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41 Cards in this Set

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True or false

The pathophysiology of anxiety disorder is unknown, but there is evidence of a biological basis and possible imbalances among several neurotransmission systems. A simplistic view involves excess of excitatory neurotransmitters (ex. Norepinephrine) or a deficiency of inhibitory neurotransmitters (ex. GABA)
True
True or false

The serotonin system although not as well understood is also through to play a role in anxiety. Both selecitve serotonin reuptake inhibitors (SSRIs) and serotonin receptor agonists are now used to treat anxiety disorder. Reasearch has suggested two possible roles for the serotonin receptor HT1A. During embryonic development stimulation of HT1A receptors by serotonin is thought to play a role in development of normal brain circuitry necessary for normal anxiety responses. However, during adulthood SSRIs act through HT1A to reduce anxiety responses.
True
True or false?

Activities that occur during the various sleep stages include increased tissue repair, synthesis of skeletal muscle protein, and secretion of growth hormone. At the same time there are decreased body temperature, metabolic rate, glucose consumption and production of catabolic hormones. Stage IV is followed by a period of 5 to 20 minutes of REM dreaming and increased physiologic activity.
True
True or false?

Insomnia has many causes, including stressors as pain anxiety, illness, changes in lifestyle or environment, an various drugs. Occasional sleeplessness is a normal response to many stimuli and is not usually harmful. Insomnia is said to be chronic when it lasts longer than 1 month. As in anxiety several neurotransmission systems are apparently involved in regulating sleep wake cycles and producing insomnia.
True
True or false?

The noradrenergic system is associated with the hyperarousal state experienced by clients with anxiety (ex feelings of panic, restlessness, tremulousness, palpitations, hyperventilation), which is attributed to excessive norepinephrine.
True
Case study: Mr. Jones suffers form an anxiety disorder. The physician orders buspirone after gradually discontinuing her current benzodiazepine prescription. You develop a teaching plan for Mr. Jones regarding the administration of the new medication.......

Mr. Jones began self administration of the medication 5 days ago. She calls the physicians office stating that the medication is not working for her. How would you explain the effects of this medication to the patient?
Although some beneficial effects of the buspirone may occur with in 7 to 10 days, optimal effects may require 3 to 4 weeks. Because therapeutic effects may be delayed, buspirone is not considered beneficial for immediate effects or occasional use.
____________ differs chemically and pharmacologically from other anti-anxiety drugs. Its mechanism of action is unclear, but it apparently interacts with serotonin and dopamine receptors in the brain. Compared with the benzodiazepines, buspirone lacks muscle relaxant and anti-convulsant effects; does ont cause sedation or physical or psychological dependence; does not increase the CNS depression of alcohol and other drugs; and is not a controlled substance.
Buspirone (BuSpar)
What are the adverse effects of Buspirone?
Nervousness and excitement. Therefore, clients who are wanting and accustomed to sedative effects may not like the drug or comply with instructions for its use.
Mr. Petski, age 35 suffers from long term insomnia, which is affecting both his work and home life. His profession is high stress, and he complains that he is unable to stop problem solving when he goes to bed. He had success with short term hypnotics in the past and asks his physician for sleep medication. The physician orders eszopiclone. You meet with Mr. Petski to discuss his medication regimen.

What information about Mr. Petski's evening habits would indicate an impact on the absorption of the medication as well as its efficacy?
Eszopiclone is rapidly adsorbed after oral administration, reaching peak plasma levels 1hr after administration. Onset of action may be delayed by approximately 1hr if the drug is taken with a high fat or heavy meal. Eszopiclone has a half life of 6hrs.
Mr. Petski, age 35 suffers from long term insomnia, which is affecting both his work and home life. His profession is high stress, and he complains that he is unable to stop problem solving when he goes to bed. He had success with short term hypnotics in the past and asks his physician for sleep medication. The physician orders eszopiclone. You meet with Mr. Petski to discuss his medication regimen.

