Ati Psych Ch. 19 Meds For Anxiety

Front 1

Meds used to treat anxiety:

Back 1

-Benzodiazepine sedative hypnotic anxiolytics (valium)
-Atypical anxiolytic/nonbarbituate anxiolytics (busprione)
-SSRIs (paxil)

Front 2

Antidepressants used to treat Anxiety

Back 2

Elavil - TCA
MAOI - Nardil
Effexor - SSRI

Front 3

Expected Pharm Action of Valium/diazepam

Back 3

Diazepam enhances the inhibitory effects of gamma-aminobutyric acid (GABA) in the CNS. Relief from anxiety occurs rapidly following administration

Front 4

Theraputic uses for valium

Back 4

seizure disorders, insomnia, muscle spasm, alcohol withdrawal, induction of anesthesia

Front 5

Valium side effect - anterograde amnesia

Back 5

(Difficulty recalling events that occur after doing)

NI: Advise PT to observe for symptoms. Instruct PT to notify MD and stop med if symptoms occur

Front 6

Nursing interventions for S/E of Valium
CNS depression - such as sedation, light headedness, ataxia, and decreased cog function

Back 6

Advise PT to observe for symptoms. Instruct PT to notify MD if symptoms occur.
Advise PT to avoid hazardous activities (driving, operating heavy equiptment/machinery)

Front 7

Acute Toxicity of VALIUM

Back 7

Oral: drowsiness, lethargy, confusion
IV: respiratory depression, severe hypotension, cardiac arrest

Front 8

S/E Valium - Paradoxical response + NI

Back 8

(insomnia, exciation, euphoria, anxiety, rage)
NI: Advise PT to observe for symptoms, notify MD if occur

Front 9

Valium Withdrawal Symptoms + NI

Back 9

(occur infrequently w/short term use - anxiety, insomnia, diaphoresis, tremors, and light headedness

Advise PT who has ben taking valium regularly and in high doses to tape dose over several weeks

Front 10

Contraindications for Diazepam

Back 10

preg risk category D

Contra in Pts w/sleep apnea and/or resp depression
*use cautiously in Pts w/liver disease or hx of substance abuse

Front 11

What is Buspirone?

Back 11

Atypical anxiolytic/nonbarbituate anxiolytic

Front 12

Expected pharm action of busprione [Atypical anxiolytic]

Back 12

Exact mechanism unknown. Binds to serotonin and dopamine receptors. There is less potential for abuse than with other anxiolytics, and use of buspirone doesn't result in sedation or potentiate effects of other CNS depressants

Front 13

Therapeutic use of busprione [Atypical anxiolytic]

Back 13

Panic disorder
OCD
Social anxiety disorder
PTSD

Front 14

S/E of busprione [Atypical anxiolytic] + NI

Back 14

dizziness, nausea, headache, light-headedness, agitation
NI: this medication doesn't interfere w/activities b/c doesn't cause sedation

Front 15

Contraindications busprione [Atypical anxiolytic]

Back 15

- preg risk category B
-not recommended for nursing mothers
- Use caution w/older adults, as well as pts w/lier and/or renal dysfunction
-Contraindicated for concurrent use w/MAOI antidepressants, or for 14 days after MAOIS d/ced. Hypertensive crisis may result.

Front 16

Medication/Food INteractions busprione [Atypical anxiolytic]

Back 16

Erythromycin, ketoconazole, and grapefruit juice may increase the effects
NI: Advise PT to avoid use of Erythromycin, ketoconazole,
and grapefruit

Front 17

Nursing Admin busprione [Atypical anxiolytic]

Back 17

-Take w/ food to avoid GI upset
-Advise effects don't occur ASAP. May take a week to notice first therapeutic effects, and several more weeks to reach full benefit. Meds should be taken on reg basis, rather than as needed.
-Tolerance, dependeance, or w/drawal not an issue w/this med

Front 18

SSRI - Paxil expected pharm action

Back 18

-Selectively inhibits serotonin reuptake, alloing more serotonin to stay at junction of neurons
-Doesn't block uptake or norepi/dopamine
-Causes CNS stimulation - which can cause insomnia
--Long effective half-life, about 4 wks necessary to produce therapeutic med levels.

Front 19

SSRI - Paxil Therapeutic Uses

Back 19

Generalized anxiety disorder
-panic disorder (decreases frequency + intensity of attacks)
-OCD
-Social anxiety disorder
-PTSD
-Depressive Disorders

Front 20

Sertraline indicated for?

Back 20

panic disorder
ocd
social anxiety disorder
PTSD

Front 21

Escitalopram indicated for?

Back 21

Gen. aNXIETY DISORDER AND ocd

Front 22

pROZAC INDICATED FOR?

Back 22

Panic disorder + GAD

Front 23

Fluvoxamine indicated for?

Back 23

OCD + social anx disorder

Front 24

Paxil - early adverse effects - first few days+weeks + NI

Back 24

-nausea, diaphoresis, tremor, fatigue, drowsiness
NI: Advise effects will subside
-Instruct to report s/s to md
-

Front 25

Paxil - later adverse effects (after 5-6 wks of therapy) + NI

Back 25

-sexual dysfunction, wt gain, headache
NI: Instruct to report probs to MD (may be managed w/dose reduction, medication holiday, or changing meds)

Front 26

Paxil + GI bleeding - NI

Back 26

NI: Use cautiously w/PTs with hx of GI bleed, ulcers, and those taking other meds that affect blood coag.
-aDVISE TO REPORT signs of bleeding, - dark stools, emesis hat has appearance of coffee grounds

Front 27

Paxil + Hyponatremia

Back 27

More likely to occur in older adults taking diuretics
-Obtain baseline sodium serum, and monior level periodically

Front 28

Serotonin Syndrome signs + symptoms

Back 28

agitation, confusion, disorientation, difficulty concentrating, anxiety, hallucinations, hyperreflexia, fever, diaphoresis, incoordination, tremors
-beings 2-72 hr after initiation of treatment
- resolves when med d/ced

Front 29

Serotonin Syndrome NI

Back 29

Watch for and advise the PT to report any of symptoms

Front 30

Paxil s/e - Bruxism + NI

Back 30

grinding and clenching of teeth, usually during sleep
NI: Report to MD who -
switch pt to another med, treat w/ low dose busprione, advise pt to use mouth guard

Front 31

Paxil + Withdrawal syndrome - s/s + NI

Back 31

Nausea, sensory disturbances, anxiety, tremor, malaise, unease
-minimized by tapering med slowly
NI: Avoid disrupt continuation

Front 32

Paxil Contraindications

Back 32

preg risk category D
Contra in taking MAOIs
-avoid alcohol
use caution w/bipolar disorder due to risk of mania

Front 33

Med/food interaction paxil

Back 33

Concurrent use of MAOIs or tricyclic antidepressants with paxil can cause serotonin syndrome

Front 34

Paxil Nursing Administration

Back 34

- can be taken w/ food
- sleep disturbances may be minimized by taking med in morning
-take daily to estab plasma levels therapeutic
-Therapeutic effects may not be experienced for 1-3 weeks