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.