Mr. Petski calls the office stating that her husband appears depressed and anxious. You notify the physician. What is the significance of Mr. Petski's behavior?
Mr. Petski may be experiencing an adverse reaction to the medication. Adverse reactions include behavior changes such as reduced inhibition, aggression or bizarre behavior, worsening depression and suicidal idealization, hallucinations, and anterograde amnesia.
Mr. Petski, age 35 suffers from long term insomnia, which is affecting both his work and home life. His profession is high stress, and he complains that he is unable to stop problem solving when he goes to bed. He had success with short term hypnotics in the past and asks his physician for sleep medication. The physician orders eszopiclone. You meet with Mr. Petski to discuss his medication regimen.

What change in Mr. Petski's medications or diet may cause adverse reactions?
Review Mr. Petski's current drug regimen to determine whether he is taking any drugs that inhibit CYP3A4 enzymes (ex. antidepressants, antifungals, erythromycin, grapefruit, protease inhibitors), which may require the physician to lower the dose of his medication to reduce adverse effects. Eszopiclone should not be taken with alcohol or other CNS depressants, to avoid additive effects.
Jane a college student is diagnosed with insomnia by her physician. He prescribes eszopiclone for sleep. Jane asks you if she will develop a tolerance to the medication. Which of the following responses is correct?

a. If you take the eszopiclone for more than 2 weeks you may develop a tolerance to the hypnotic benefits of the medication and should call your physician.

b. During the drug testing tolerance to the hypnotic benefits of eszopiclone was not observed over a 6 month period.

c. During drug testing tolerance to the hypnotic benefits of eszopiclone was observed after administration of the drug for a 6 month period.

d. Eszopiclone may be taken indefinitely with out tolerance to the hypnotic benefits of the medication.
b.

Rationale: Eszopiclone (Lunesta) is the first oral nonbenzodiazepine hypnotic to be approved for long term use (up to 12 months). During drug testing tolerance to the hypnotic benefits of eszopiclone was not observed over a 6 month period.
Your patient asks when eszopiclone should be taken to promote sleep. Which of the following is the correct explanation?

a. Eszopiclone is rapidly absorbed after oral administration, reaching peak plasma levels 30 mins after administration.

b. Eszopiclone is rapidly absorbed after oral administration, reaching peak plasma levels 20 mins after administration.

c. Eszopiclone is rapidly absorbed after oral administration reaching peak plasma levels 1hr after administration.
c.

Rationale: Eszopiclone is rapidly absorbed after oal administration, reaching peak plasma levels 1hr after administration. Onset of action may be delayed by approximately 1hr if the drug is taken with a high fat or heavy meal. Eszopiclone has a half life of 6hrs.
Mrs. Bright experiences nausea and vomiting whenever she undergoes general anesthesia. Which of the following medication would you expect the physician to order before surgery?

a. Hydroxyzine

b. Ramelton

c. Eszopiclone

d. Zalplon
a

Rationale: Hydroxyzine (Vistaril) is an antihistamine with sedative and antiemetic properties. Clinical indication for use include anxiety, preoperative sedation, nausea and vomiting associated with surgery or motion sickness, and pruritus and urticaria associated with allergic dermatoses.
Ms. Dwyers a 35yr old is recently divorced and having difficulty coping. She visits her physician, and he diagnoses her with situational anxiety. She is fearful that the anxiety she feels will become chronic. How would you describe situational anxiety to this patient?

a. A normal response to a stressful situation.

b. An abnormal response to a stressful situation.

c. A method of coping with the divorce.

d. A feeling that will go away on its own.
a.

Rationale: Situational anxiety is a normal response to a stressful situation. I may be beneficial when it motiviates the person toward constructive, problem solving, coping activities of daily living, it is called anxiety disorder.
Mr. Nickolson's anxiety is interfering with his ability to perform basic activities of daily living and return to work. Which of the following diagnoses will probably be made by his physician?

a. Intermittent anxiety disorder

b. Anxiety disorder

c. Abnormal anxiety disorder

d. Chronic anxiety disorder
b.

