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mental health ch 4psychopharmacology > the nursing process: antianxiety agents > Flashcards

the nursing process: antianxiety agents Flashcards

1
Q

What are the indications for anti-anxiety agents?

A 
anxiety disorders, 
anxiety symptoms,
 acute alcohol withdrawal,
 skeletal muscle spasms,
 convulsive disorders, 
status epilepticus,
 and preoperative sedation.
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2
Q

What is the action of anti-anxiety agents?

A

Depression of the CNS (except Buspirone)

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3
Q

what are contraindication/precautions for anti-anxiety medications?

A 
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.
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4
Q

what interactions with anti- anxiety medications

A 
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
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5
Q

nursing diagnosis for antianxiety medications

A 
risk for injury
anxiety
risk or activity intolerance
disturbed sleep pattern
deficit knowledge
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6
Q

Monitor clients taking anti anxiety medications for the following side effects.

A 
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)
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7
Q 
Which of the following medications would be an appropriate PRN medication for an individual with anxiety symptoms?
Buspirone
alprazolam
fluoxetine
sertraline
A

Alprazolam

it is a benzodiazepine hat works as a CNS depressant o produce quick acting effects of relaxation in an individual with anxiety symptoms

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8
Q

Buspirone

A

has a delayed effect (should not be used as a PRN med)

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9
Q

Fluoxetine and sertraline

A

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

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10
Q

Indications for anti depressants are?

A 
dysthymia, 
major depressive disorder,
 depression associated with organic disease,
 alcoholism,
 schizophrenia
, intellectual disability,
 depressive phase of bipolar disorder
, depression accompanied by anxiety
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11
Q

Action of anti depressants?

A

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)

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12
Q

Contraindication/Precautions of anti depressants?

A

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.

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13
Q

Drug interactions with SSRIs

A

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.

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14
Q

drug interactions with TCAs

A

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.

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15
Q

drugs interaction with MAOIs

A

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

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16
Q

Nursing diagnosis for antidepressants

A 
Risk for suicide
Risk for injury
Social isolation
Risk for constipation
Insomnia
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17
Q

Planning/implementation for antidepressants

A

Monitor client for the following side effects:
May occur with all chemical classes
Dry mouth, sedation, nausea
Discontinuation syndrome

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18
Q

Most commonly occur with tricyclics and heterocyclics

A

Blurred vision, constipation, urinary retention, orthostatic hypotension, reduction of seizure threshold, tachycardia, arrhythmias, photosensitivity, weight gain

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19
Q

Most commonly occur with SSRIs and SNRIs

A

Insomnia, agitation, headache, weight loss, sexual dysfunction, serotonin syndrome

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20
Q

Most commonly occur with MAOIs

A 
Hypertensive crisis
 Site reactions (selegiline transdermal system)
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21
Q

Miscellaneous side effects

A 
Priapism (with trazodone)
 Hepatic failure (with nefazodone)
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22
Q

Educate client and family about the medication.

A

and side effects

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23
Q

Indications:Mood-Stabilizing Agents

A

Prevention and treatment of manic episodes associated with bipolar disorder

24
Q

Examples:Mood-Stabilizing Agents

A

Examples: Lithium carbonate, clonazepam, carbamazepine, valproic acid, lamotrigine, topiramate, oxcarbazepine, verapamil, various antipsychotics

25
Q

Action:Mood-Stabilizing Agents

A

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.

26
Q

Nursing diagnosis for mood stabilizing agents

A

Risk for injury
Risk for self-directed or other-directedviolence
Risk for activity intolerance

27
Q

Therapeutic range

for Lithium

A
  1. 0–1.5 mEq/L (acute mania)

0. 6–1.2 mEq/L (maintenance)

28
Q

Initial symptoms of Lithium toxicity include

A

Blurred vision, ataxia, tinnitus, persistent nausea and vomiting, and severe diarrhea

29
Q

what should be ensured when a client is taking Lithium

A

Ensure that client consumes adequate sodium and fluid in diet.

30
Q

INDICATIONS FOR ANTIPSYCHOTICS

A

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.

31
Q

Action

Typical antipsychotics

A

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.

32
Q

Action

Atypical antipsychotics

A

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

33
Q

Contraindications/precautions (atypicals)

A

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.

34
Q

Nursing diagnosis

for antipsychotics

A

Risk for other-directed violence
Risk for injury
Risk for activity intolerance
Noncompliance

35
Q

The Nursing Process: Antipsychotics
Planning/implementation
Monitor client for the following side effects:

A

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

36
Q

Sedative-Hypnotics

Indications:

A

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.

37
Q

Sedative-Hypnotics Action

A

Depression of the CNS

38
Q

Sedative-Hypnotics Exception:

A

Ramelteon’s sleep-promoting properties are the result of agonist activity on selective melatonin receptors.

39
Q

Sedative-Hypnotics

Contraindications

A

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.

40
Q

Sedative-Hypnotics precautions

A

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.

41
Q

Nursing diagnosis Sedative-Hypnotics

A

Risk for injury
Disturbed sleep pattern/insomnia
Risk for activity intolerance
Risk for acute confusion

42
Q

Planning/implementation Sedative-Hypnotics

Monitor client for the following side effects

A

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

43
Q

ADHD Agents

Indications:

A

Attention deficit/hyperactivity disorder (ADHD) in children and adults

44
Q

ADHD Agents Actions

A

The CNS stimulants increase levels of norepinephrine, dopamine, and serotonin in the CNS.

45
Q

Their effectiveness in the treatment of ADHD is thought to be based on the activation of

A

dopamine D4 receptors in the basal ganglia and thalamus, which depress, rather than enhance, motor activity.

46
Q

Atomoxetine inhibits ?

A

the reuptake of norepinephrine, and bupropion blocks the neuronal uptake of serotonin, norepinephrine, and dopamine.

47
Q

Clonidine and guanfacine stimulate what?

A

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.

48
Q

CNS stimulants: Contraindicated in clients with?

A

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

49
Q

Atomoxetine and bupropion: Contraindicated in clients

A

with hypersensitivity to the drugs, in lactation, and in concomitant use with or within 2 weeks of using MAOIs

50
Q

Atomoxetine: Contraindicated in clients with

A

narrow-angle glaucoma

51
Q

Bupropion: Contraindicated in clients with

A

known or suspected seizure disorder, acute phase of MI, and in clients with bulimia or anorexia nervosa

52
Q

Alpha agonists: Contraindicated in clients with

A

known hypersensitivity to the drugs

53
Q

CNS stimulants: Use caution in

A

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.

54
Q

Atomoxetine and bupropion: Use caution in clients with

A

urinary retention; hepatic, renal, or cardiovascular disease; suicidal clients; pregnancy; and elderly and debilitated clients.

55
Q

Alpha agonists: Caution in clients with

A

cerebrovascular coronary insufficiency, recent MI, or disease; in chronic renal or hepatic failure; the elderly; and in pregnancy and lactation

56
Q

Nursing diagnosis

ADHD agents

A

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

57
Q

Planning/implementation ADHD agents

Monitor client for the following side effects:

A

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)

mental health ch 4psychopharmacology (3 decks)

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