Ch 15 drugs relieving anxiety & promoting sleep Flashcards
What does the amygdala do?
It receives incoming sensory signals & then communicates with the frontal lobe of the brain.
The amygdala can signal the brain that a threat is present & set off a fear response or anxiety.
What system in the brain is responsible for emotion?
The limbic system located in the middle of the brain.
It is known to be primarily responsible for emotions; anxiety, restlessness, expression,learning and memory.
What is the hippocampus responsible for?
The hippocampus is responsible for processing threatening or traumatic stimuli.
How does the brain send its messages to the brain?
The brain sends its messages to the body by way of the nervous system.
What is GAD?
Excessive anxiety lasting more than 6 months.
What does stage 1 of sleep include?
Stage 1 consists of light sleep; brain waves are irregular & rapid.
What does stage 2 of sleep consist of?
In stage 2 brain waves are larger than stage 1; with bursts of electrical activity.
What does stages 3&4 of sleep consist of?
Deep sleep; with even larger, slower brain waves called delta waves.
Narcolepsy
Sudden irresistible sleep attacks of unknown origin lasting from seconds to minutes; 2-6 times per day.
Drugs to treat anxiety & insomnia.
Antidepressants (Lexapro) Benzodiazepines ( Ativan) Barbituates ( phenobarbital) Non- benzodiazepines, non barbituates, CNS depressants (Ambien) Anti seizure Beta blockers
What are the 2 major categories of mood disorders?
Depression: characterized by a sad or despondent mood.
Bipolar disorder: alternating between depression & mania.
Name antidepressant drugs.
TCA’s
SSRI’s
SNRI’s
MAOI’s
What are drugs that treat bipolar disorders?
Lithium
Anti seizure drugs ( tegretol, lamictal, depakene)
atypical antipsychotic drugs ( Zyprexa, Seroquel, Risperdal)
What are sedatives?
Medications that depress the CNS (lower dose of antidepressants) EX: benzodiazepines (lorazepam/ Ativan) Non benzodiazepines ( zolpidem/ Ambian Barbituates ( pentobarbital/ Nembutal) Antihistamines ( diphenhydramine/ Benadryl) OTHERS: choral hydrate, alcohol, herbals
What are hypnotics?
Medications that induce sleep.
same meds at a higher dose
In severe stress & many mood & anxiety related disorders; what is true of serotonin?
Serotonin levels are LOW.
What are the 5 types of SSRI drugs?
fluoxetine ( Prozac) sertraline ( Zoloft) citalopram ( Celexa) paroxetine ( Paxil) escitalopram (Lexapro)
What is true of SSRI’s?
SSRI’s are the 1st choice for treating depression.
Preferred over TCA’s & MAOI’s because they can cause less side effects.
What is the prototype drug of SSRI’s
Sertraline ( Zoloft)
What core drug knowledge regarding sertraline ( Zoloft)needs to be addressed.
Treatment of depression , anxiety and PTSD.
Administered: orally
Metabolized: in the liver
Steady state: 7 days ( requires close monitoring of pt’s with liver failure)
10 days to 4 week to take effect & months to have a minimum therapeutic effect.
What are contraindications, adverse effects and drug interactions of sertraline?
Contraindicated in patients with decreased liver function
Adverse effects: GI distress, headache, fatigue, insomnia, & sexual dysfunction.
Administration with highly protein bound drugs.
What are the core pt. variables of sertraline?
Health status: past medical, including drug use & physical assessment
Life span & gender: pregnancy category C
can affect sexual function
Assess cultural background
TCA’s
Another class of antidepressants
Are as effective as SSRI’s in treating most anxiety disorders
TCA’s work by affecting the regulation of serotonin or norepinephrine in the brain
TCA’s have higher adverse effects than SSRI’s which limits their use as antidepressants
We’re named for their molecular structure
Very narrow therapeutic index
All tricyclics enhance the activity of norepinephrine & serotonin by blocking neuronal reuptake of these neurotransmitters.
What is the prototype drug of TCA’s?
nortiptyline (Pamelor)
Name some TCA medications
amitriptyline (Elavil, Endep) amoxapine clomipramine (Asendin) desipramine ( Norpramin, Pertofrane) doxepine imipramine (Adapin, Simequan) Tofranil nortiptyline ( Pamelor, Aventyl) protriptyline ( Vivactil) trimipramine ( Surmontil)
What is the core drug knowledge of nortiptyline?(TCA)
Used to treat depression & chronic pain Administered: orally Metabolized: in the liver Peak: 2-4 hours Specifically blocks reuptake of norepinephrine into nerve terminals, thereby allowing increased concentration at post synaptic effector sites.
Y
What are contraindications, adverse effects & drug interactions of nortiptyline?
nortiptyline is contraindicated in clients with cardiovascular disorders
Adverse effects include: disturbed concentration and confusion, headache, tremors, nausea, vomiting, bone marrow depression, urinary retention and sexual disturbances. It has multiple drug interactions.
