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ATI Pharmacology > CH 7: Anxiolytic Agents > Flashcards

CH 7: Anxiolytic Agents Flashcards

1
Q

Anxiety disorders include

A

Generalized anxiety disorder, Panic disorder, Obsessive-compulsive disorder, Social anxiety disorder, and PTSD

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2
Q

Psychological manifestations of anxiety

A

fear and apprehension

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3
Q

Physical manifestations of anxiety

A

Palpitations, tachycardia, SOB

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4
Q

Major Medications: Benzodiazepines Sedative Hypnotic Anxiolytics such as

A

Lorazepam, Diazepam, Clonazepam, Chlordiazepoxide, Clorazepate, Oxazepam

select prototype med: Alprazolam

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5
Q

Benzodiazepines: Expected Pharmacological Action

A

Enhance the inhibitory effects of GABA in the CNS. Relief from anxiety occurs rapidly following administration. Short-term use recommended due to

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6
Q

Benzodiazepines: Therapeutic Uses

A
  1. Mainly Generalized Anxiety Disorders (GAD) and panic disorder
  2. Trauma and stressor related disorders: acute stress disorder (ASD) and PTSD
  3. Hyper-arousal manifestations of dissociative disorders
  4. Seizure disorders
  5. Insomnia
  6. Muscle spasms
  7. Alcohol withdrawal (for prevention an tx of acute manifestations)
  8. Induction of anesthesia
  9. Amnesic prior to surgery or procedures
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7
Q

Benzodiazepines complications include

A

CNS depression, Anterograde amnesia, toxicity, paradoxical response, withdrawal effects

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8
Q

Benzodiazepines Complications: CNS Depression–What does it include?

A

complications include sedation, lightheadedness, ataxia, decreased cognitive function

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9
Q

Benzodiazepines Complications: CNS Depression–Client education?

A
  1. Observe for CNS depression. Notify the provider if effects occur
  2. Avoid activities that require alertness (driving, operating heavy equipment/ machinery).
  3. Avoid alcohol and other anti-anxiety meds due to potentiated depressant effects such as severe respiratory depression.
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10
Q

Benzodiazepines Complications: Anterograde Amnesia–What is it?

A

difficulty recalling events that occur after dosing

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11
Q

Benzodiazepines Complications: Anterograde Amnesia–Client education?

A

Observe for manifestations. Notify the provider if effects occur.

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12
Q

Benzodiazepines Complications: Toxicity– Oral vs IV toxicity manifestations?

A

Oral: drowsiness, lethargy, confusion
IV: respiratory depression, severe hypotension, ot cardiac/respiratory arrest

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13
Q

Benzodiazepines for IV use include:

A

Diazepam and Lorazepam

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14
Q

Benzodiazepines Complications: Toxicity– Nursing Actions and client education

A
  1. For oral toxicity. gastric lavage is used, followed by the administration of activated charcoal or saline cathartics.
  2. Administer flumazenil for benzo toxicity to counteract sedation and reverse adverse effects.
  3. Monitor vital signs, maintain patent airway, and provide fluids to maintain BP.
  4. Have resuscitation equipment available
  5. Inform patient to watch for manifestations. Notify provider if these occur
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15
Q

Benzodiazepines Complications: Paradoxical Response– What does it include? Client Education?

A

Complications include insomnia, excitation, euphoria, anxiety, rage

Client Education: watch for manifestations. Notify provider if these occur.

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16
Q

Benzodiazepines Complications: Withdrawal effects– What does it include? Client Education?

A

Complications include anxiety, insomnia, diaphoresis, tremors, lightheadedness, delirium, HTN, muscle twitching, and seizures

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17
Q

Benzodiazepines Complications: Withdrawal effects– Client Education?

