Medications for Anxiety Disorders Flashcards
What is the suffix to know benzodiazepines by?
“pam”
What is the therapeutic outcome of benzos?
rapid relief from anxiety by inhibiting effects of gamma-aminobutyric acid in the CNS
sedation, general anxiety disorders, anxiolytic, alcohol withdrawal, amnesia, seizure disrders
What benzo is commonly used for conscious sedation?
midazolam (versed)
What are some adverse effects of benzos?
CNS depression
Respiratory depression/obstruction
hypotension
withdrawal symptoms - tremors, anxiety, insomnia, diaphoresis
paradoxal response - opposite effect of what expected. become excitable
amnesia - can be an intended effect
What are some nursing considerations for benzos?
Fall risk, careful when giving other sedatives like narcotics - CNS depression
maintain airway, respiratory assessment is very important (primary assessment)
monitor BP (hypotension)
Withdrawal symptoms usually only occur with long term use, remember scheduled IV doses, taper off slowly
monitor, patients might become more excitable
amnesia may bean intended effect if used with procedures (can cause anterograde amnesia which is amnesia that occurs after the dosing, tell patient to report if occurs)
monitor vitals
have resuscitation equipment ready
provide fluids and maintain BP
What are the manifestations of acute oral benzo toxicity? how is it reversed?
drowsiness, lethargy, confusion
gastric lavage may be used, followed by activated charcoal or saline cathartics
What are manifestations of IV benzo toxicity? how is it reversed?
respiratory depression, severe hypotension, cardiac/respiratory arrest
diazepam and lorazepam
reversed with flumazenil (Romazicon) to counteract sedation and reverse adverse effects
What are the manifestations of benzo withdrawals?
anxiety, insomnia, diaphoresis, tremors, light-headedness
these arent common with short term use
Taper off over several weeks if taking regularly
NOT THE SAME AS SEROTONIN SYNDROME
`What are some other nursing considerations for benzos?
Give IV slowly - over 2-3 minutes
May need to adjust dosing if also taking narcotics, also there are age-related dosing adjustments
most have very LONG half-lives
reversal agent (antagonst) - flumazenil (Romazicon)
have resuscitation equipment available, apply oxygen if needed
What are some key patient teaching points for benzos?
dont drink alcohol or take any other CNS depressants
fall risk - sedation
Take as directed and dont stop suddenly (withdrawals) - taper off over several weeks
dont drive or operate heavy machinery until effects are known
Avoid pregnancy (category D)
keep away from children!!!
What pregnancy category are benzos?
Cat D, SOME ARE X
Are benzos controlled substances?
YES
When is diazepam contraindicated?
sleep apnea, respiratory depression, glaucoma
USE CAUTIOUSLY IN PATIENTS WITH LIVER DISEASE, HISTORY OF MENTAL ILLNESS, OR A SUBSTANCE USE DISORDER
Are benzos usually used long term?
NO, they are usually used short term because of their risk for dependence
Describe buspirone (Buspar).
No sedation or other CNS effects
Dependency and withdrawal is not an issue
DO NOT TAKE CONCURRENTLY WITH AN MAOI, WAIT 14 DAYS AFTER DISCONTINUATION (HTN CRISIS)
May take weeks till full effects
Avoid grapefruit juice and St. Johns wort (increases effects), so does ketoconazole and erythromycin
can cause dizziness, nausea, agitation, HA
avoid in older adults and adults who have liver/renal dysfunction