How can a nurse maximize therapeutic effects of nortiptyline?
Monitor blood plasma drug levels
A single dose @ bedtime may be used
How can a nurse minimize adverse effects of nortiptyline?
May need to dose the the drug 2x per day to avoid adverse effects
Older adults should receive a smaller initial dose.
MAOI’s
Oldest class of antidepressants Occasionally prescribed for panic disorder & social phobia Monoamine oxidase is the enzyme that degrades serotonin into the synapse. By inhibiting the enzyme, higher levels of serotonin can remain in the synapse and be active.
What MAOI’s are used to treat anxiety?
phenelzine ( Nardil
tranylcypromine (Parnate)
isocarboxazid ( Marplan)
What is the prototype drug of MAOI’s
phenelzine (Nardil)
What core drug knowledge should a nurse know about phenelzine? (MAOI)
Used to treat depression Administered: orally Excreted: urine Peak: 2-4 hours Increases the concentrations of DA, NE and serotonin within the neuronal synapse.
What are the contraindications, adverse effects and drug interactions of phenelzine? MAOI
It is contraindicated in patients with decreased liver function & CHF
Adverse effects include: liver damage,anticholinergic effects, agranulocytosis , leukopenia, thrombocytopenia, and sexual dysfunction.
FATAL HYPERTENSIVE CRISIS WHEN COMBINED WITH TYRAMINE TRYPTOPHAN IN DIET.
What are core patient variables to know when administering phenelzine? (MAOI)
Cardiovascular assess & baseline labs.
Pregnancy category C/ not recommended for ppl under 16 yrs.
Assess ADL capability and environment where drug will be given
How can a nurse maximize the therapeutic effects of phenelzine?(MAOI)
Platelet MAO enzyme activity ( mostly B subtype) is usually measured before therapy & drug therapy.
How can a nurse minimize the adverse effects of phenelzine?
Numerous dietary & medication restrictions
Monitor for symptoms of hypertensive crisis.
What patient and family education can a nurse tech regarding phenelzine?
Warn patients about not eating foods with high tyramine content or consuming alcohol; including soy sauce.
Perform frequent blood pressure monitoring during therapy
Benzodiazepines
Used for a # of therapeutic effects
As a class benzodiazepines appear to Potentiate the effects of GABA
the result is more CNS depression than would normally be found
Binds to specific receptor sites to produce their effects
High margin of safety
What conditions are benzodiazepines used to treat?
Anxiety Seizures Alcohol withdrawal Muscle relaxation Sleep promotion Preoperative sedation Conscious sedation Induction of general anesthesia
Name some benzodiazepines.
lorazepam ( Ativan) triazolam ( Halcion) midazolam (Versed) diazepam ( Valium) oxazepam ( Serax) alprazolam ( Xanax) flurazepam ( Dalmane) clonazepam ( Klonopin)
What is the core drug knowledge regarding lorazepam?
Used in treating anxiety disorders and insomnia Administered: parenteral or orally Distributed: to body tissues Metabolized: in the liver Excreted: in the kidneys INCREASES THE EFFECTS OF GABA
What are complications, adverse effects & drug interactions of lorazepam?
lorazepam is contraindicated in clients with hypersensitivity, psychosis, acute narrow- angle glaucoma and children younger than 6 months. Adverse effects include mild drowsiness, ataxia, confusion, respiratory disturbances, bradycardia, and hypotension.
lorazepam has several drug interactions
What are core patient variables to consider when administering lorazepam?
Assess for renal & hepatic impairment
Pregnancy category D
assess pt. for the use of other CNS depressants
Oral formulation can be given in any environment
Longer half life in Asians
How can a nurse maximize therapeutic effects for a patient taking lorazepam?
Give at scheduled intervals throughout the day.
How can a nurse minimize the adverse effects for a patient taking lorazepam?
If GI distress occurs; administer with food
Monitor for paradoxical reactions and stop drug if they occur
Dilute injectable lorazepam with an equal volume of compatible solution.
What should the nurse educate the patient on regarding lorazepam?
Caution against use of alcohol
Discuss side effects of medication
How long is the duration of action in lorazepam?
Lorazepam has a short onset of action therefore divide the daily dose for treating anxiety into 2-3 doses and administer throughout the day.
buspirone (BuSpar)
Is an azaspirodecanedione that is not chemically or pharmacologically related to benzodiazepines.
Used to treat symptoms of anxiety, although exactly how it works is unknown.
Optimum relief of anxiety usually occurs after 3-4 weeks of treatment.
Is buspirone recommended for long or short therapy?
buspirone (BUSpar) is for short term therapy; patients who have been treated with buspirone for up to 1year HAVE NOT required a dosage increase to maintain therapeutic effect.
