anxiety

Question 1

what is anxiety

Answer 1

• a very common disorder that can occur with everyday events
• an intense, excessive, and persistent worry and fear about everyday situations
• most ommon of the mental disorders
• a common emotion

Question 2

name some different types of anxiety

Answer 2

• generalized anxiety disorder
• social anxiety disorder
• panic disorder
• obsessive compulsive disorder

Question 3

describe the pathophysiology of anxiety

Answer 3

• exact cause is unknown
• environmental stressors
• possible imbalances among neurotransmitters (excess norepi or GABA)
• general medical conditions

Question 4

what are the clinical manifestations of anxiety

Answer 4

physical: motor tension, muscle tension, restlessness, trembling, palpitations, tachycardia, seating, dry mouth

psychological: excessive worry, hypervigilance, racing thoughts, impaired concentration

behavioral: avoidance, obsessive or compulsive, distress in social situations

these differ slightly between the different disorders

Question 5

what drugs are used for anxiety

Answer 5

• antidepressants
• benzos

Question 6

describe antidepressants

Answer 6

• SSRIs and SNRIs
• first line treatment
• effective and safer
• 4-6 weeks for full effect

Question 7

describe benzos

Answer 7

• immediate relief
• used for short term treatment of anxiety
• habit forming
• increase effects of neurotransmitters

Question 8

give examples of benzodiazepines

Answer 8

diazepam

clonazepam, lorazepam, alprazolam, etc

Question 9

describe the action of benzodiazepines

Answer 9

facilitating the binding of the inhibitory neurotransmitter GABA at various GABA receptors throughout the CNS

Question 10

what are benzodiazepines used for

Answer 10

short term treatment for anxiety disorders

Question 11

whats the IV onset of benzodiazepines

Answer 11

1-5 minutes

start with low dose and use caution in older adults

Question 12

what are some adverse effects of benzodiazepines

Answer 12

• CNS depression

black box warning: resp failure if used in combo with opioid analgesics or other CNS depressants and risk for abuse and dependence

Question 13

what are some contraindications of benzodiazepines

Answer 13

• resp compromise
• liver/kidney disease
• history of alcohol or other drug abuse

Question 14

describe administration of benzodiazepines

Answer 14

• reversal agent: flumazenil
• PO can be given with/without food
• IV: undiluted and push slow (5mg/5min)
• pre/post assessment (based on route and onset)
• closely monitor resp status

Question 15

what are some nursing implications of benzodiazepines

Answer 15

• use caution with combo of opioids and other CNS depressants (antidepressants, antpscyhotics, sedatives, antihistamines, alchol)
• use caution with long acting vs short acting oncet (maintenance vs breakthrough)
• utilize nonpharmacologic options (counseling)
• wean to oral medication

Question 16

describe patient education for benzodiazepines

Answer 16

• take only as prescribed
• do not share drugs with others
• take with a glass of water and food if GI upset occurs
• do not stop abruptly
• do not crush or chew pills
• dispose of drug properly
• dont drive

Question 17

a woman is receiving treatment for acute short term anxiety with some benzos. the nurse should teach which of the following?

1. monitor serum glucose
2. avoid alcohol
3. take with food
4. expect a delay in therapeutic effects of several weeks

Answer 17

2. avoid alcohol

combining alcohol can lead to excessive drowsiness, difficulty breathing, and potentially serious adverse drug effects

Question 18

flumazenil is the treatment of choice for patients who have which of the following conditions?

1. severe agitation
2. schizophrenia
3. benzo OD
4. opioid dependence

Answer 18

3. benzo OD

flumazenil is a benzo antagonist that interacts with GABA receptors to reverse overdose