A
  1. withdrawal effects are not common with short-term use.
  2. If taking benzos regularly and in high doses, taper dose over several weeks
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18
Q

Benzodiazepines: Contraindications/Precautions

A
  1. Pregnancy risk category D. Causes fetal harm and harm to infants due to transmission through human milk. Avoid giving meds to pregnant clients or those who are breastfeeding
  2. Classified under Schedule IV of Controlled Substance Act
  3. Contraindicated in clients who have sleep apnea, respiratory depression, or glaucoma
  4. Use cautiously in older adult clients and those who have liver disease or a hx of substance use disorder.
  5. Generally used short-term due to the risk for dependence
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19
Q

Which substances interact with Benzodiazepines?

A

CNS depressants, grapefruit juice, high-fat meals

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20
Q

Benzodiazepines: Interactions– CNS depressants
Client education?

A
  1. CNS depressants (alcohol, barbiturates, opioids) can result in respiratory depression. Anticonvulsants and antihistamines can cause increased CNS depression.

Client Education
1. avoid alcohol and other substances that cause CNS depression
2. Avoid activities that require alertness (driving, operating heavy equipment/machinery).

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21
Q

Benzodiazepines: Interactions– Grapefruit juice
Client education?

A

Can reduce metabolism

Client Education: avoid use of grapefruit juice

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22
Q

Benzodiazepines: Interactions– High-fat meals
Client education?

A

Can reduce absorption

Client Education: Do not take with fatty foods

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23
Q

Benzodiazepines: Nursing Administration

A
  1. Administer the med with meals or snacks if GI upset occurs
  2. Administer the med at bedtime if possible due to sedation
  3. Advise clients to swallow sustained-release tablets and to avoid chewing or crushing the tablets.
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24
Q

Benzodiazepines: Client Education

A
  1. Do not take in larger amounts or more often than prescribed w/o consulting the provider.
  2. Dependency can develop during or after tx. Notify provider if indications of withdrawal occur.
  3. Store in a secure place to prevent misuse by others
  4. Swallow sustained-release tablets and do not crush or chew them
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25
Q

Atypical anxiolytic/ Non-barbiturate includes which medication?

A

Buspirone

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26
Q

Atypical anxiolytic/Non-barbiturate: Expected Pharmocological Action

A

Exact MOA is unknown.
Binds to serotonin and dopamine receptors.

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27
Q

Buspirone Side effects

A

Dependency is much less likely than with other anxiolytics. Doesn’t cause sedation or potentiate the effects of other CNS depressants. Carries no risk of misuse.

28
Q

Buspirone Disadvantages

A

anti-anxiety effects develop slowly.
initial responses take a week at least 2-4 weeks to reach its full effects
taken on a scheduled basis, not suitable for PRN basis

29
Q

Buspirone: Therapeutic Uses

A
  1. Panic Disorder
  2. Social anxiety Disorder
  3. Obsessive-compulsive and related disorders
    4.Trauma- and stressor related disorders, PTSD
  4. Generalized anxiety disorder (GAD)
30
Q

Buspirone Complications include

A
  1. Dizziness, nausea, HA, lightheadedness, agitation
  2. Constipation
  3. Suicidal ideation
31
Q

Buspirone Complications: Dizziness, nausea, HA, lightheadedness, agitation– Client Education

A
  1. Take w/ food to decrease nausea
  2. Avoid activities that require alertness until effects are known
  3. Most adverse effects are self-limiting
32
Q

Buspirone Complications: Constipation– Client Education

A

Increase fiber and fluid

33
Q

Buspirone Complications: Suicidal ideation–Nursing Actions

A

Monitor and report manifestations of depression and thoughts of suicide

34
Q

Buspirone Contraindications/Precautions

A
  1. Pregnancy Risk category B
  2. not recommended for use by clients who are pregnant or breastfeeding
  3. Use cautiously in older adult clients and clients who have liver and/or renal dysfunction
  4. Contraindicated for concurrent use with MAOI antidepressants or for 14 days after MAOIs are discontinued. Hypertensive crisis can result
35
Q

Buspirone Interactions include:
Client education?

A

Erythromycin, ketoconazole, St. John’s wort, and grapefruit juice can increase the effects of buspirone.

