Study Guide 10 Flashcards
Anxiolytics is another term you may see when referring to the anti-anxiety drugs.
Antianxiety drugs
alprazolam (Xanax), chlordiazepoxide (Librium), diazepam (Valium), lorazepam (Ativan)
Examples of Benzodiazepines
Schedule IV controlled substances because of the ability to cause dependency
Benzodiazepines are classified as
Benzodiazepines are used for short term anxiety relief due to the risk of what?
Physical dependence and phycological dependence result from long term used of the benzodiazepines
Benzodiazepines exert their effects how?
They exert their tranquilizing effect by potentiating the effects of gamma-aminobutyric acid (GABA), an inhibitory transmitter
Vistaril works how and where?
It produces its anti-anxiety effect by acting on the hypothalamus and brainstem reticular formation
Vistaril Uses
• Isolated episodes of intense anxiety
• Temporary use for those with severe functional impairment
• Preanesthetic sedation and muscle relaxation
• Convulsion or seizures
• Alcohol withdraw
Vistril Adverse Reactions
• Mild drowsiness or sedation
• Lightheadedness or dizziness
• Headache
• Lethargy, apathy, fatigue
• Disorientation
• Anger
• Restlessness
• Nausea, constipation, or diarrhea, dry mouth
• Visual disturbances
Vistril Dependence
Physical dependance (tolerance): increasingly larger doses required to obtain the desired effect
Withdrawal symptoms can occur when medication is stopped. Therefore, a gradually decreasing dosage schedule (known as tapering) should be used when stopping a benzodiazepine
The client will display anxious behaviors and request to be put back on or increase the dose of he benzodiazepine. This behavior is frequently viewed by others as addiction to the benzodiazepine drugs rather than a fear reaction
Symptoms of Withdrawl
• Increased anxiety and panic
• Fatigue
• Hypersomnia and nightmares
• Metallic taste
• Concentration difficulties
• Headache and tinnitus
• Tremors
• Numbness in the extremities
• Tachycardia, hypertension
• Nausea, vomiting, diarrhea
• Fever and sweating
• Muscle tension, aching, and cramps
• Psychoses and hallucination
• Agitation
• Memory impairment
• Convulsions (possible)
Contraindications to Vistril
• Do not administer anti-anxiety drugs to clients with known hypersensitivity, psychoses, and acute narrow-angle glaucoma
• Pregnancy (category D drugs) and labor
• Reports of floppy infant syndrome manifested by sucking difficulties, lethargy, and hypotonia have been seen in the newborn of a mother using benzodiazepines
• Lactating woman (can cause lethargy and weight loss on infant)
• When clients are in a coma or shock and if the vital signs of the client in acute alcoholic are low
Owing to a specific enzyme reaction, grapefruit or its juice should not be taken if the client is on buspirone and diazepam
Specific Enzyme Reactions
Vistril Interactions
• Alcohol: increased risk for CNS depression or convulsions
• Analgesics: increased risk for CNS depression
• Tricyclic antidepressants: increased risk for sedations and respiratory depression
• Antipschotics: increased risk for sedation and respiratory depression
• Digoxin: increased risk for digitalis toxicity
Anxiolytics are not recommended for
They aren’t recommended for people with a history of substance misuse or addiction
Only short periods such as
1-2 weeks.
When these drugs are given in an outpatient setting, instruct both the client and family about adverse reactions (dizziness, lightheadedness, or ataxia) that can cause a client to fall and become injured. This is very important when the drugs are administered to older patients.
Risk For Injury
Unsteady gait; muscular incoordination
Ataxia
What is excreted more slowly in adults
• Benzodiazepines
Lorazepam and oxazepam are typically used for older adults because
it does not cause excessive sedation and the risk of falling is not as great
Anxiolytics can cause dryness of the
mucous membranes & slower transit in the intestines.
What nursing actions would you recommend?
