohol
with the antianxiety drugs can cause convulsions and coma.
Buspirone causes less additive CNS depression than do the other antianxiety drugs.
However, it is recommended that concurrent use with a CNS depressant be
avoided. Buspirone may increase serum digoxin levels,
which increases the risk of digitalis toxicity.
disorders of the mind. The types of psychotherapeutic drugs used to
treat mental illness include:
• Antianxiety drugs (tranquilizers);
• Antidepressant drugs; and
• Antipsychotic drugs.
Anxiety is a feeling of apprehension, worry, or uneasiness that may or may not be based on reality.Anxiety may be seen in many types of situations, ranging from the anxiety that may accompany one’s employment to the acute anxiety that may be seen during withdrawal from alcohol. Although a certain amount of anxiety is normal, excess anxiety interferes with day-to-day functioning and can cause undue stress in the lives of certain individuals.
Drugs used to treat anxiety are called antianxiety drugs. Another term that refers to the
antianxiety drugs is anxiolytics.
Antianxiety drugs include the benzodiazepines and the nonbenzodiazepines. Examples of the
benzodiazepines include alprazolam (Xanax), chlordiazepoxide (Librium),
clorazepate (Tranxene), diazepam (Valium), lorazepam (Ativan), and oxazepam (Serax).
All benzodiazepines are classified as Schedule IV in the Controlled Substances
Act by the Drug Enforcement Agency (DEA) regulations (see Chap. 1). Nonbenzodiazepines
useful as antianxiety drugs are buspirone (BuSpar), hydroxyzine (Atarax), and
zolpidem (Ambien).
ACTIONS
The exact mechanism of action of the antianxiety drugs is not fully understood. However,
it is believed that the benzodiazepines exert their tranquilizing effect by potentiating the effects
of gamma-aminobutyric acid (GABA),
an inhibitory transmitter, by binding to the specific benzodiazepine receptor sites.
Nonbenzodiazepines exert their action in various ways. For example, buspirone is
thought to act on the brain’s dopamine and serotonin receptors. Hydroxyzine (Atarax)
produces its antianxiety effect by acting on the hypothalamus and brain stem
reticular formation.
USES
Antianxiety drugs are used in the management of anxiety disorders and short-term treatment
recommended because prolonged therapy can result in drug dependence and serious withdrawal
symptoms.
Some of these drugs may have additional uses as sedatives, muscle relaxants, anticonvulsants,
and in the treatment of alcohol withdrawal. For example, clorazepate (Tranxene) and
diazepam (Valium) are used as anticonvulsants
ADVERSE REACTIONS
Transient, mild drowsiness is commonly seen during the first few days of treatment with
antianxiety drugs.
Discontinuation of therapy because of the undesirable effects of the antianxiety agent is rare.
Depending on the severity of anxiety or other circumstances, it may be desirable to allow some
degree of sedation to occur during early therapy. Other adverse reactions include
lethargy, apathy, fatigue, disorientation, anger, restlessness, constipation, diarrhea, dry mouth, nausea,
visual disturbances, and incontinence. Some adverse reactions may be seen only when higher dosages are
used.
Dependence
Long-term use of antianxiety drugs may result in physical drug dependence (addiction) and
tolerance (increasingly larger dosages required to obtain the desired effect).
Withdrawal syndrome has occurred after as little as 4 to 6 weeks of therapy with a benzodiazepine. Withdrawal syndrome is more likely to occur when the benzodiazepine is taken for 3 months or
more and is abruptly discontinued. The antianxiety drugs must never be discontinued
abruptly because withdrawal symptoms,
which can be extremely severe, may occur. The onset of withdrawal symptoms is usually
within 1 to 10 days after discontinuing the drug, with the duration of withdrawal
symptoms from 5 days to 1 month. Some antianxiety drugs, such as buspirone (BuSpar),
seem to have less abuse potential and less effect on motor ability and cognition than that
of the other antianxiety drugs.
CONTRAINDICATIONS
The antianxiety drugs are contraindicated in patients with known hypersensitivity, psychoses,
acute narrow-angle glaucoma, and shock. These drugs are also contraindicated in patients in
a coma or with acute alcoholic intoxication with depression of vital signs.
The benzodiazepines are Pregnancy Category D drugs,and the drug metabolite freely crosses
the placenta. Use of these drugs during pregnancy is contraindicated
because of the risk of birth defects or neonatal with drawal syndrome manifested by irritability
tremors and respiratory problems. The benzodiazepines are contraindicated during labor because
of reports of floppy infant syndrome manifested by sucking difficulties,
lethargy, and hypotonia. Lactating women should also
avoid the benzodiazepines because of the effect on the
infant, who becomes lethargic and loses weight.PRECAUTIONS
Antianxiety drugs are used cautiously in patients withimpaired liver or kidney function and in elderly anddebilitated patients. The metabolism of the benzodiazepines is slowed in the liver, increasing the risk of benzodiazepine toxicity. Lorazepam and oxazepam are the only benzodiazepines whose elimination is not significantly affected by liver metabolism. Two nonbenzodiazepines are Pregnancy Category B drugs (buspirone and zolpidem); hydroxyzine is a Pregnancy
Category C drug. No adequate studies have been performed in pregnant women. These drugs should be used during pregnancy only when clearly needed and when the potential good would outweigh any harm to the fetus.
INTERACTIONS
Central nervous system (CNS) depressants such as alcohol, narcotic analgesics, tricyclic
antidepressants, and the antipsychotic drugs, increase the sedative effects of the antianxiety drugs.
Combination of any of these drugs with the antianxiety drugs is dangerous and can cause serious
respiratory depression and profound sedation. Ingestion of alcohol
with the antianxiety drugs can cause convulsions and coma.
Buspirone causes less additive CNS depression than do the other antianxiety drugs.
However, it is recommended that concurrent use with a CNS depressant be
avoided. Buspirone may increase serum digoxin levels,
which increases the risk of digitalis toxicity.
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Ditulis oleh:
Unknown - Sunday, 25 April 2010
