PHARM ATI ch 7 Anxiety disorders

what medications are classified as sedative hypnotic anxiolytic-benzodiazepine?
-alprazolam (xanax)
-diazepam (valium)
-lorazepam (ativan)
-chlordiazepoxide (librium)
-clorazepate (tranxene)
-oxazepam (serax)
– clonazepam (klonopin)

what are the pharmalogical action of Diazepam?
enhances the inhibitory effects of gamma-aminobutyric acid in the CNS. Relief from anxiety occurs rapidly following administration

what are the therapeutic uses of benzodiazepines?
-Generalized anxiety disorder and panic disorder
-seizures disorders
-insomnia
-muscle spasm
-alcohol withdrawal
-induction of anesthesia
-amnesic prior to surgery or procedures

the following are nursing interventions for which type of benzodiazepines adverse effect?
-advise clients to observe for CNS depression, instruct the client to notify the provider if effects occur
-advise clients to avoid hazardous activities (driving, operating heavy equipment/machinery)
CNS depression, (sedation, lightheadedness, ataxia, decreased cognitive function)

the following are nursing interventions for which type of benzodiazepines adverse effect?
-advise clients to observe for manifestations. instruct clients to notify the provider if effects occur
anterograde amnesia (difficulty recalling events that occur after dosing)

the following are nursing interventions for which type of benzodiazepines adverse effect?
-for oral toxicity, gastric lavage can be used, followed by the administration of activated charcoal or saline cathartics
-for IV toxicity, administer flumazenil (Romazicon) to counteract sedation and reverse adverse effect
-monitor the clients vital signs, maintain patent airway, and provide fluids to maintain blood pressure
-have resuscitation equipment available
-acute toxicity
-oral toxicity (drowsiness, lethargy, confusion)
-iv toxicity (may lead to respiratory depression, severe hypotension, or cardiac/ respiratory arrest)

Benzodiazepines for IV use include?
– Diazepam (Valium)
-Lorazepam (ativan)

the following are nursing interventions for which type of benzodiazepines adverse effect?
-advise clients to watch for manifestations. notify the provider if these occur
-paradoxical response (insomnia, excitation, euphoria, anxiety, rage)

the following are nursing interventions for which type of benzodiazepines adverse effect?
-advise clients that withdrawal effects are not common with short term
-advise clients who have been taking diazepam regularly and in high doses to taper the dose over several weeks
manifestations of withdrawal include anxiety, insomnia, diaphoresis, tremors, light-headedness

what are contraindications/precautions for the use of benzodiazepines?
-classified under schedule IV of the controlled substances Act
-short term due to risk for dependence
Diazepam:
– cautiously with clients who have liver disease or mental illness or substance use disorder
-contraindicated in clients who have sleep apnea, respiratory depression, and or glaucoma
-pregnancy risk category D medication

interaction of benzodiazepines and CNS depressants results in
respiratory depression; therefore clients should avoid hazardous activities

benzodiazepines nursing administration
-take as prescribed avoid abrupt discontinuation to prevent withdrawal manifestation
-when discontinuing benzodiazepines that have been taken regularly for long periods and in higher doses, taper the dose over several weeks
-administer with meals and snacks if GI upset occurs
-swallow sustained-released and to avoid chewing or crushing the tablets
-dependency during and after treatment and to notify provider if indications of withdrawal occur

what kind of medications are Atypical anziolytic/nonbarbiturate anxiolytic
buspirone (Buspar)

what is the pharmacological action of buspirone (Buspar)?
it is unknown, binds to serotonin and dopamine receptors, dependency is much less likely than with other anxiolytics and use of buspirone does not result in sedation or potentiate the effects of other CNS depressants.

what are the therapeutic use of Buspirone (Buspar)
-panic disorder
-social anxiety disorder
-obsessive- compulsive and related disorders
-trauma- and stressor- related disorders, such as post-traumatic stress disorder (PTSD)

what are buspirone (Buspar) adverse effects?
dizziness, nausea, headache, lightheadedness, agitation

what are nursing intervention for buspirone’s adverse effects?
-advise clients to take with food to decrease nausea
– instruct client that most adverse effects are self-limiting

what are contraindications/precautions for buspirone’s?
-pregnancy risk category B
-not recommended for use by women who are breastfeeding
-cautiously in older adult clients and clients who have liver and/ or renal dysfunction
-contraindicated for concurrent use with MAOI antidepressants or for 14 days after MAOIs are discontinued. Hypertensive crisis may result

what increased the effects of buspirone?
interaction with
-erythromycin
-ketoconazole
– St. John’s wort
-grapefuit juice

how do you administer buspirone?
– advise clients to take medication with meals to prevent gastric irritation
-effects do not occur immediately may take a week to notice the first therapeutic effects and 3 to 6 weeks for the full benefit.
-medication should be taken on a regular basis and not PRN
– instruct clients that tolerance, dependence, or withdrawal effects are not an issue with this medication

what medication is a selective serotonin reuptake inhibitors (SSRI antidepressants)
-paroxetine (paxil)
-sertraline (zoloft)
-escitalopram (lexapro)
-fluoxetine (prozac)
-fluvoxamine (luvox)

what is the pharmalogical action of Paroxetine (Paxil)?
-inhibits serotonin reuptake, allowing more serotonin to stay at the junction of the neurons
-does not block uptake of dopamine or norepinephrine
-produces CNS stimulation, which can cause insomnia
-medication has a long effective half-life. a time frame of up to 4 weeks to necessary to produce therapeutic medication levels

Therapeutic uses of Paroxetine?
-GAD
-panic disorders (decreases both the frequency and intensity of panic attacks and also prevents anticipatory anxiety about attacks
-obsessive- compulsive disorder (OCD) Reduces manifestations by increasing serotonin
-social anxiety disorder
-trauma- and stressor-related disorders
-depressive disorders

what is sertraline used for?
panic disorder, OCD, social anxiety disorder, and PTSD

What is escitalopram used for?
GAD and OCD

What is fluoxetine used for?
panic disorder and OCD

what is fluvoxamine used for?
OCD and social anxiety disorder

what are adverse effects of SSRI antidepressants for the first few days/weeks?
-nausea
-diaphoresis
-tremor
-fatigue
-drowsiness

what are late adverse effects of SSRI antidepressants? after 5-6 weeks
-sexual dysfunction
-impotence
-delayed or absent orgasm
-delayed or absent ejaculation
-decreased sexual interest

what are adverse effects of SSRI antidepressants?
-GI bleeding
-hyponatremia (on older adults)
-agitation, confusion, disorientation, difficulty
-bruxism: grinding and clenching of teeth, usually during sleep
-withdrawal syndrome

what are contraindications/precautions of paroxetine?
-is a pregnancy risk category D medication
-contraindicated in clients taking MAOIs or a TCA
-avoid alcohol
-cautiously in clients who have liver and renal dysfunction, seizure disorders or a history of GI bleeding

interaction of paroxetine and MAOI antidepressants or TCA can cause?
serotonin syndrome
-agitation, confusion, disorientation, difficulty concentration, anxiety, hallucinations, hyperreflexia, incoordination, tremors, fever, diaphoresis

nursing administration of SSRI?
-advise clients that medications may be taken with food, sleep disturbances are minimized by taking medication in the morning
-instruct clients to take the medication on a daily basis to establish therapeutic plasma levels
-assist with medication regimen adherence by informing clients that it may take up to 4 weeks to achieve therapeutic effects from an SSRI

effectiveness of SSRI?
-maintaining normal sleep pattern
-verbalizing feeling less anxious and more relaxed
-greater ability to participate in social and occupational interactions

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