Anxiety and Insomnia

Question 1

Benzodiazepines

Answer 1

"AM's and Ide's"
Lorazepam (Ativan): N/V, Seizures 
Diazepam (Valium)
Alprazolam (Xanax)
Chlordiazepoxide (Librium)

Question 2

What are Lorazepam (Ativan)
Diazepam (Valium)
Alprazolam (Xanax)
Chlordiazepoxide (Librium) used for

Answer 2

• Routine mngt of anxiety
• Preoperative anxiety
• Anxiety for pts w/ ventilators
• Off label use:
• Seizures/ Status Epilepticus
• Insomnia
• EtOH Withdrawal

Question 3

MOA for Benzodiazepines

Answer 3

• Potentiate GABA

- Depress CNS at different levels: Relax, Sleep, Coma

Question 4

Adverse effects for Benzodiazepines “AM’s and Ide’s”

Answer 4

CNS: 
Ataxia
Dizziness
Drowsiness
Blurred Vision
Confusion
Paradoxical CNS Stimulation: Excitatory Effects 
Psych Pts. Elderly, and ADHD

Question 5

Administration for Benzodiazepines “AM’s and Ide’s”

Answer 5

Slow IV push or infusion

Question 6

Assessment for Benzodiazepines “AM’s and Ide’s”

Answer 6

Assess baseline Vital signs and LOC

Question 7

Precautions for Benzodiazepines “AM’s and Ide’s”

Answer 7

Warning:

• No Alcohol
• Avoid driving/operating machinery
• Taper needed; sudden withdrawal causing status epilepticus
• Benzodiazepines do not address pain

Question 8

Barbiturates

Answer 8

Phenobarbital (Luminal)

Question 9

Phenobarbital (Luminal)

is used for

Answer 9

• Status epilepticus by IV push

- Short term management of insomnia

Question 10

MOA for Phenobarbital (Luminal)

Answer 10

Bind GABA receptors and enhance activity

Question 11

Adverse effects of Phenobarbital (Luminal)

Answer 11

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

Question 12

Assessment for Phenobarbital (Luminal)

Answer 12

Assess patient every 15min for IV route
Monitor therapeutic serum levels of drug
Signs of blood dyscrasias

Question 13

Interactions with Phenobarbital (Luminal)

Answer 13

EtOH

Other CNS depressants

Question 14

Hydantoins

Answer 14

Phenytoin (Dilantin)

Question 15

what is Phenytoin (Dilantin)

Answer 15

effective in the management of most types of seizures but have many adverse effects

Question 16

MOA for Phenytoin (Dilantin)

Answer 16

• Delay influx of Na+ ions in neurons and slows abnormal, electrical discharges
• Do not elevate seizure threshold

Question 17

Adverse effects for Phenytoin (Dilantin)

Answer 17

CNS: 
Lethargy
Headache
Drowsiness and dizziness
Nystagmus- alterations of extraocular movements
Confusion
Ataxia
Coma & Seizures at high doses

Question 18

Miscellaneous

Answer 18

Carbamezepine (Tegretol)

Question 19

Carbamezepine (Tegretol) is used for

Answer 19

• a drug of choice for many tonic-clonic and partial seizures
• Used with phenytonin for patients requiring polytherapy

Question 20

MOA for Carbamezepine (Tegretol)

Answer 20

• Inhibit Na+ channels and block repetitive, sustained firing of neurons
• Other mechanisms likely but incompletely understood

Question 21

Valproic Acid (Depacon)
is used for

Answer 21

• Absence seizures

- Complex partial seizures

Question 22

MOA for Valproic Acid (Depacon)

Answer 22

• Increase concentration of GABA in brain

- Suppress abnormal neuronal discharges by blocking influx of Na+ into neurons

Question 23

Nursing Concerns ALL Ant seizure Agents

Answer 23

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