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16 Cards in this Set
- Front
- Back
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Anxiety |
A vague, uneasy feeling, the course of which is often nonspecific, or unknown to the individual |
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Anxiety Characteristics |
Feeling of fear or dread Tremors and palpitations Sweating Faintness Increase HR De-realization Breathing disturbances |
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Insomnia |
Inability to sleep or remain asleep throughout the night Affects over 3 million Canadians; mostly the elderly; most are undiagnosed or untreated, usually related to a medical condition |
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Hypersomnia |
Too much sleep |
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Parasomnia |
Disorders associated with the sleep stages |
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Sleep-wake schedule disorders |
Normal sleep but at the wrong time |
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Benzodiazepines |
Drug of choice for anxiety and insomnia Relatively safe drug- large therapeutic range - Diazepam (Valium) - Lorazepam (Ativan) - Alprazolam (Xanax) |
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Benzodiazepines Actions |
GABA- inhibitory neurotransmitter located throughout CNS Potentiates actions of GABA in limbic and cortical areas of brain Not direct agonists but amplify the actions of endogenous GABA Limits exist for amount of CNS depression |
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Diazepam (Valium) MOA |
Binds to GABA receptor sites on the Cl channels in the brain--> opens the Cl channel complex--> increase opening of the channel by GABA--> Cl flows in the cell and hyperpolarizes; inhibits the cells ability to fire; so decrease excitation that causes anxiety |
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Diazepam (Valium) Clinical Uses |
Anxiety Insomnia Seizure disorders Panic disorders General anesthesia Pre-op sedation Muscle spasms Withdrawal from alcohol |
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Diazepam (Valium) Adverse Reactions |
Drowsiness Lack of coordination Difficulty concentrating Antergrade amnesia Paradoxical effect Respiratory depression N/V Headache |
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Diazepam (Valium) Pharmacokinetics |
Absorption: good PO (highly lipid soluble, BBB) (IM/ IV in ER) Metabolism: extensively metabolized (metabolites active; half-life: 2-3 hrs but active metabolites for 50 hrs) |
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Diazepam (Valium) Time Course of Action |
Varies, depends on pts needs - Falling asleep: Triazolam (Halcion) (rapid onset) - Avoid waking: Estazolam (Prosom) (slower onset) - Anxiety: Ionazepam (Ativan) (Intermediate duration) |
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Diazepam (Valium) Toxicity |
Exhibited by signs of drowsiness, lethargy, confusions, gastric lavage, antidote- Flumazeril (Receptor antagoinst) |
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Diazepam (Valium) Nursing Implications |
For sleep- take at bedtime, intermittent sleep Good sleep hygiene- regular schedule, no naps If gastric upset, take with food Prepare for adverse events (e.g. ambu bag, O2) Anxiety- non-pharmacologic measures Use cautiously with patients who are potentially suicidal Do not crush/ chew sustained release formulations |
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Phenobarbital |
Act as direct GABA agonists No limits on CNS depression Drugs of choice for suicide Stimulate drug metabolizing enzymes |
