CH 20 Flashcards
What is anxiety ?
An unpleasant feeling of tension, fear, or nervousness in response to an environmental stimulus, whether real or imaginary.
What is an anxiolytic?
A drug used to suppress the CNS: prevents and reduces the signs and symptoms of anxiety
What is a barbiturate?
The former mainstay class of drug used for:
* Anxiety
* Sedation
* Sleep induction
However it is associated with potentially severe side effects and many drug to drug interactions, which has made it less desireable.
What is a benzodiazepine?
A class of drug that acts on the limbic system producing GABA, an inhibitory neurotransmittor.
What do we mean by hypnosis?
Extreme sedation resulting in CNS depression and sleep
What is a hypnotic?
Drug used to depress the CNS: causes sleep
What do we mean by sedation?
Loss of awareness and reaction environmental stimuli
What is a sedative?
a drug that depresses the CNS: produces a loss of awareness and of reaction to the environment
What Are important nursing assessments when prescribing anxiolytic and hypnotic medications?
Full CNS/Neuro exam
Kidney and liver function
Current medications (precribed and OTC)
Respiratory assessment
Vital signs
Weight baseline
What actions do we expect from Benzodiazepines
- Act in the limbic system and the RAS
- Make GABA more effective
- Causes interference with neurons firing
- Lower doses exist with enxiety
- higher doses cause sedation and hypnosis
What are the indicated uses for Benzodiazepines?
Anxiety disorders
Alcohol withdrawal
hyperexcitability
preoperative relief of anxiety
Are benzodiazepines recommended for long term use?
No, they are not recommended for more than 6 months
Where are benzodiazepines absorbed, metabolized and excreted?
Absorbed in the GI tract, metabolized in the liver and excreted primarily in the urine (kidneys)
Do benzodiazepines cross the placenta and enter the breast milk?
yes
Are benzodiazepines addictive?
Yes, they are schedule IV Highly addictive
What are the condraindications/cautions for benzodiazepines
- Allergy to benzodiazepines
- H/O psychosis, psychosis
- Acute narrow angle glaucoma
- Coma/shock
- Acuta alcohol intoxication
- Pregnancy
- Not recommended for long term
Adverse effects of Benzodiazepines
- Sedation
- Drowsiness
- CNS depression
- Depression
- Lethargy
- Blurred vision
- Confusion
- Dry Mouth
- constipation
- Nausea
- vomiting
- hypotension
- Urinary retention
Benzodiazepine examples
- Alprazolam
- Clonazepam
- diazepam
- Lorazepam
- Oxazepam
Benzodiazepine Drug-Drug interactions
- Increase CNS depression when taken with alcohol
- Increase in effect when taken with cimetidine, oral contraceptives, or disulfiram
- Decrease in effect if given with thophyline (asthma med) or ranitidine
A client presents at the clinic with symptoms of hyperexcitability and agitation. Which medication would the nurse expect the physician to prescribe?
a) Hypnotic
b) Benzodiazepine
c) Barbiturate
d) other anxiolytic and hypnotic drugs
B) Benzodiazepine
What are some examples of Barbiturates ?
- Phenobarbital
- Secobarbital
What are the actions of barbiturates?
- CNS depressants
- Inhibit neuronal impulse conduction in the ascending RAS
- Depress cerebral cortex
- Depress motor output
- Causes sedation hypnosis anasthesia and coma
Indications for use of barbiturates
- Relief of the signs and symptoms of anxiety
- sedation
- Insomnia
- Preanasthesia
- Seizures
Pharmacokinetics of Barbiturates
- Well absorbed
- reaching peak in 20-60 mins
- Metabolized in the liver
- Excreted in the urine
Barbiturates contraindications and cautions
- Allergy to any barbiturate
- Previous history of addiction to sedative–hypnotic drugs
- Latent or manifest porphyria
- Marked hepatic impairment or nephritis
- Respiratory distress or severe respiratory dysfunction
- Pregnancy
- Not recommended for long-term use.
Adverse effects of barbiturates
- Vertigo
- Nausea
- Vomiting
- Constipation
- CNS Depression
- Physical Dependency
- Drowsiness
- Somnolence
- Lethargy
- Ataxia
Barbiturates Drug to Drug interactions
- Increased CNS depression when given with alcohol,
- antihistamines, and other tranquilizers
- Altered response to phenytoin
- MAO cause increase serum levels and effect
- Decrease effectiveness of:
- anticoagulants, digoxin, tricyclic antidepressants,
- corticosteroids and oral contraceptives
Name three other anxiolytic/Hypnotic drugs
- Antihistamines
- Buspirone
- Zolpidem (ambien)
Why are antihistamines sometimes used as anxiolytics?
It can be used as a pre or postoperative drug to decrease the need for narcotics. It lacks muscle relaxant and sedative effect
What are the uses of buspirone
Reduces the signs and symptoms of anxiety without severe CNS and adverse effects. Often used for alcohol withdrawal
what are the most common uses for Zolpidem (ambien)
Sleep disturbance. The short half life makes it an ideal candidate for allowing patients to awaken feeling refreshed
You are admitting a new patient to the clinic. A review of home
medications indicates the patient is taking a barbiturate to help
him sleep. The patient tells you that he is having problems
with both his visual and auditory senses. The patient wants to
know what is wrong. What would be the best response?
A. We will have to wait and see what the doctor says.
B. What you are describing could be adverse effects from the
sleep medicine you are taking.
C. There is nothing wrong. You are just getting older.
D. Sometimes these things happen with our patients. We need
to do a complete assessment before we know for sure.
B. What you are describing could be adverse effects from the
