Anxiety and Insomnia Flashcards
Benzodiazepines
"AM's and Ide's" Lorazepam (Ativan): N/V, Seizures Diazepam (Valium) Alprazolam (Xanax) Chlordiazepoxide (Librium)
What are Lorazepam (Ativan)
Diazepam (Valium)
Alprazolam (Xanax)
Chlordiazepoxide (Librium) used for
- Routine mngt of anxiety
- Preoperative anxiety
- Anxiety for pts w/ ventilators
- Off label use:
- Seizures/ Status Epilepticus
- Insomnia
- EtOH Withdrawal
MOA for Benzodiazepines
- Potentiate GABA
- Depress CNS at different levels: Relax, Sleep, Coma
Adverse effects for Benzodiazepines “AM’s and Ide’s”
CNS: Ataxia Dizziness Drowsiness Blurred Vision Confusion Paradoxical CNS Stimulation: Excitatory Effects Psych Pts. Elderly, and ADHD
Administration for Benzodiazepines “AM’s and Ide’s”
Slow IV push or infusion
Assessment for Benzodiazepines “AM’s and Ide’s”
Assess baseline Vital signs and LOC
Precautions for Benzodiazepines “AM’s and Ide’s”
Warning:
- No Alcohol
- Avoid driving/operating machinery
- Taper needed; sudden withdrawal causing status epilepticus
- Benzodiazepines do not address pain
Barbiturates
Phenobarbital (Luminal)
Phenobarbital (Luminal)
is used for
- Status epilepticus by IV push
- Short term management of insomnia
MOA for Phenobarbital (Luminal)
Bind GABA receptors and enhance activity
Adverse effects of Phenobarbital (Luminal)
Strong Effects on elderly and those with Renal Disease CNS: Drowsiness Lethargy Dizziness Hang-Over Reduced REM sleep GI: N/V/D CV: Respiratory Depression
Assessment for Phenobarbital (Luminal)
Assess patient every 15min for IV route
Monitor therapeutic serum levels of drug
Signs of blood dyscrasias
Interactions with Phenobarbital (Luminal)
EtOH
Other CNS depressants
Hydantoins
Phenytoin (Dilantin)
what is Phenytoin (Dilantin)
effective in the management of most types of seizures but have many adverse effects
MOA for Phenytoin (Dilantin)
- Delay influx of Na+ ions in neurons and slows abnormal, electrical discharges
- Do not elevate seizure threshold
Adverse effects for Phenytoin (Dilantin)
CNS: Lethargy Headache Drowsiness and dizziness Nystagmus- alterations of extraocular movements Confusion Ataxia Coma & Seizures at high doses
Miscellaneous
Carbamezepine (Tegretol)
Carbamezepine (Tegretol) is used for
- a drug of choice for many tonic-clonic and partial seizures
- Used with phenytonin for patients requiring polytherapy
MOA for Carbamezepine (Tegretol)
- Inhibit Na+ channels and block repetitive, sustained firing of neurons
- Other mechanisms likely but incompletely understood
Valproic Acid (Depacon) is used for
- Absence seizures
- Complex partial seizures
MOA for Valproic Acid (Depacon)
- Increase concentration of GABA in brain
- Suppress abnormal neuronal discharges by blocking influx of Na+ into neurons
Nursing Concerns ALL Ant seizure Agents
Assessment
- Complete neurologic assessment including pupil response, LOC, orientation, motor response, verbal response, and cognition
- Obtain baseline data – history, previous drug reactions, vital signs, electrolytes, CBC
- Monitor seizure activity
- Assess serum levels of drugs
- Watch for blood dyscrasias
- Ensure environmental safety issues