Rationale: Although there is no clear boundary between normal and abnormal anxiety, when anxiety is severe or prolonged and impairs the ability to function in usual activities of daily living it is called an anxiety disorder.
Judy S. is prescribed a benzodiazepine for anxiety. She asks you if she can stop the drug when she feels better. Which of the following would be your response?

a. Benzodiazepine does not cause physiologic dependence; and withdrawal symptoms will not occur if the drug is stopped abruptly.

b. Benzodiazepine may cause physiological dependence; bu withdrawal symptoms will not occur if the drug is stopped abruptly.

c. Benzodiazepine may cause physiologic dependence; and withdrawal symptoms will occur if the drugs dosages are tapered.

d. Benzodiazepine may cause physiologic dependence; and withdrawal symptoms will occur if the drug is stopped abruptly.
d.

Rationale: Benzodiazepines are widely used for anxiety and insomnia and are also used for several other indications. They have a wide margin of safety between therapeutic and toxic doses and are rarely fatal, even in overdose, unless combined with other CNS depressant drugs, such as alcohol. They are schedule IV drugs under the controlled substances act. They are drugs of abuse and may cause physiologic dependence; therefore, withdrawal symptoms occur if the drugs are stopped abruptly.
Which of the following is the prototype benzodiazepine?

a. Alprazolam (Xanax)

b. Diazepam (Valium)

c. Lorazepam (Ativan)

d. Clonazepam (Klonopin)
b.

Rationale: Diazepam (Valium) is the prototype benzodiazepine. High potency benzodiazepines such as alprazolam (Xanax), lorazepam (ativan) and clonaxepam (Klonopin) may be more commonly prescribed due to their greater therapeutic effects and rapid onset of action.
The physician orders eszopiclone (Lunesta) for Mr. Jude as a treatment of intermittent insomnia. He states that eh feels the prescription works well as a a sleep aid, but he is having difficulty with short therm memory loss. Which of the following is this patient experiencing?

a. An anticipated effect of the drug

b. An allergic reaction.

c. An adverse reaction.

d. A common side effect.
c.

Rationale: Eszopiclone (Lunesta): Adverse reactions include behavior changes such as reduced inhibition, aggression or bizarre behavior, worsening depression and suicidal idealization, hallucinations and antierograde amnesia.
Mr. Smiths physician orders ramelton for his long term insomnia. Mr. Smith is concerned that he will become dependant on the drug and is hesitant to take it. As part of your teaching plan, you tell Mr. Smith which of the following?

a. Ramelton may cause physical dependence.

b. Ramelton may cause physical dependence with constant use.

c. Ramelton causes physical dependence only if you have a documented sensitivity to the drug.

d. Ramelton does not cause physical dependence.
d.

Rationale: Ramelton does not cause physical dependence.
Mr. Smith asks how long before sleep should I take ramelton? Which of the following time frames would you give this patient as part of your patient teaching?

a. 15 mins.

b. 45 mins.

c. 10 mins

d. 20 mins.
b.

Rationale: Ramelton is rapidly absorbed orally reaching peach plasma levels in about 45 mins.
Mr. Peters is prescribed zaleplon for short term treatment of his insomnia. He states that it only works once in a while. Upon review of his evening habits, you discover which of the following behaviors that may interfere with the absorption of his prescriptions.

a. A late heavy meal before bedtime.

b. Exercise before bed time

c. Fasting before bed time

d. Doing paperwork before bed time.
a

Rationale: Zaleplon is well absorbed orally, reaching peak plasma levels in about 45 mins.
A combination of zaleplon and alcoholic my cause which of the following effects?

a. Hypertension and respiratory excitement.

b. Respiratory and depression and excessive sedation.

c. Cardiac dysrhythmias

d. A hangover effect.
b

Rationale: Zalephlon should not be taken concurrently with alcohol or other CNS depressant drugs because of the increased risk of excessive sedation and respiratory depression.
Mr. Nobel asks why the over the counter drug cimetidine may affect his zaleplonn dosage. You state that the physician may need to do which of the following?

a. Decrease the dose of the zaleplon to 10mg.

b. Decrease the dose of zaleplon to 5mg

c. Increase the dose of zaleplon to 15mg

d. Increase the dose of the zaleplon to 7mg.
b.