Client education
1. avoid the use of these antimicrobial agents
2. Avoid herbal preparations containing St. John’s wort
3. Avoid drinking grapefruit juice

36
Q

Buspirone: Client Education

A
  1. Take the med with meals to prevent gastric irritation.
  2. Effects do not occur immediately. It can take a week to notice the first therapeutic effects and 2-4 weeks for the full benefit. Take on a regular basis and not PRN
  3. Tolerance, dependence, or withdrawal effects are not an issue w/ this med
37
Q

Selective serotonin reuptake inhibitors (SSRI antidepressants) include which meds?

A

select prototype med: Paroxetine
other meds: sertraline, citalopram, escitalopram, fluoxetine, fluvoxamine

38
Q

SRRI Expected Pharmacological Action

A
  1. Paroxetine selectively inhibits serotonin reuptake, allowing more serotonin to stay at the junction of the neurons
  2. It does not block uptake of dopamine or norepinephrine.
  3. The med has a long effective half-life. A time frame up to 4 weeks is necessary to produce therapeutic medication levels
39
Q

Paroxetine Therapeutic Uses

A
  1. GAD
  2. Panic Disorder: decreases both the frequency and intensity of panic attacks and also prevents anticipatory anxiety about attacks
  3. OCD: reduces manifestations by increasing serotonin
  4. Social anxiety disorder
  5. Trauma-and-stressor disorders
  6. Dissociative disorders
  7. Depressive disorders
  8. Adjustment disorders
40
Q

Sertraline Therapeutic Uses

A

Panic disorder, OCD, social anxiety disorder, and PTSD

41
Q

Escitalopram Therapeutic Uses

A

GAD and OCD

42
Q

Fluoxetine Therapeutic Uses

A

panic disorder, OCD, PTSD

43
Q

Fluvoxamine Therapeutic Uses

A

OCD and social anxiety disorder

44
Q

SSRI complications include

A

weight changes, GI bleeding, Hyponatremia, Serotonin syndrome, Bruxism, withdrawal syndrome, Postural hypotension, suicidal ideation

45
Q

SSRI early adverse effects
client education?

A

first few days/weeks: Nausea, diaphoresis, tremor, fatigue, drowsiness

Client education:
1. Report adverse effects to the provider
2. Take the medication as prescribed
3. These effects should soon subside

46
Q

SSRI Later adverse effects
client education?

A

After 5 to 6 weeks of therapy: Insomnia, HA, and sexual dysfunction (impotence, delayed or absent orgasm and/or ejaculation, decreased sexual interest)

Client education:
report problems with sexual function (managed with dose reduction, medication holiday, changing medications)

47
Q

SSRI Complications: Weight Change
Nursing action?
Client education?

A

occurrence of weight loss early in therapy that can be followed by weight gain with long-term treatment

Nursing actions: monitor the client’s weight
Client education: follow a well-balanced diet and exercise regulary

48
Q

SSRI Complications: GI Bleeding
Nursing actions?
client education?

A

Nursing actions: use caution in clients who have a hx of GI bleed or ulcers and in clients taking other meds that affect blood coagulation

Client education: report indications of bleeding (dark stool, coffee–ground emesis)

49
Q

SSRI Complications: hyponatremia
Nursing actions?

A

more likely in older adult clients taking diuretics

Nursing actions: obtain baseline blood sodium level, and monitor level periodically throughout tx

50
Q

SSRI Complications: Serotonin syndrome
manifestations?

A

agitation, confusion, disorientation, difficulty concentrating, anxiety, hallucinations, myoclonus, hyperreflexia, incoordination, tremors, fever, diaphoresis, hostility, delirium, seizures, tachycardia, labile BP, nausea, vomiting, diarrhea, abdominal pain, coma leading to apnea, and death in severe cases

51
Q

SSRI Complications: Serotonin syndrome
Nursing actions?

A
  1. Serotonin syndrome usually begins 2-72 hr after initiation of tx
  2. This resolves when the med is discontinued.
  3. Watch for and advise clients to withhold the med and report any of these manifestations, which could indicate lethal problem
52
Q

SSRI Complications: Bruxism
Nursing Actions?
Client education

A

grinding and clenching of teeth, usually during sleep

Nursing actions
1. report bruxism to the provider, who might switch the client to another class of medication
2. treat with low-dose buspirone

Client education: use a mouth guard during sleep

53
Q

SSRI Complications: Withdrawal syndrome
manifestations?
nursing actions?
client education?

