the nursing process: antianxiety agents Flashcards
What are the indications for anti-anxiety agents?
anxiety disorders, anxiety symptoms, acute alcohol withdrawal, skeletal muscle spasms, convulsive disorders, status epilepticus, and preoperative sedation.
What is the action of anti-anxiety agents?
Depression of the CNS (except Buspirone)
what are contraindication/precautions for anti-anxiety medications?
contraindicated in known hypersensitivity in combination with other CNS depressants. in pregnancy and lactation narrow angle glaucoma shock and coma CAUTION : with the elderly debilitated clients, clients with renal failure, hepatic dysfunctions, those with a history of drug abuse or addiction those who are depressed or suicidal.
what interactions with anti- anxiety medications
INCREASED AFFECTs with alcohol barbiturates narcotic antipsychotics antidepressants antihistamines neuromuscular blocking agents cimetidine disulfiram kava kava valerian root. DECREASED EFFECTS; with cigarette smoking and caffeine consumption
nursing diagnosis for antianxiety medications
risk for injury anxiety risk or activity intolerance disturbed sleep pattern deficit knowledge
Monitor clients taking anti anxiety medications for the following side effects.
drowsiness confusion lethargy tolerance physical and psychological dependence potentation of other CNS depressants aggravation of depression orthosatic hypotension paradoxical excitement dry mouth, nausea vomiting blood dyscrasias, delayed onset (only with buspirone)
Which of the following medications would be an appropriate PRN medication for an individual with anxiety symptoms? Buspirone alprazolam fluoxetine sertraline
Alprazolam
it is a benzodiazepine hat works as a CNS depressant o produce quick acting effects of relaxation in an individual with anxiety symptoms
Buspirone
has a delayed effect (should not be used as a PRN med)
Fluoxetine and sertraline
may be used on a long term basis with individuals who have anxiety disorders but are not effective on a PRN basis for anxiety symptoms
Indications for anti depressants are?
dysthymia, major depressive disorder, depression associated with organic disease, alcoholism, schizophrenia , intellectual disability, depressive phase of bipolar disorder , depression accompanied by anxiety
Action of anti depressants?
increase concentration of norepinepherine, serotonin, and/or dopamine in the body either by blocking their reuptake by the neurons (tricyclics, tetracyclics, SSRIs, SNRIs) or by inhibiting the release of monoamine oxidase inhibitors (MAOIs)
Contraindication/Precautions of anti depressants?
CONTRAINDICATED in known hypersensitivity (all), acute phase of recovery from myocardial infarction(MI) and in angle-closure glaucoma(tricyclics) and concomitant with MAOIs (all)
CAUTION: with elderly or debilitated clients
; clients with hepatic cardiac or renal insufficiency;
psychotic clients;
clients with benign prostatic hypertrophy;
and those with a history of seizures.
Drug interactions with SSRIs
Buspirone(BuSpar), TCAs (especially clomipramine), selegiline(Eldepryl), St. Johns wart
ADVERSE EFFECTS: SEROTONIN SYNDROME
MAOIs: adverse effects with ssri’s ; HYPERTENSIVE CRISIS
WARFARIN, NSAIDS; adverse effects; INCREASED RISK OF BLEEDING
ALCOHOL, BENZODIAZAPINES; adverse effects; INCREASED SEDATION
ANTIEPILEPTICS; adverse effects; LOWERED SEIZURE THRESHOLD.
drug interactions with TCAs
MAOIs: adverse effects; HIGH FEVER, CONVULSIONS, DEATH
ST. JOHNS WART, TRAMADOL(ultram); adverse effects; SEIZURES, SEROTONIN SYNDROME
CLONIDINE(catapres), EPINEPHRINE; adverse effects; SEVERE HYPERTENSION
ACETYLCHOLINE BLOCKERS; adverse effects, PARALYTIC ILEUS
ALCOHOL, CARBAMEZIPINE; adverse effects; BLOCKS ANTIDEPRESSANT ACTION, INCREASES SEDATION
CIMETIDINE(tagamet) BUPROPION(BuSpar); adverse effects; INCREASED TCA BLOOD LEVELS, INCREASED SIDE EFFECTS.
