Anxiolytic and Hypnotic Agents for Different Age Groups
不同年龄组的抗焦虑药和催眠药
CHILDREN 儿童
Use of anxiolytic and hypnotic drugs with children is challenging. The response of the child to the drug may be unpredictable; inappropriate aggressiveness, crying, irritability, and tearfulness are common.
儿童使用抗焦虑药和催眠药很有挑战性。儿童对药物的反应是不可预测的。不恰当的攻击性、哭叫、易怒和泪流满面是普遍现象。
Of the benzodiazepines, only chlordiazepoxide, clonazepam, clorazepate, and diazepam have established pediatric dosages. Some of the others are used in pediatric settings, and dosage may be calculated using age and weight.
The barbiturates, being older drugs, have established pediatric dosages. These drugs must be used with caution because of the often unexpected responses. Children must be monitored very closely for CNS depression and excitability.
在苯二氮卓类药中，只有氯氮卓、氯硝西泮、氯拉卓酸和地西泮等有既定的小儿剂量。至于其他药物，有些也已经用于小孩，但剂量要根据年龄和体重计算。巴比妥酸盐类是一种比较老的药物，它的小孩剂量也是已经确定的。这些药物使用必须谨慎，因为常常会出现一些意想不到的反应。必须密切监测儿童是否出现CNS抑制和兴奋性。
Chloral hydrate is approved for use in children. The potential for adverse effects and the unpleasant taste and odor make the drug less desirable as a sleep agent. The antihistamines diphenhydramine and promethazine are more popular for use in helping to calm children and to induce rest and sleep. Care must be taken to assess for possible dried secretions and effects on breathing. Dosage must be calculated carefully.
水合氯醛已获准用于儿童。作为一种睡眠药，它的潜在不良效应和难耐的味道和气味导致病人不太愿意使用。抗组胺药苯海拉明和异丙嗪在帮助镇静儿童和诱导休息和睡眠方面更受欢迎，但必须仔细评估可能的干燥分泌物以及对呼吸的影响。剂量必须仔细计算。 ADULTS 成人
Adults using these drugs for the treatment of insomnia need to be cautioned that they are for short-term use only. The reason for the insomnia should be sought (e.g., medical, hormonal, or anxiety problems). Other methods for helping to induce sleep—established routines, quiet activities before bed, a back-rub or warm bath—should be encouraged before drugs are prescribed. Adults receiving anxiolytics also may need referrals for counseling and diagnosis of possible causes. Adults should be advised to avoid driving and making legal decisions when taking these drugs. Liver function should be evaluated before and periodically during therapy.
必须提醒用其治疗失眠的成人，这些药物只能短期使用。失眠的原因必须弄清楚（如，医疗问题、激素问题、或焦虑问题等）。处方这些药物前，应鼓励使用其他方法帮助诱导睡眠，如已确立的一些常规做法、就寝前做一些闲适活动、擦背或温水浴等。进行抗焦虑药治疗的成人也需要安排心理咨询，并诊断可能的原因。应建议成人使用这些药物时避免开车和做法律决定。开始治疗及治疗期间应定期进行肝功能检查。
These drugs are contraindicated during pregnancy and lactation because of the potential for adverse effects on the fetus and possible sedation of the baby. The antihistamines, which have not been associated with congenital malformations, may be the safest to use, with caution, if an anxiolytic or hypnotic drug must be used.
妊娠、哺乳期禁忌使用这些药物，因为会对胎儿产生潜在的不良效应，对婴儿产生镇静作用。抭组胺药与先天性畸形无相关性，是最安全的药物，但是，在必须使用抗焦虑药或催眠药时还是要慎重。 OLDER ADULTS 老人
Older patients may be more susceptible to the adverse effects of these drugs, from unanticipated CNS effects to increased sedation, dizziness, and even hallucinations. Dosages of all of these drugs should be reduced and the patient should be monitored very closely for toxic effects and to provide safety measures if CNS effects do occur.
老年患者对这些药物的不良效应，--从意外的CNS效应到镇静增强、头晕、甚至幻觉，更加易感。所有药物的剂量均须减量，必须密切监测其毒性效应，一旦出现CNS效应，应采取安全措施。
Baseline liver and renal function tests should be performed, and these values should be monitored periodically for any changes that would indicate a need to decrease dosage further or to stop the drug.
应行基线肝、肾功能检查，应定期监测这些检验值有无变化，因为变化可能提示需要进一步减少剂量或停药。
Nondrug measures to reduce anxiety and to help induce sleep are important with older patients. The patient should be screened for physical problems, neurological deterioration, or depression, which could contribute to the insomnia or anxiety.
对老年病人来说，用非药物性措施减轻焦虑帮助诱导睡眠很重要。应检查患者是否存在身体问题、神经性退化或抑制症，这些情况都会促进失眠或焦虑。
★Vocabulary for Today ★
challenging – a. 有挑战性的
chlordiazepoxide – n. 氯氮卓
clonazepam – n. 氯硝西泮
clorazepate – n. 氯拉卓酸
diazepam – n. 地西泮
established – a. 已被确认的
barbiturate – n. 巴比妥酸盐
excitability – n. 兴奋性
chloral hydrate – n. 水合氯醛
diphenhydramine – n. 苯海拉明
promethazine – n. 异丙嗪
insomnia – n. 失眠
congenital – a. 先天的
malformation – n. 畸形
deterioration – n. 退化，衰退
1. The client diagnosed with a general anxiety disorder is prescribed alprazolam. Which information should the clinic nurse discuss with the client? Select all that apply.
A. Explain to the client that this medication is for short-term use.
B. Inform the client that rage and excitement are expected side effects.
C. Tell the client to avoid foods that are high in vitamin K.
D. Discuss the importance of not driving due to drowsiness.
E. Instruct the client to take the medication with at least 8 ounces of water.
2. The female client taking lorazepam for panic attacks tells the clinic nurse that she is trying to get pregnant. Which intervention should the nurse implement fi rst?
A. Tell the client to inform the obstetrician she is taking lorazepam.
B. Instruct the client to quit taking the medication.
C. Determine how long the client has been taking the medication.
D. Encourage the client to stop taking lorazepam prior to getting pregnant.
Alprazolam (Xanax), a benzodiazepine, has the potential for dependency, but that potential can be minimized by using the lowest effective dosage for the shortest time necessary. Besides, alprazolam (Xanax) can initially cause drowsiness, so the client should not drive automobiles or use machinery.
2.C. Determine how long the client has been taking the medication.
The nurse should first determine how long the client has been taking lorazepam (Ativan), a benzodiazepine, and what dosage (or how many pills) to determine if the medication can be discontinued abruptly or if it must be gradually decreased.
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