Pharmacology, part 25: Nervous System Medications for Anxiety

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In this article, we cover nervous system medications that are used for mental health disorders. The Nursing Pharmacology video series follows along with our Pharmacology Flashcards, which are intended to help RN and PN nursing students study for nursing school exams, including the ATI, HESI, and NCLEX.

Cool Chicken When you see this Cool Chicken, that indicates one of Cathy's silly mnemonics to help you remember. The Cool Chicken hints in these articles are just a taste of what's available across our Level Up RN Flashcards for nursing students!

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Anxiety overview

Anxiety is an emotion characterized by feelings of uneasiness, worry, tension, or nervousness. Sometimes, anxiety can become an anxiety disorder. For a general overview on anxiety, check out our article on Psychiatric Mental Health Principles: Stress, General Adaptation Syndrome, and Anxiety. The Psychiatric Mental Health series follows along with our Psychiatric Mental Health Nursing Flashcards.

Benzodiazepines - diazepam (Valium), lorazepam (Ativan), midazolam (Versed), chlordiazepoxide (Librium)

Benzodiazepines such as lorazepam (Ativan), midazolam (Versed), diazepam (Valium), and chlordiazepoxide (Librium) are a class of drugs that produce central nervous system (CNS) depression. They are used to treat a range of conditions including anxiety, seizures, muscle spasms, alcohol withdrawal and the induction and maintenance of anesthesia.

Mode of action

Benzodiazepines, sometimes called by the slang term “benzos,” enhance the effect of the neurotransmitter gamma-aminobutyric acid (GABA) at the GABAA receptor, resulting in sedative, hypnotic (sleep-inducing), anxiolytic (anti-anxiety), anticonvulsant, and muscle relaxant properties.

Side effects

Benzodiazepines can carry some serious side effects including sedation (usually intended), respiratory depression, amnesia, dependency, and withdrawal.

Administration

Benzodiazepines are not designed for long term use and should only be administered for a short period. Patients should NOT abruptly discontinue use as they could experience uncomfortable withdrawal symptoms including anxiety, sweating, nausea and insomnia.

Antidote

It’s important to know that the antidote for benzodiazepines is flumazenil. Flumazenil acts as a benzodiazepine antagonist and is useful in reversing the sedation and respiratory depression that often occur when benzodiazepines are administered to patients undergoing anesthesia or when patients have taken an intentional benzodiazepine overdose.

Cool Chicken Pam takes lorazepam for her anxiety. She doesn’t drive her benz anymore because benzos cause sedation.

Buspirone (Buspar)

Buspirone (Buspar) is an anti-anxiety medication that affects chemicals in the brain that may be unbalanced. Buspirone can be used to treat anxiety, obsessive compulsive disorder (OCD) and post-traumatic stress disorder (PTSD).

Mode of action

Buspirone works by affecting neurotransmitters in the brain such as serotonin and dopamine. It is a serotonin and dopamine agonist, meaning that it increases action at both the serotonin and dopamine receptors in the brain, which in turn helps to alleviate anxiety and anxiety symptoms.

Side effects

Side effects for buspirone are minor compared with what we saw above with benzodiazepines and can include dizziness, nausea, and headache. Sedation is usually not a problem with buspirone.

Administration

Compared to benzodiazepine, buspirone is a better choice for patients that need to take an anti-anxiety medication for the long term. It’s also important to note that buspirone will take several weeks before a patient feels the effects. They should take buspirone as prescribed and not discontinue use too early thinking it’s not working.

Patient teaching

When caring for a patient on buspirone, it is important to counsel them to either always take the medication with food, or always take it without food to prevent a change in how buspirone is absorbed in the body.

It is also important to let the patient know that grapefruit juice should not be consumed while taking buspirone because it is contraindicated with this medication.

Cool Chicken Taking a bus to a pier and sitting quietly helps my anxiety (just like taking buspirone).

Full Transcript: Pharmacology, part 25: Nervous System Medications for Anxiety

In this video, we are going to start in on our nervous system medications, and we will first talk about medications that are used for mental health disorders. So if you are following along with cards, I'm on card 55 in our Pharmacology Flashcards Edition 2.0.

Let's start with talking about medications that can be used to treat anxiety.

One such class are benzodiazepines. So medications that fall within this class include lorazepam, diazepam, midazolam, as well as chlordiazepoxide. A lot of these end in that -pam, but obviously chlordiazepoxide does not, but it does have that -diaze- which helps you to remember that it falls within the class of benzodiazepines.

So benzodiazepines can be used to treat anxiety. They can also be used to treat alcohol withdrawal, muscle spasms, seizures, and they are also used in the induction and maintenance of anesthesia.

The mode of action of benzodiazepines is to increase the effect of GABA in the central nervous system.

There are some serious side effects with this class of medication, which can include sedation, respiratory depression, as well as amnesia, and dependency, and withdrawal.

So these medications are not designed for long-term use. So short-term use only is recommended, and we never want to have our patient abruptly discontinue the use of benzodiazepines.

It's also very important to know what the antidote is for benzodiazepines, which is flumazenil. So it is not naloxone or Narcan, which is the antidote for opioid analgesics. It is flumazenil. So I would definitely remember that.

And then my little silly way to remember this is that Pam has anxiety, and she takes lorazepam for that anxiety. However, she does not drive her Benz anymore, her Mercedes Benz, because of the sedating effect of benzodiazepines.

Now let's talk about another medication that is used for anxiety, which is buspirone or Buspar is the brand name.

Buspirone can be used for anxiety, as well as OCD and PTSD.

It works by binding to serotonin and dopamine receptors in the brain, and it also increases norepinephrine metabolism.

So side effects are definitely more minor than what we saw with benzodiazepines. They can include dizziness, nausea, and headache. Sedation is usually not a problem with buspirone.

So for a patient who needs to use an anti-anxiety medication long term, this is definitely a better choice than benzodiazepines.

However, keep in mind that it takes several weeks before the patient feels the full effects of buspirone, so they're not going to take one pill and immediately feel better. It's going to take several weeks.

Also, you want to counsel your patient that they should always take the medication with food or always take it without food to prevent a change in the absorption of buspirone.

Also, grapefruit juice is contraindicated with this medication.

So my little tip for remembering this is if you take a bus to a pier and sit there quietly, it will help to ease your anxiety, just like the effects of buspirone.

Okay, so that's it for our anxiety-only medications that I'm going to go through. In my next video, we will talk about depression medications, and then in the following video, we'll talk about some medications that are used for both anxiety and depression. Thanks so much for watching!

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