drugs interaction with MAOIs
SSRIs, TCAs, atomoxetine (Strattera), duloxetine (Cymbalta), dextromethorphan (an ingredient in many cough syrups), venlafaxine (Effexor), St. John’s Wort, ginkgo adverse effects Serotonin syndrome
All other antidepressants, pseudoephedrine, amphetamines, cocaine cyclobenzaprine (Flexeril), dopamine, methyldopa, levodopa, epinephrine, buspirone (BuSpar) ADVERSE EFFECTS;Hypertensive crisis (these side effects can occur even if taken within 2 weeks of stopping MAOIs)
Morphine and other narcotic pain relievers,
antihypertensives ADVERSE EFFECTS; Hypotension
Buspirone (BuSpar); ADVERSE EFFECTS; Psychosis, agitation, seizures
Antidiabetics; ADVERSE EFFECTS; Hypoglycemia
Tegretol; ADVERSE EFFECTS; Fever, hypertension, seizures
Nursing diagnosis for antidepressants
Risk for suicide Risk for injury Social isolation Risk for constipation Insomnia
Planning/implementation for antidepressants
Monitor client for the following side effects:
May occur with all chemical classes
Dry mouth, sedation, nausea
Discontinuation syndrome
Most commonly occur with tricyclics and heterocyclics
Blurred vision, constipation, urinary retention, orthostatic hypotension, reduction of seizure threshold, tachycardia, arrhythmias, photosensitivity, weight gain
Most commonly occur with SSRIs and SNRIs
Insomnia, agitation, headache, weight loss, sexual dysfunction, serotonin syndrome
Most commonly occur with MAOIs
Hypertensive crisis Site reactions (selegiline transdermal system)
Miscellaneous side effects
Priapism (with trazodone) Hepatic failure (with nefazodone)
Educate client and family about the medication.
and side effects
Indications:Mood-Stabilizing Agents
Prevention and treatment of manic episodes associated with bipolar disorder
Examples:Mood-Stabilizing Agents
Examples: Lithium carbonate, clonazepam, carbamazepine, valproic acid, lamotrigine, topiramate, oxcarbazepine, verapamil, various antipsychotics
Action:Mood-Stabilizing Agents
Lithium is thought to modulate the effects of norepinephrine, serotonin, dopamine, glutamate, and GABA, which may contribute to the symptomatology of bipolar disorder, the role of anticonvulsants, verapamil, and antipsychotics in the treatment of bipolar mania is not fully understood.
Nursing diagnosis for mood stabilizing agents
Risk for injury
Risk for self-directed or other-directedviolence
Risk for activity intolerance
Therapeutic range
for Lithium
- 0–1.5 mEq/L (acute mania)
0. 6–1.2 mEq/L (maintenance)
Initial symptoms of Lithium toxicity include
Blurred vision, ataxia, tinnitus, persistent nausea and vomiting, and severe diarrhea
what should be ensured when a client is taking Lithium
Ensure that client consumes adequate sodium and fluid in diet.
INDICATIONS FOR ANTIPSYCHOTICS
Used for the treatment of schizophrenia and other psychotic disorders;
selected agents are also used in the treatment of bipolar mania, as antiemetics, in the treatment of intractable hiccoughs, and for control of tics and vocal utterances in Tourette’s disorder.
Action
Typical antipsychotics
Block postsynaptic dopamine receptors in the basal ganglia, hypothalamus, limbic system, brainstem, and medulla.
Demonstrate varying affinity for cholinergic, alpha-1-adrenergic, and histaminic receptors.
Inhibit dopamine-mediated transmission of neural impulses at the synapses.
Action
Atypical antipsychotics
Weaker dopamine receptor antagonists than the typical antipsychotics
Potent antagonists of the serotonin type 2A (5HT-2A) receptors
Exhibit antagonism for cholinergic, histaminic, and adrenergic receptors
Contraindications/precautions (atypicals)
Contraindicated in hypersensitive, comatose, or severely depressed patients; elderly patients with dementia-related psychosis; certain medications are contraindicated in patients with a history of QT prolongation or other heart issues.
Caution with elderly or debilitated patients; patients with cardiac, hepatic, or renal insufficiency; those with a history of seizures; patients with diabetes or risk factors for diabetes; clients exposed to temperature extremes under conditions that cause hypotension; and pregnant clients or children.
Nursing diagnosis
for antipsychotics
Risk for other-directed violence
Risk for injury
Risk for activity intolerance
Noncompliance
The Nursing Process: Antipsychotics
Planning/implementation
Monitor client for the following side effects:
Anticholinergic effects, nausea, gastrointestinal upset, skin rash, sedation, orthostatic hypotension, photosensitivity, hormonal effects, electrocardiogram changes, reduction of seizure threshold, agranulocytosis (especially with clozapine), hypersalivation (with clozapine), extrapyramidal symptoms, tardive dyskinesia, neuroleptic malignant syndrome, hyperglycemia and diabetes, increased risk of mortality in elderly patients with NCD-related psychosis
Sedative-Hypnotics
Indications:
Short-term management of various anxiety states and treatment of insomnia; selected agents are used as anticonvulsants, as preoperative sedatives, and to reduce anxiety associated with alcohol withdrawal.
