Anxiety Disorders: Medications and Therapies (Nursing)

by Brenda Marshall, EdD, MSN, RN

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    00:00 What kind of anti-anxiety medications do we use? So you may hear anti-anxiety, you may also hear anxiolytics.

    00:09 Antihistamines are used as anti-anxiety medications.

    00:15 And Vistaril is a good example of the antihistamine that is used specifically when a patient has anxiety.

    00:28 We also have benzos, benzodiazepines.

    00:32 They are sedatives like Xanax, Librium, Klonopin, Tranxene, Valium, Ativan, Serax.

    00:40 Other anti-anxiety medications are Azaspirodecanedione, also known as Buspirone, or the carbonate derivatives like Miltown and Equanil, which the generic name is Meprobamate.

    00:55 Beta-blockers are also used to reduce anxiety.

    01:00 Common beta-blockers are Propanalol, which is Inderal and Atenolol which is Tenormin.

    01:08 They become very popular remedies for performance anxiety.

    01:13 One of the other things that you need to be constantly thinking about.

    01:18 With beta-blockers, remember, beta-blockers can cause a drop in blood pressure, which raises a person's fall risk, but also with all of the others with the benzodiazepines that across the lifespan, you want to make sure that that patient is able to take this medication safely, that we're not increasing the fall risk and we are not making them dizzy.

    01:46 We are giving them all of the information they need to know about when to use it, how to use it and how to take care of themselves.

    01:58 Other anti-anxiety medications that are being used are anti-depressants.

    02:03 Fluoxetine, for example, which is Prozac or Sarafem, Citalopram (Celexa), Sertraline which is Zoloft, Paroxetine which is Paxil, Paxeva or Brisdelle, and Escitalopram which is Lexapro.

    02:22 Anti-depressants often work to reduce the anxiety because there are mechanisms are being able to allow the person to just calm their neural pathways.

    02:38 Anticonvulsants like Pregabalin, which is Lyrica are also used as anti-anxiety medications.

    02:48 All of these medications don't just work on the brain, right? If we're working on the brain, we're working on the body.

    02:57 And so we have to be willing to take the time to do the patient education that needs to be done.

    03:04 Our older patients who may be at an increased fall risk already either due to age, to vision, or to other physical problems they may have.

    03:15 We want to make sure that we are documenting, that this education takes place and that the patient is aware and knows how to take these medications safely.

    04:39 Let's think about specific medications that are specific for the anxiety disorders because we've talked about quite a number of anxiety disorders, and it's not one size fits all.

    04:53 So when you think about a person who has general anxiety disorder, or perhaps panic disorder, we're gonna thinking about the anxiolytics, the anti depressants, the anti hypertensives and the anticonvulsants.

    05:08 These have all been demonstrated to be effective in reducing anxiety and GAD and panic disorder.

    05:17 When we're thinking about the phobias, we're looking at the anxiolytics, the anti depressants and the anti hypertensives.

    05:27 If the patient has trichotillomania or the hair pulling, unfortunately, none of the medications that have been identified for all the anxiety disorders have been demonstrated to be.

    05:44 That reduce the hair pulling.

    05:47 But the patients are often treated with an anti depressant, because that sense of depression is sometimes coupled with this behaviour.

    06:03 Antidepressants are the medications that are used for a person with Body Dysmorphic Disorder.

    06:13 There are different types of therapies for persons who have anxiety disorder, not just medications.

    06:21 And in fact, when medications are given, they are always better when they are done alongside of some sort of psychotherapy.

    06:32 Cycle psychotherapy in general is usually talk therapy.

    06:37 Cognitive Therapy is when the patient is engaged in cognitive examination of their automatic behaviours or thoughts.

    06:46 Behavioural Therapy is when we use positive or negative reinforcement to increase a behaviour that is desirable or to extinguish a behaviour that is not desirable.

    07:00 And then there's cognitive behavioural therapy, which is the combination of engaging that patient in examining cognitively their automatic behaviours and then taking a second different type of behaviour trying it out to see if it reduces that anxiety.

    07:21 Now, nurses unless they are specifically trained and usually certified in one of these types of therapies, do not engage in psychotherapy, cognitive behavioural or CBT.

    07:36 These are therapies that are done by trained therapists, some of whom are nurses.

    08:17 Other types of therapy again, always done by trained therapists.

    08:21 One is Systematic Desensitisation, which is relaxation that is combined with progressive exposure, and implosion therapy, which is flooding, which is when you are exposing the patient to the stimulus that causes the anxiety.

    08:38 Systematic Desensitisation and implosion therapy used very effectively.

    08:45 But once again, they are done by trained therapist and the patient is carefully guided through the experience.

    08:56 With persons with anxiety disorders, there are wonderful opportunities for nurses to engage in patient and family teaching.

    09:06 The first area would be to discuss the diagnosis itself.

    09:12 To separate the diagnosis from the person, you are not your obsessions, you are not your compulsions, you are you and these are thoughts and these are behaviours and provide information on recovery from the different anxiety disorders.

    09:35 We want to really examine what are the symptoms that the patient is displaying, that is part of the disorder and identify them and let the patient examine them too.

    09:48 Let the patient start to deal with the fact that these are, their coping mechanisms that have become maladaptive and that they are no longer keeping them from having anxiety.

    10:03 But in fact, they have become a barrier to them having a full and healthy life.

    10:09 You want to explore how to manage the illness with medications as well as behavioural interventions like stress management.

    10:18 It's oftentimes much more fun to engage in a behaviour with others to reduce the stress.

    10:24 For example, running, having a running buddy that you can rely on really helps and it helps you to keep up with it.

    10:35 With my patients, I often ask them on a scale of one to five before you run, how is your stress.

    10:43 And then when you come back from your run on a scale of one to five, how is your stress? It helps them gain the insight that, that running is an intervention that actually successfully lowered their stress level.

    10:59 We're also a resource for our patients.

    11:02 And so we need to be able to have a list of support services that we can make available to our patients and to their families if they need it, like support groups, self help groups, and also psychotherapists that are available, crisis lines and other different types of resources in your community that are available to your patients.

    About the Lecture

    The lecture Anxiety Disorders: Medications and Therapies (Nursing) by Brenda Marshall, EdD, MSN, RN is from the course Anxiety and Anxiety Disorders: GAD, Phobias, OCD, PTSD (Nursing).

    Included Quiz Questions

    1. Antihistamines
    2. Beta-Blockers
    3. Benzodiazepines
    4. Antidepressants
    5. ACE inhibitors
    1. Hydroxyzine
    2. Azaspirodecanedione
    3. Pregabalin
    4. Benztropine
    5. Hydrochlorothiazide
    1. “I know that I will likely be on this medication for the rest of my life.”
    2. “I will avoid drinking alcohol when taking this medication.”
    3. “I will not take this medication before driving.”
    4. “This medication may cause me to become dizzy.”
    1. The student nurse initiates a cognitive behavioral therapy session with the client.
    2. The student nurse takes the client’s blood pressure before dispensing their medications.
    3. The student nurse helps the client read through the worksheet they received during group therapy.
    4. The student nurse encourages the client to try the coping strategies they have been practicing when they endorse feelings of increasing anxiety.
    1. Systematic Desensitization
    2. Implosion therapy
    3. Cognitive behavioral therapy
    4. Progressive muscle relaxation

    Author of lecture Anxiety Disorders: Medications and Therapies (Nursing)

     Brenda Marshall, EdD, MSN, RN

    Brenda Marshall, EdD, MSN, RN

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