Anxiety and Traumatic Stress-Related Disorders Flashcards
Medications affecting nervous system
Benzodiazepines Medications
Alprazolam (prototype) Diazepam Lorazepam Chlorodiazepoxide Clorazepate Oxazepam Clonazepam
Expected Pharmacologic Actions: Benzodiazepines
Benzodiazepines enhance the inhibitory effects of gamma-aminobutyric acid (GABA) in the CNS. Relief from anxiety occurs rapidly following adminstration
Therapeutic Uses: Benzodiazepines
Generalized anxiety disorder (GAD) and Panic Disorder
Other Uses:
- trauma and stressor-related disorders: Acute stress disorder (ASD) and post-traumatic stress disorder (PTSD)
- hyperarousal manifestations of dissociative disorders
- seizure disorders
- insomnia
- muscle spasm
- alcohol withdrawal (for prevention and treatment of acute manifestations
- induction of anesthesia
- amnesic prior to surgery or procedure
Complications: Benzodiazepines
- CNS Depression: sedation, lightheadedness, ataxia, decreased cognitive function
- Anterograde amnesia: difficulty recalling events that occur after dosing.
- Toxicity: drowsiness, lethargy, confusion, respiratory depression, severe hypotension, or cardiac/respiratory arrest
- Paradoxical Response: insomnia, excitation, euphoria, anxiety, rage
- Withdraw Effects: anxiety, insomnia, diaphoresis, tremors, lightheadedness, delirium, HTN, muscle twitching, and seizures
Contraindications /Precautions: Benzodiazepines
- Pregnancy Risk Category D
- classified under schedule 4 of the Controlled Substances Act
- Contraindicated: in clients who have sleep apnea, respiratory depression, or glaucoma
- Caution: older clients and those who have liver disease of history of mental illness or a substance abuse disorder
- generally used short term due to the risk of dependence
Interactions: Benzodiazepines
CNS DEPRESSANTS:
- can result in respiratory depression.
- Anticonvulsants and antihistamines can cause increased CNS depression.
- advise clients to avoid alcohol and other substances that cause CNS depression
- advise clients to avoid activities that require alertness (driving, operating heavy equipment/machinery)
GRAPE FRUIT JUICE REDUCE METABOLISM
- avoid use of grapefruit juice
- HIGH FAT MEALS REDUCE ABSORPTION
- do not take with fatty foods
RN Administration: Benzodiazepines
- take the medication as prescribed and to avoid abrupt discontinuation of treatment to prevent withdrawal manifestations. Do not change the dose or frequency without prior approval of provider
- when discontinuing benzodiazepines that have been taken regularly for long periods and in higher doses, taper the dose over several weeks
- administer the medication with meals to snacks if GI upset occurs
- advise clients to swallow sustained release tablets and to avoid chewing or crushing the tablets
- inform clients about the possible development of dependency during and after treatment and to notify the provider if indications of withdrawal occur.
- advise clients to keep benzodiazepines in a secure place due to they abuse potential
Atypical Anxiolytic/Nonbarbiturate Anxiolytic
Buspirone
Action: Atypical Anxiolytic
Action:
- exact mechanism of this medication is unknown. Binds to serotonin and dopamine receptors. Dependency is much less likely than with other anxiolytics, and the use of buspirone does not result in sedation or potentiate the effects of other CNS depressants
- major disadvantage is the anti anxiety effects develop slowly. Initial response take a week, and at least 206 weeks for it to reach its full effects. As a result of this pharmacological action, buspirone is taken on a schedule basis, and is. mot suitable for
Therapeutic Uses: Atypical Anxiolytic
Therapeutic Uses:
- panic disorder
- social anxiety disorder
- OCD and related disorder
- trauma - and stressor-related disorder, PTSD
Complications: Atypical Anxiolytic
Dizziness, nausea, headache, lightheadedness, agitation.
- advise the client to take with food to decrease nausea
- avoid activities that require alertness until effects are known
- instruct the client that most adverse effects are self-limiting
Constipation
- advise client to increase fiber and fluid
Suicidal Ideation
- monitor and report manifestations of depression and thoughts of suicide.
Contraindications: Atypical Anxiolytic
- Pregnancy Risk Category B
- No recommended for use by women who are breastfeeding
- contraindicated for concurrent use with MAOI or for 14 days after MAOIs are discontinued. Hypertensive crisis can result
Cautions: Atypical Anxiolytic
- older clients
- clients with liver and/or renal dysfunction
Interactions: Atypical Anxiolytic
Erythromycin, Ketaconazole, St. John’s wort, and grapefruit juice can increase the effects of buspirone
- advise clients to avoid the use of these antimicrobial agents
- advise clients to avoid herbal preparations containing St. John’s wort.
- advise clients to avoid drinking grapefruit juice
Increased risk for Serotonin syndrome with SSRI’s
- monitor for serotonin syndrome: fever, diarrhea, and delirium. Avoid concurrent use.
RN Administration: Atypical Anxiolytics
- advise clients to take the medication with meals to prevent gastric irritation
- advise clients that effects do no occur immediately. It can take a week to notice the first therapeutic effects and 2-6 weeks for the full benefit. Take on a regular basis and not PRN
- instruct clients that tolerance, dependence, or withdrawal effects are not an issue with this medication
- labeled for short term treatment of anxiety, but has shown therapeutic benefit for as long as a year