Anxiety Flashcards
Anxiety has four levels
Mild , moderate , severe, and panic
Mild anxiety
Lowest level of anxiety
Part of everyday life - can motivate a person
Symptoms of mild anxiety
*restlessnes
*mild tension
*irritable
*himpatient
* foot / finger tapping
* butterfly feeling
* difficulty sleeping
Moderate anxiety
Moderate anxiety
Thinking clearly can be imparied
Symptoms for moderate anxiety
‘increased heart rate,sweating , headache, frequent uriniation, GI upset, muscle tension , easily irritable / distracted, difficulty concentrating
Severe anxiety
Impaired ability to function
Doesn’t pay attention, doesn’t respond to redirections
Symptoms of sever anxiety
Panic attack, hyperventilating, chest pain, rapid speech, disconnected from reality, diaphoresis” sweating “
Panic anxiety
Highest level
Overwhelming feeling of terror / helplessness
Panic attacks happen sudden and unexpected
Panic anxiety symptoms
Chest pain
Dizziness
Difficulty breathing
Feel like they are dying , going crazy
Distorted perception
Loss rational thought
BENZODIAZEPINES
They work quick - for ACUTE symptoms
Used for short term
It is not giving to elder P.T
BENZODIAZEPINES
THERAPEUTIC CLASS
Sedative hypotonic anxiolytics
Example;
AlprazolAM(xanax), diazepAM(Valium), lorazepAM(Ativan), clonazepAM(Klonopin)
BENZODIAZEPINES INDICATIONS
- Treats anxiety
- Insomnia
- Seizures
- Muscle spasms
Acute anxiety symptoms!!
Benzodiazepines side effects
- CNS depressant
- Drowsiness
- Dizziness
- Impaired coordination
5.memory problems
Can worsen the anxiety *
Can lead to insomnia *
Withdraw effects from benzodiazepines
Anxiety
Insomnia
Diaphoresis (excessive sweating)
Hypertension
Lightheaded
Nursing considerations for BENZODIAZEPINES
Take nap after taking med
Avoid activities that require alertness
Avoid alcohol / other depressants
Fall precaution
Rick for dependency
Reverse adverse effect for BENZODIAZEPINES
Flumazenil
If P.T has glaucoma , can they take benzodiazepines
NO.
CAN LEAD TO PERMANENT VISION LOST!
BUSPIRONE
To treat anxiety disorders
It binds serotonin and dopamine receptors in the brain
Can be used long term (safer )
Takes 2-4 weeks for full effect
(P.T should be educated that it develops slowly)
Low potential fro abuse / dependence
BUSPIRONE side effects
Headache
Dizziness
Drowsiness]nause
Nervousness
Restlessness
Lightheadedness
Nursing considerations for BUSPIRONE
Monitor for depression / suicidal thoughts
It’s metabolized by the LIVER
ST John’s wort med and grapefruit can lead to toxicity / bad effects
SSRI Antidepressant
Serotonin reuptake inhibitors
Increases level of serotonin in the brain -> increased serotonin gives elevated mood and less depression
Takes 4 weeks for therapeutic effect
Take same time everyday
But too much serotonin can lead to serotonin syndrome
Serotonin syndrome
Hyperthermia (Makes you hot ), agitation, confusion, rapid H.R, high BP, sweating , loss coordination, diarrhea, seizures.
It’s a result of excessive serotonin in the body
Symptoms occurs within several hours
Resolved when med is discontinued
Symptoms are
SSRI therapeutic class
Floxetine ( Prozac)
Sertraline (Zoloft )
Paroxetine (Paxil)
Citalopram (celexa)
Escitalopram ( lexapro)
SSRI Indications
Treat anxiety disorders
Depression
OCD
PTSD
Side effects of SSRI
Nausea
Headache
Insomnia
Sexual dysfunction
Drowsiness
Dizziness
Weight gain
Risk of suicidal thought
Withdrawal syndrome - must TAPER dose with long term use
Nursing considerations for SSRI
Can interact with other medications “ANTIPLATELET”, NSAIDS, anticoagulant drugs
Increased risk of bleeding , suicidal thoughts , behavior
Change in mood
P.T. Can grind there teeth , recommend a mouth guard
SNRI ANTIDEPRESSANTS
*Similar to SSRI
*Can NOT take SSRI & SNRI at same time
*Increases serotonin and norepinephrine in brain
*Takes up to 4 weeks for therapeutic effect , take aT same time everyday
SNRI therapeutic class
Serotonin norepinephrine reuptake inhbitor
Venlafaxine (EFFEXOR)
Duloxetine ( CYMBALTA)
Desvenlafaxine (pristiq)
SNRI Indications
Major depressive disorders
Anxiety
Panic disorder
SNRI Side effects
Nausea
Headache
Isnomnia
Sexual dysfunction
Drowsiness
Dizziness
Weight gain
Suicidal risk
Withdrawal syndrome
Tricyclic antidepressants
First anti depressant
TCA does not use anymore bc of major side effects
Takes 10-14 days to work 4-8 weeks for full effect
Narrow therapeutic window = drawing blood
Tricyclic therapeutic class
Amitriptyline (ELAVIL)
Nortriptyline (PAMELOR)
Tricyclic indications
Major depressive disorder, anxiety , panic disorder
Tricyclic side effects
Dry mouth
Blurry vision
Constipation
Dizzy
Weight gain
Hypotension
Urinary retention
Cardiac dysthymia
MAO inhibitor
Only prescribed when nothing else works
Take 1-3 weeks 2-3 months for full therapeutic effect
Diet is needed with this med (avoid tyramine )
It can lead to Hyponatremia (low sodium)
Avoid other medications without telling provider
Taper off med 14 days before surgery
MAO classification
Phenelzine (nardil)
Isocarboxazid ( Marplan)
MAO indication
Treatment to depression when other antidepressants doesn’t work
MAO side effects
Dizziness
Headache
Dry mouth
Constitution
Blurry vision
Sexual dysfunction
Serotonin syndrome
Can you take SNRI & SSRI together
No