What are facts about hydroxyzine?
- hydroxyzine ( Vistaril) is a miscellaneous anti anxiety drug.
- it excerpts CNS depressant activity in subcortical areas
- it rapidly produces a feeling of calm & relieves anxiety without impairing mental alertness.
- it may be co- administered with a narcotic to control pain while minimizing the nausea that may be an adverse effect of the narcotic.
What is true of eszopiclone (Lunesta)?
It is a non benzodiazepine hypnotic
Induces sleep quickly; prevents waking through the night
Believed to achieve its therapeutic effect from interaction with GABA- receptor- benzodiazepine receptor complexes.
It is the only drug for insomnia that is approved for long term use( up to 6 months)
What is the time of onset for eszopiclone?( Lunesta)
Has a rapid onset within one hour.
Is metabolized in the liver
Excreted in the the urine
What are the most common adverse effects of eszopiclone (Lunesta) after 6 months of use?
Headache, prolonged drowsiness and a unpleasant taste
Zaleplon ( Sonata)
is a sedative for SHORT TERM USE up to 28 days.
Although not a benzodiazepine and not chemically related to benzodiazepines, it does interact with the GABA- benzodiazepine complex.
What are the most common adverse effects of zaleplon?
Drowsiness, dizziness, lightheaded sea, and difficulty with coordination.
Pregnancy category C drug.
May lead to dependency, and rebound insomnia if possible.
zolpidem ( Ambien)
Is used for short term treatment of insomnia/ generally NOT FOR MORE THAN 7-10 days.
It induces sleep rapidly and should be taken immediately before going to bed.
Although not chemically related to benzodiazepines, it does interact selectively with GABA-BZ receptor complex and shares some pharmacological properties with benzodiazepines.
Generally preserves all of the sleep stages and has only minor effects of REM sleep.
What are the most common adverse effects of zolpidem?
Headache, prolonged drowsiness and dizziness
trazadone ( Desyrel)
Atypical antidepressant
Causes significant sedation as an adverse effect
Most commonly used to promote sleep.
choral hydrate
choral hydrate is a non- barbituate hypnotic used to induce sleep and to,cause preoperative sedation.
Can be used as an adjunct to opiates and analgesics in pain control
In therapeutic doses, choral hydrate has little effect on respirations, BP, or reflexes.
It does produce numerous adverse effects in the CNS.
What are uses for barbituates?
Used for short term tx of insomnia…..very high habit forming
Clients can develop tolerance and physical dependence on the drug.
- were used to treat insomnia before the availability of benzodiazepines.
Name some barbituates
pentobarbital (Bellatal)
secobarbital ( Seconal)
pentobarbital ( Nembutal)
Describe the physiology of mood stabilizers.
The brain contains billions of specialized cells called neurons.
The communication between neurons is called neurotransmission
Several neurotransmitters exist, each of which travels to a specific neuroreceptor.
Neurotransmission plays a role in both normal & abnormal brain function.
The mind and brain are the same organ
What is the prototype drug of mood stabilizers?
lithium carbonate ( Eskalith)
What is the core drug knowledge of lithium?
It's primary action is to prevent extreme mood swings Administered: orally Metabolized: in the liver Excreted: kidneys Onset: 5-7 days Duration: 1-4 hours
What are the pharmacodynamics of lithium?
Competes with calcium, magnesium, potassium, and sodium in body tissues and at binding sites.
It alters sodium transport in nerve and muscle cells.
What are contraindications of the administration of lithium?
Severe cardiovascular disease or renal disease.
What are adverse effects of lithium?
Muscle twitching, coarse hand tremors, severe GI UPSET, blurred vision, drowsiness and confusion
What are drug interactions of lithium?
Thiazides diuretics and angiotensin- converting enzyme inhibitors
What is an acute symptom to watch out for regarding lithium?
Thirst
N/V
Polyuria
Fine hand tremors
What are chronic symptoms of lithium?
Wt. gain
Hair loss
Acne
Cognitive impairment
What are signs and symptoms of toxicity regarding lithium?
Coarse hand tremors Severe GI upset Blurred vision Drowsiness Slurred speech Muscle twitching Seizure Coma Arrhythmias And permanent neurological impairment
What are core patient variables to assess regarding lithium?
Past medical and physical assessment Pregnancy category D Assess alcohol and caffeine intake Assess environment where drug will be given Assess for Japanese heritage
What can a nurse do to maximize therapeutic effects regarding lithium?
Instruct pt. About early warning signs of a relapse of mania.
What can a nurse do to minimize adverse effects regarding lithium therapy?
Monitor blood levels of lithium
Assess for dehydration, which increases risk of toxicity.
What can alter lithium?
Sodium imbalance
What does lithium cause?
It causes fluid retention
