ANXIOLYTICS

PUTU INDRAYONI, S.FARM., M.FARM., APT

 anxiolytic Preanesthetic
drugs

Psychotropic
drugs

antipsychotic antidepressant
 Benzo Rapid onset of action
diazepine
Anxiolytic
Benzodiazepine
Relatively high therapeutic
index, availability of Flumazenil
for treatment of overdose
Nonbenzodiazepine
Low risk of drug interactions
based on liver enzyme
induction
• Risk of Minimal effects on
dependence
• Depression of cardiovascular or autonomic
CNS functions functions
• Amnestic effects
 Mekanisme Aksi
• Meningkatkan efek GABA sehingga
menimbulkan hiperpolarisasi dan
Benzodiazepine menurunkan eksitabilitas neuronal

• Agonis reseptor dopamine dan

serotonin (Buspirone)
Nonbenzodiazepine • Bekerja pada pembentukan hipotalamus
dan brain stem reticular (Hydroxyzine)
 Dependensi

Long –term use

• Addiction
• Tolerance

Withdrawal syndrome
• 4-6 minggu terapi benzodiazepine
• Onset of withdrawal syndrome muncul 1-10 hari setelah putus obat
• Durasinya 5 hari- 1 bulan
 Pemutusan
penggunaan
benzodiazepine
dengan menurunkan
dosis selama 4-8
minggu untuk
mencegah munculnya
withdrawal
symptoms
 Hipersensitif, psychoses, narrow-angle glaucoma, shock
KI
Coma, acute alcoholic intoxication with depression of vital
sign
Risk of birth defects
Pregnancy
Neonatal withdrawal syndrome : irritability tremors &
respiratory problems
Floppy infant syndrome : sucking difficulties, lethargy, hypotonia
Labor

Effect on the infant : lethargic, loses weight

Lactating
women
 Precaution

Metabolismenya di hati lambat

Impaired liver or kidney
sehingga meningkatkan resiko
function
toksisitas benzodiazepine

Lansia
 Preadministration Assessment
• Cek status mental dan tingkat ansietas
• Observasi anxiety symptoms
• Psychomotor agitation (extreme restlessness)
• Facial grimaces
• Tense posture
• Manifestasi fisiologis :
• Peningkatan tekanan darah
• Peningkatan denyut nadi
• Peningkatan laju dan kedalaman respirasi
• Peningkatan ketegangan otot
 Ongoing Assessment
• Cek tekanan darah sebelum pemberian obat. Jika tekanan sistolik
turun 20 mmHg, tunda pemberian obat
• Monitor secara berkala status mental dan tingkat ansietas selama
terapi.
• Lakukan penilaian peningkatan ataupun penurunan gejala fisik dan
perilaku yang sudah diidentifikasi sebelumya
• Prolonged therapy (>3-4 bulan) dapat timbul dependensi
 Pustaka
• Katzung, B. G. 2018. Basic & Clinical Pharmacology. 14th Ed. New York:
McGraw Hill Education Lange, pp. 473
• Whalen, K., Field, C., Radhakrishnan, R. 2019. Lippincott Illustrated
Reviews : Pharmacology. 7th Edition. Philadelphia : Wolters Kluwer.