Frequent sips of water to relieve dry mouth and provide adequate hydration. Chew sugarless gum or suck on hard candy to reduce discomfort or dry mouth. Administer oral antianxiety drugs with food or meals to decrease the possibility of GI upset.
causes sedation, respiratory depression, and coma
Benzo toxicity
Slurred speech, ataxia and altered mental status
Signs & symptoms of Benzo toxicity
Xanax: Anxiety disorders, short-term relief of anxiety, panic attacks
Alprazolam
Valium: Anxiety disorders, short term relief of anxiety, acute alcohol withdrawal, anticonvulsant, procedural relief of anxiety and tension
Diazepam
Ativan: Anxiety disorders, short term relief of anxiety, preanesthetic
Lorazepam
Vistaril: anxiety and tension associated with psychoneurosis, pruritus, preanesthetic sedative
Hydroxyzine
reverse sedation or drowsiness of benzodiazepine and some sleep aids, lessen benzodiazepine withdrawal symptoms
Flumazenil
Sedatives and Hypnotics:
Are used to treat what?
Barbiturates May be used in cases where a deep, non waking sleep is desired, such as the few states where assisted suicide is legal.
Nonbarbiturates are now used as sedatives in place of barbiturates, because they are more effective in treating insomnia and the adverse reactions are less than those of the barbiturates. May also be used for an antianxiety drug.
Drug that induces sleep
Hypnotic
Drug producing a relaxing, calming effect
Sedative
With prolonged usage of high doses what can occur?
Physical tolerance and psychological dependence may occur.
Sedatives and Hypnotics Uses
The sedatives and hypnotic drugs are used in the treatment of :
*Insomnia
*Convulsions or seizures
They are also used as adjuncts for anesthesia and for:
*Preoperative sedation
*Conscious sedation
Sedatives and Hypnotics Adverse reactions
Nervous system reactions include dizziness, drowsiness, and headache
*A common gastrointestinal reaction is nausea
Sedatives and Hypnotics Contraindications
These drugs contraindicated in clients with known hypersensitivity to sedatives or hypnotics. Do not administer these drugs to comatose clients, those with service respiratory problems, those with a history of drug and alcohol habitual use, or pregnant or lactating women.
Classified as Category X drugs
Women taking benzodiazepines should be warned of the potential risk to the fetus so that contraceptives methods may be instituted, if necessary. A child born to a mother taking benzodiazepines may experience withdrawal symptoms during the postnatal period.
Sedatives and hypnotics should be used cautiously
in lactating clients and in clients with hepatic or renal impairment, habitual alcohol use, and mental health problems.
Melatonin is a hormone produced by the pineal gland in the brain. Melatonin has been used in treating insomnia, overcoming jet leg, improving the effectiveness of the immune system, and as an antioxidant. The most significant use at low doses is the short-term treatment of insomnia.
Herbal remedy for Insomnia
Kava is a popular herbal remedy thought to relieve stress, anxiety and tension: and provide relief from menstrual discomfort
Herbal remedy for mild anxiety
What helps with sleep
Back rubs, night lights, or darkened room, and a quiet atmosphere
What interferes with sleep
Caffeine, such as coffee, cola, or energy drinks, which can contribute to wakefulness
May cause memory loss or amnesia. A person may not remember getting up out of bed, driving or eating. These drugs should be taken only when a person plans for 7-8 hours
Ambien
Safety issues
After administration of a hypnotic, such as before for a surgical or diagnostic procedure, raise the side rails of the bed and advise the client to remain in bed and call for assistance.
Excitement or confusion
Paradoxical reaction
Ineffective Breathing patterns
Sedatives and hypnotics depress the CNS and can cause respiratory depression.
Halcion: Sedative, hypnotic
Triazolam
selective serotonin reuptake inhibitors
SSRI
same mode of action as the barbiturates,
‘The nonbenzodiazepine sedatives and hypnotic
they depress the CNS
SSRI uses
Transient insomnia, Convulsions or Seizures. They are also used for Preoperative sedation, and conscious sedation.
Drowsiness, Headache, Rebound Insomnia, Nausea, Myalgia
Neuro dizziness, drowsiness and headache
GI/GU nausea
Adverse Reactions Of SSRI
venlafaxine (Effexor XR) and bupropion (Wellbutrin)
SNRI
SNRI Unlabeled Uses
Include enhancing weight loss and treating aggressive behaviors, menstrual disorders, cocaine withdrawal, and alcohol cravings, migraine headache prevention, and stress incontinence
SNRI adverse reactions
Neuro *Somnolence, migraine headache, hypotension, dizziness, lightheadedness, and vertigo. *Blurred vision, photosensitivity, insomnia nervousness or agitation, and tremor
GI Nausea, dry mouth, anorexia, thirst, diarrhea, constipation, bitter taste
Other *Fatigue, tachycardia, and palpation, Change in libido, impotence. Skin rash, itching, vasodilation resulting in flushing and excessive sweating
TD
TARDIVE DYSKINESIA
TCA
Tricyclics
NMS
Neuroleptic malignant syndrome
MAOI
Monoamine Oxidase Inhibitors
MAOI Uses
MAOI antidepressants are less frequently used in the treatment of depressive episodes owning to the possible reaction of hypersensitive crisis and other unwanted adverse reactions.
