Anxiolytics Flashcards
Neurtransmitters in Anxiety
LOW GABA (Gamma-aminobutyric acid); Low Serotonin; High Norepinephrine
If pt Low GABA, use what and why?
Benzodiazepine because it increases the attraction of the GABAa receptors to GABA; “Nurse please give Mr. Gabalow Ativan 2mg IM STAT”
Ativan, Xanax, Valium depress what?
depress CNS
Benzodiazipine facts
CNS depression, can’t really OD on it; additive effect with ETOH; pt can have increased tolerance and cross tolerance; cross tolerance is if pt tolerance to Xanax, also tolerance to Ativan, so Ativan may be ineffective to give.
Benzodiazipine W/D s/s (short term use)
agitation, insomnia, tremors, mm cramping, sweating, anorexia, tremor, nervousness
Benzodiazipine Geriatric Considerations
Paradoxical reaction; more agitated, talkative, anger and rage; So more Ativan = more agitation (not desired effect); can’t restraint d/t unsafe, DVT or decub
List two noradrenergic agents
Inderal (propanolol), Catapress (clonidine); noradrenergic agents inhibit physiological feedback
Use of Inderal propanolol
social anxiety; this is a non selective BB; decreases HR and BP; so more relaxed
Use of Clonidine Catapres
to decrease BP; when anxious norepinephrine go up, vessel constrict via alpha-adrenergic receptor, BP go up; alpha adrenergic receptors are targeted by both catecholamines (norepi and epi)
Benzodiazipine caution with what herbs?
Kava kava should not be combined with benzodiazipine because of increased sedative affect.
Anxiolytics are used to treat what?
anxiety and insomnia.
Name a major anxiolytic group?
Benzodiazepine. It’s a minor tranquilizer group.
Do benzodiazipine cause tolerance?
Yes. Tolerance within weeks and months
Difference between primary and secondary anxiety?
primary not caused by medical condition or drug. Secondary is.
Action of anxiolytics resembles
sedative-hypnotic effect (i.e. calm-sleep effect)
Before giving anxiolytic, tx by
nonpharma measures: relaxation, psychotherapy, support groups.
Other uses of Benzodiazipine besides sever prolonged anxiety
anticonvulsant, sedative-hypnotic, preoperative drug
How bezondiazipine is absorbed
lipid soluble and rapidly absorbed in GI tract
Examples of Benzodiazipines
chlordiazepoxide librium, diazepam valium, clorazepate dipotassium tranxene, lorazepam ativan, and alprazolam xanax
What the most popular benzodiazipine?
Ativan lorazepam
How long to is benzodiazipine present in urine?
weeks or months after pt stopped taking
How long should benzodiazipine be prescribed?
3 to 4 months
Buspirone Buspar anxiolytic contrainidicated with
grapefruit juice. Leads to toxicity. Limit grapefruit juice to cup/day or half grapefruit.
S/E of benzodiazipines
sedation, dizzy, HA, dry mouth, blurred vision, rare urinary incontinence, constipation,
A/E of benzodiazipines
leukopenia (decreased WBC); so s/s fever, malaise, sore throat, tolerance, dependency
Abrupt discontinuation of benzodiazipine causes
w/d sypmtoms onset 2-10 days, duration several weeks
If pt OD on benzodiazipine
give antiemetic, follow with activated charcoal if pt conscious. If pt not conscious, do gastric lavage. Give benzodiazipine atangonist flumazenil romazicon IV if needed. Maintain airway, give O2 for low RR, monitor VS. Give vasopressor IV for severe low BP. Request mental health consult.
What is antidote for benzodiazipine?
flumazenil Romazicon IV
Benzodiazipine W/D s/s (long term/high dose use)
paranoia, delirium, panic, HTN, status epilepticus.
How to prevent convulsions during w/d
give anticonvulsant
Substances contraindicated with benzodiazipine
ETOH and CNS depressants. Leads to RR depression
Substances that decrease effect of benzodiazipine
tobacco, caffeine, sympathomemetics
Who should not take benzodiazipine?
the fetus; it’s teratogenic
Noradrenergic agents are affected by what hormone?
norepinephrine