A

nausea, sensory disturbances, anxiety, tremor, malaise, unease

Nursing action: minimized by tapering the med slowly
Client education: do not discontinue use abruptly but slowly taper the dose of med before stopping, especially with long-term use.

54
Q

SSRI Complications: Postural hypotension
Nursing actions?

A

monitor for hypotension and advice client to change positions slowly

55
Q

SSRI Complications: Suicidal ideation
Nursing actions?

A

monitor and report manifestations of depression and thoughts of suicide

56
Q

SSRI Contraindications/Precautions

A
  1. Paroxetine is a pregnancy risk category D med
  2. Paroxetine is contraindicated in clients taking MAOIs or a TCA
  3. Clients taking paroxetine should avoid alcohol
  4. Use paroxetine cautiously in clients who have liver and renal dysfunction, seizure disorders, or a hx of GI bleeding
57
Q

SSRI Interactions

A
  1. Use of St. John’s wort, MAOI antidepressants, or TCAs can cause serotonin syndrome
    Nursing actions: educate the client about this combination. Avoid concurrent use
  2. Antiplatelet medications and anticoagulants can increase risk for bleeding
    Nursing actions: monitor for bleeding. Avoid concurrent use.
58
Q

SSRI Nursing Administration and Client Education

A
  1. administer with food
  2. It can take up to 4 weeks to achieve therapeutic effects
  3. Taking the medication at the same time daily promotes therapeutic levels
  4. Taking the med in the morning can prevent sleep disturbances
59
Q

SSRI: Effectiveness is evidenced by the following

A
  1. verbalizing feeling less anxious and more relaxed
  2. description of improved mood
  3. improved memory retrieval
  4. maintaining regular sleep pattern
  5. greater ability to participate in social and occupational interactions
  6. improved ability to cope with manifestations and identified stressors
60
Q

A nurse working in an emergency department is caring for a client who has benzo toxicity. Which of the following actions is the nurse’s priority

a. administer flumazenil
b. identify the client’s level of orientation
c. infuse IV fluids
d. prepare the client for gastric lavage

A

b

61
Q

A nurse is teaching a client who has a new prescription for escitalopram for treatment of GAD. Which of the following statements by the client indicates understanding of the teaching?

a. “I should take the med on an empty stomach.”
b. “I will follow a low sodium diet while taking this medication.”
c. “I need to discontinue this med slowly.”
d. “I should not crush the med before swallowing.”

A

c

62
Q

A nurse is providing teaching to a client who has a new prescription for buspirone to treat anxiety. Which of the following info should the nurse include?

a. “take this med on an empty stomach”
b. “expect optimal therapeutic effects within 24 hr”
c. “take this medication when needed for anxiety”
d. “this med has a low risk for dependency”

A

d

63
Q

A nurse is teaching a client who has OCD and has a new prescription for paroxetine. Which of the following instructions should the nurse include?

a. “it can take several weeks before you feel like the med is helping”
b. “take the med just before bedtime to promote sleep”
c. “you should take the med when needed for obsessive urges”
d. “monitor for weight gain while takng this med”

A

a

64
Q

A nurse is caring for a client who takes paroxetine to treat PTSD and reports that they grind their teeth during the night. The nurse should identify which of the following interventions to manage bruxism? (Select all that apply)

a. concurrent administration of buspirone
b. administration of a different SSRI
c. use of a mouth guard
d. changing to a different class of antidepressant medication
e. increasing the dose of paroxetine

A

a, c, d

65
Q

Risk factors for Serotonin Syndrome

A
  1. onset of tx with an SSRI within the last 2 to 72 hr
  2. concurrent use of an SSRI with an MAOI
  3. Concurrent use of an SSRI with a TCA

ATI Pharmacology (5 decks)

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