Anxiety and PTSD Flashcards
Benzodiazepine sedative hypnotic anxiolytics
Prototype
Alprazolam (Xanax)
Also:
Diazepam (Valium)
Lorazepam (Ativan)
Clonazepam (Klonopin)
Chlordiazepoxide (Librium)
Clorazepate (Tranxene)
Oxazepam (Serax)
Benzodiazepine sedative hypnotic anxiolytics
Indication
Short-term treatment of anxiety and panic disorders
Seizure disorders
Insomnia
Muscle spasm
Alcohol withdrawal
Anesthesia/amnesic prior to surgery
Benzodiazepine sedative hypnotic anxiolytics
MOA
Enhance inhibitory effects of GABA in CNS with rapid induction of anxiety relief
Benzodiazepine sedative hypnotic anxiolytics
Adverse effects
CNS depression: sedation, ataxia, lightheadedness
Anterograde amnesia: difficulty recalling events that occur after dosing
Paradoxical response: anxiety, insomnia, euphoria, rage
Toxicity: respiratory depression, severe hypotension, cardiac arrest (IV), drowsiness, lethargy, confusion (PO)
Withdrawal: anxiety, insomnia, diaphoresis, tremors, delirium, seizures, dizziness
Benzodiazepine sedative hypnotic anxiolytics
Contraindications
Pregnancy
Lactation
Sleep apnea
Glaucoma
Resp. depression
Caution with liver disease and SUD
Benzodiazepine sedative hypnotic anxiolytics
Admin
PO or IV
Admin with meals to avoid gastric upset
Taper dose to avoid withdrawal
Avoid hazardous activities
Benzodiazepine sedative hypnotic anxiolytics
Nursing actions for acute toxicity
PO toxicity:
* Gastric lavage
* Activated charcoal
PO and IV toxicity:
* Administer flumazenil to reverse adverse effects
* Monitor VS
* Maintain airway
* Administer fluids to maintain BP
Atypical anxiolytics/nonbarbiturate anxiolytics
Prototype
Buspirone (BusPar)
Atypical anxiolytics/nonbarbiturate anxiolytics
Indication
Generalized anxiety disorder
Atypical anxiolytics/nonbarbiturate anxiolytics
MOA
Unknown
* Binds to serotonin and dopamin receptors
* No sedation or interaction with other CNS depressants
* No risk of misuse
Atypical anxiolytics/nonbarbiturate anxiolytics
Adverse effects
CNS effects: dizziness, nausea, headache, agitation
Atypical anxiolytics/nonbarbiturate anxiolytics
Contraindications
Preganancy and lactation
Use with MAOI due to risk of hypertensive crisis
Use with caution with liver or kidney disease
Atypical anxiolytics/nonbarbiturate anxiolytics
Admin
- PO
- Take at same time every day
- Take with meals to prevent GI upset
- 1 week for onset and 4 weeks for peak benefits
Atypical anxiolytics/nonbarbiturate anxiolytics
Interactions
Grapefruit
Erythromycin
Ketoconazole
St. John’s Wort
(all increase the effects of buspirone)
Other meds used for anxiety
Select SSRIs: sertraline, paroxetine, fluoxetine, citalopram, escitalopram, fluvoxamine
Select SNRIs: Venlafaxine, duloxetine, desvenlafaxine
Trycyclic antidepressants
MAOIs
Trazadone (serotonin antagonist and reuptake inhibitor)
Antihistamines: hydroxyzine hydrochloride, hydroxyzine pamoate
Beta blockers: propanolol
Anticonvulsants: gabapentin, pregabalin
