Anxiety

Question 1

Other uses for Benzos

Answer 1

Seizure disorders

Insomnia

Muscle spasm

Alcohol withdrawal (prevention and tx of acute symptoms)

Induction of anesthesia

Amnesic prior to surgery

Question 2

Adverse effects of Benzos

Answer 2

CNS depression

Anterograde amnesia

Acute toxicity , Oral - lethargy, confusion. IV - respiratory depression, severe hypotension, cardiac arrest (IV- valium, ativan)

Paradoxial response ( insomnia, excitation, euphoria, anxiety, rage)

Withdrawel effects ( anxiety, insomnia, diaphoresis, tremors, light-headedness)

Question 3

Client teaching (Benzos)

Answer 3

Take as prescribed

Don’t quit suddenly

Take with meal if GI upset

Swallow ER tabs, don’t chew/crush

Advise of dependency potential

Notify Dr of withdrawel symptoms

Question 4

Med/Food Interactions(Benzos)

Answer 4

Don’t mix with CNS depressants (alcohol, barbiturates, opiates) - may cause respiratory depression

Question 5

Benzodiazepine Sedative Hypnotic Anoxiolytics

Answer 5

diazepam (Valium)

alprazolam (Xanax)

clonazepam (Klonopin)

lorazepam (Ativan)

chlordiazepoxide (Librium)

clorazepate (Tranxene)

oxazepam (Serax)

Question 6

AntiAnxiety/Non-Barbiturate

Answer 6

buspirone (BuSpar)

Less chance of dependency.

Does not increase CNS depressant effects.

Does not cause sedation.

Used for: Panic, OCD, Social anxiety, PTSD

SE: dizziness, nausea, HA, agitation

Question 7

What other drugs are sometimes used to treat anxiety?

Answer 7

Beta-blockers, antihistamines, and anticonvulasants

Question 8

Short acting sedative-Hypnotic sleep agents

(Benzodiazepine-like drugs)

p395 Lehne

Answer 8

zolpidem (Ambien)- short term use. Rapid onset - will help falling asleep. Ambien CR will help maintain sleep.

zaleplon (Sonata)- short term use. Rapid onset, short duration of action. Helps falling asleep but not maintaining sleep. Useful middle of night sedative, no hangover.

eszopiclone (Lunesta)- no time limit on use. Reduces time to get to sleep and nightime awakening.

Question 9

Side Effects of zolpidem (Ambien)

Short acting sedative-hypnotic/Benzo like drug

Answer 9

Increase effects of other CNS depressants (alcohol, barbiturates, opiods)

Daytime drowsiness, dizziness, sleep driving, sleep related complex behaviors

Client teaching: No alcohol, barbituates, or opiods

Question 10

Side effects of zaleplon(Sonata)

Short acting sedative/Benzo like drug

Answer 10

H/A, nausea, drowsiness, dizziness, myalgia, abd pain, sleep driving

Mild rebound insomnia after drug withdrawel

cimetidine can increase Sonata levels

Question 11

Side effects of eszopiclone(Lunesta)

Short acting sedative/Benzo like drug

Answer 11

Bitter aftertaste, H/A, somnolence, dizziness, dry mouth, sleep driving

Question 12

Melatonin Receptor Agonist

New hypnotic

Answer 12

ramelteon (Rozerem)

Approved for tx of chronic insomnia with difficult sleep onset but not sleep maintenance.

No rebound insomnia, no time limit on use

Activates receptors for melatonin.

Does not bind with GABA receptors.

Question 13

Trycyclic Antidepressant used as anti-anxiety/hypnotic

p186 ATI mental health book

Answer 13

doxepin (Silenor)

Prevents reuptake of norepinephrine and seretonin

SE: orthostatic htn, sedation, toxicity, decreased seizure threshold, excessive sweating, anticholinergic effects (dry mouth, blurred vision, photophobia, urinary retention, constipation, tachycardia)

Advise client to get up slowly, drink water, chew gum, exercise, pee before taking med. Advise client of excess sweating.

Monitor seizure pts, baseline EKG, frequent vitals. Toxicity signs: dysrhythmias, mental confusion, agitation. Followed by: seizures, coma death.