Sedative-Hypnotics Action
Depression of the CNS
Sedative-Hypnotics Exception:
Ramelteon’s sleep-promoting properties are the result of agonist activity on selective melatonin receptors.
Sedative-Hypnotics
Contraindications
Contraindicated in known hypersensitivity, pregnancy, and lactation, and in severe hepatic, cardiac, respiratory, or renal disease. Chloral hydrate is contraindicated in persons with esophagitis, gastritis, or peptic ulcer disease.
Sedative-Hypnotics precautions
Caution is advised with clients with hepatic, cardiac, renal, or respiratory insufficiency. Caution is also advised with those who are suicidal and those who have been addicted to drugs. Chloral hydrate should be used with caution in clients susceptible to acute intermittent porphyria.
Nursing diagnosis Sedative-Hypnotics
Risk for injury
Disturbed sleep pattern/insomnia
Risk for activity intolerance
Risk for acute confusion
Planning/implementation Sedative-Hypnotics
Monitor client for the following side effects
Drowsiness, confusion, lethargy, tolerance, physical and psychological dependence, potentiation of other CNS depressants, aggravation of depression, orthostatic hypotension, paradoxical excitement, dry mouth, nausea, vomiting, and blood dyscrasias
Abnormal thinking and behavioral changes
ADHD Agents
Indications:
Attention deficit/hyperactivity disorder (ADHD) in children and adults
ADHD Agents Actions
The CNS stimulants increase levels of norepinephrine, dopamine, and serotonin in the CNS.
Their effectiveness in the treatment of ADHD is thought to be based on the activation of
dopamine D4 receptors in the basal ganglia and thalamus, which depress, rather than enhance, motor activity.
Atomoxetine inhibits ?
the reuptake of norepinephrine, and bupropion blocks the neuronal uptake of serotonin, norepinephrine, and dopamine.
Clonidine and guanfacine stimulate what?
central alpha-adrenergic receptors in the brain resulting in reduced sympathetic outflow from the CNS.
The exact mechanism by which these nonstimulant drugs produce the therapeutic effect in ADHD is unclear.
CNS stimulants: Contraindicated in clients with?
hypersensitivity to sympathomimetic amines; clients with advanced arteriosclerosis, cardiovascular disease, hypertension, hyperthyroidism, glaucoma, agitated or hyperexcitability states; clients with a history of drug abuse; clients during or within 14 days of receiving therapy with MAOIs; in children younger than 3 years of age; and in pregnancy and lactation
Atomoxetine and bupropion: Contraindicated in clients
with hypersensitivity to the drugs, in lactation, and in concomitant use with or within 2 weeks of using MAOIs
Atomoxetine: Contraindicated in clients with
narrow-angle glaucoma
Bupropion: Contraindicated in clients with
known or suspected seizure disorder, acute phase of MI, and in clients with bulimia or anorexia nervosa
Alpha agonists: Contraindicated in clients with
known hypersensitivity to the drugs
CNS stimulants: Use caution in
children with psychoses; clients with Tourette’s disorder, anorexia, or insomnia; elderly, debilitated, or asthenic clients; and clients with history of suicidal or homicidal tendencies; prolonged use may result in tolerance and physical or psychological dependence.
Atomoxetine and bupropion: Use caution in clients with
urinary retention; hepatic, renal, or cardiovascular disease; suicidal clients; pregnancy; and elderly and debilitated clients.
Alpha agonists: Caution in clients with
cerebrovascular coronary insufficiency, recent MI, or disease; in chronic renal or hepatic failure; the elderly; and in pregnancy and lactation
Nursing diagnosis
ADHD agents
Risk for injury
Risk for suicide
Insomnia
Imbalanced nutrition: less than body requirements
Nausea related to side effects of atomoxetine or bupropion
Pain related to side effects of abdominal pain with atomoxetine or bupropion or headache (all agents)
Risk for activity intolerance
Planning/implementation ADHD agents
Monitor client for the following side effects:
Overstimulation, restlessness, insomnia, palpitations, tachycardia, anorexia, weight loss, tolerance, physical and psychological dependence, nausea and vomiting, constipation, dry mouth, sedation or rebound syndrome (alpha agonists), potential for seizures (bupropion), liver damage (atomoxetine), and new or worsened psychiatric symptoms (CNS stimulants and atomoxetine)
