Pharmacologic Profile

General Use

Antianxiety agents are used in the management of various forms of anxiety, including generalized anxiety disorder (GAD). Some agents are more suitable for intermittent or short-term use (benzodiazepines) while others are more useful long-term (buspirone, doxepin, fluoxetine, paroxetine, sertraline, venlafaxine).

General Action and Information

Most agents cause generalized CNS depression. Benzodiazepines may produce tolerance with long-term use and have potential for psychological or physical dependence. These agents have NO analgesic properties.

Contraindications

Hypersensitivity. Should not be used in comatose patients or in those with pre-existing CNS depression. Should not be used in patients with uncontrolled severe pain. Avoid use during pregnancy or lactation.

Precautions

Use cautiously in patients with hepatic impairment, severe renal impairment, or severe underlying pulmonary disease (benzodiazepines only). Use with caution in patients who may be suicidal or who may have had previous drug addictions. Patients may be more sensitive to CNS depressant effects; dosage ↓ may be required.

Interactions

Mainly for benzodiazepines; additive CNS depression with alcohol, antihistamines, some antidepressants, opioid analgesics, or phenothiazines may occur. Most agents should not be used with MAO inhibitors.

Nursing Implications

Assessment

• Monitor BP, pulse, and respiratory status frequently throughout IV administration.
• Prolonged high-dose therapy may lead to psychological or physical dependence. Restrict the amount of drug available to patient, especially if patient is depressed, suicidal, or has a history of addiction.
• Assess degree of anxiety and level of sedation (ataxia, dizziness, slurred speech) before and periodically throughout therapy.

Potential Nursing Diagnoses

• Risk for injury (Side Effects)
• Deficient knowledge related to disease processes and medication regimen (Patient/Family Teaching)

Implementation

• Patients changing to buspirone from other antianxiety agents should receive gradually ↓ doses. Buspirone will not prevent withdrawal symptoms.

Patient/Family Teaching

• May cause daytime drowsiness. Caution patient to avoid driving and other activities requiring alertness until response to medication is known.
• Advise patient to avoid the use of alcohol and other CNS depressants concurrently with these medications.
• Advise patient to inform health care professional if pregnancy is planned or suspected.

Evaluation/Desired Outcomes

• Decrease in anxiety level.