MAOI Adverse Reactions
• Neuromuscular reactions include orthostatic hypotension, dizziness, vertigo, headache, and blurred vision
• GI ang genitourinary system reactions include constipation, dry mouth, nausea, diarrhea, and impotence
• A serious adverse reaction associated with MAOIs is hypersensitive crisis (extremely high blood pressure), which may occur when food containing tyramine (an amino acid) are eaten
Foods to avoid: containing
If taking MAOI
Tyramine
not a true antidepressant drug,
Lithium
Toxic levels can occur when serum blood levels are >
1.5 mEq/L
How do antacids affect effectiveness?
Antacids will decrease the effectiveness of lithium.
Give signs of toxicity:
Level 1.5-2
diarrhea vomiting, nausea, drowsiness, muscular weakness, lack of coordination (early signs of toxicity)
Give signs of toxicity
Level 2-3
giddiness, ataxia, blurred vision, tinnitus, vertigo, increasing confusion, slurred speech, blackouts, myoclonic twitching or movements, urinary or fecal incontinence, agitation or manic like behavior, hyperreflexia, hypertonia, dysarthria
Give signs of toxicity
Level >3
May produce a complex clinical picture involving multiple organs and organ systems, including seizures (generalized and focal), arrythmias, hypotension, peripheral vascular collapse, stupor, muscle group twitching, spasticity, coma
Risk for suicide
Verbal cueing: statements of worthlessness or that a “situation” will be over soon.
*Coming out of depressive mood: when a person is at the greatest risk of self-harm
*A “command” hallucination: when “voices” are telling a client they are worthless and should die
*Lack of alternatives: when a person who has relatively few coping skill/support networks has the false belief that they have ruled out all resources available and death is now the only solution
Imbalanced fluid volume
Serum lithium levels of less than 1.5 mEq/L
Give trade name for Trazodone
Desyrel
Escitalopram
Lexapro
Fluoxetine
Prozac
Paroxetine
Paxil, Brisdelle, Pexeva
Amitriptyline
Elavil
Phenelzine
Nardil
characterized by disordered thinking, perceptual disturbance, behavioral abnormality, affective problems, and impaired socialization.
schizophrenia
drugs act on the dopamine receptors of the brain.
Antipsychotic
Endocrine Changes (SGA)
Weight gain
Increased cholesterol, triglyceride, and blood sugar levels
extreme restlessness and increased motor activity
Akathisia
(EPS) refers to a group of adverse reactions affecting the extrapyramidal portion of the nervous system as a result of antipsychotic drugs.
Extrapyramidal Syndrome
(TD) is a syndrome consisting of potentially irreversible, involuntary movements.
Tardive Dyskinesia
abnormal condition of the blood cells
Blood dyscrasias
decrease or lack of granulocytes (a type of white blood cell [WBC])
agranulocytosis
Chlorpromazine
Thorazine and Largactil
Fluphenazine
Modecate
Haloperidol
Haldol
Olanzapine
Zyprexa
Quetiapine
Seroquel
Risperidone
Risperdal
Seizure control
Hydantoins
increase the levels of gamma (γ)-aminobutyric acid (GABA), which stabilizes cell membranes.
Carboxylic Acid
How would you treat status epilepticus?
an emergency characterized by continual seizure activity with no interruptions) can occur. Lorazepam (Ativan) is the drug of choice for this condition.
Epilepsy, migraine headache, mania
Depakote: valproic acid
Epilepsy, bipolar disorder, trigeminal/postherpetic neuralgia
Tegretol: carBAMazepine
Focal/tonic–clonic seizures, migraine headache
Topamax: topiramate
Phenytoin is contraindicated in clients with sinus bradycardia, sinoatrial block, Adams–Stokes syndrome, and second- and third-degree atrioventricular block
Antiepileptics Contraindication