Rationale: Cimetidine inhibits both the aldehyde oxidase and the cytochrome P450 CYP3A4 enzymes that metabolize zaleplon. If cimetidine is taken, zaleplon dosage should be reduced to 5mg. It is very important that the clients taking zaleplon be taught about this prescription, and the client may not inform the healthcare provider who prescribes zaleplon about taking cimetidine.
Mr. Abernathy is not only having difficulty falling asleep but wakes up frequently during the night. The physician prescribes zolpidem in the CR form. The client asks what makes this form of the drug different. Which of the following explanations would you give the patient?

a. Ambien CR contains a slower releasing layer of medication which aids a person in falling asleep in a second layer which is released rapidly to promote sleep all night.

b. Ambien CR contains a rapid releasing layer of medication which aids a person in falling asleep and a second layer which is also released rapidly to promote sleep all night.

c. Ambien CR contains a slow releasing layer of medication which aids a person in falling asleep and a second layer which is released even more slowly to promote sleep all night.

d. Ambien CR contains a rapid releasing layer of medication which aids a person in falling asleep and a second layer which is released more slowly to promote sleep all night.
d.

Rationale: A newer controlled release form of zolpidem medication which aids a person in falling asleep and a second layer which is released more slowly to promote sleep all night.
Mr. Diaz took zolpidem daily for 1 week with good response then stopped the medication. Two days later he returns to the physicians office stating that his insomnia is worse than it ever was. You are responsible for the development of a teaching plan for the client, including adverse reactions. After 1 week of regular use, which of the following adverse reactions may occur with zolipidem?

a. Chronic insomnia

b. Short ter insomnia

c. Rebound insomnia

d. Long term insomnia
c.

Rationale: Adverse effects of zolpidem include daytime drowsiness, dizziness, nausea, diarrhea, and anterograde amnesia. Rebound insomnia may occur for a night or two after stopping the drug, and withdrawal symptoms may occur if it is stopped abruptly after approximately 1 week of regular use.
Mrs. Rodriguesz physician prescribes alproazolam in addition to the clients antidepressant fluvoxamine. The nurse knows that the physician will modify the benzodiazepine dose by doing which of the following?

a. Reduceing the dose by 50%

b. Increaseing the dose by 25%

c. Tapering the initial doses of the medication.

d. Increasing the dose by 5%
a.

Rationale: Alprazolam is the most commonly prescribed benzodiazepine; its dose should be reduced by 50% if it is given concurrently with the antidepressant fluvoxamine.
Mr. Anspa, age 70, asks why he is recieving a lower dose of zaleplon then his son. As part of your teaching plan which of the following explanations would you give?

a. Older adults metabolize the drug more quickly, but due to renal dysfunctions, the medication must be reduced.

b. Older adults metabolize the drug more slowly and half lives are longer then in younger adults.

c. Older adults metabolize the drug at the same speed as younger adults; I will check with dosage with your physician.

d. Older adults do not need as much of the medication for the desired effect as a younger adult does.
b.

Rationale: In older adults most benzodiazepines are metabolized more slowly, and half lives are longer then in younger adults. Exceptions are lorazepam and oxazepam, whose half lives and dosages are the same for older adults as for younger ones. The recommended initial dose for zaleplon or zolpidem is 5mg, one half of the initial dose recommenced for younger adults. Dosages of ezopiclone should also be reduced for older adults beginning with 1mg initially not to exceed 2mg at bedtime.
As a medication nurse , you know that when benzodiazepines are used with opioid analgesics the analgesic dose should be adjusted in which of the following ways?

a. It should be increased initially and reduced gradually.

b. I should be reduced initially and increased gradually.

c. It should be reduced initially and incrementally thereafter.

d. It should be increased initially and incrementally thereafter.
b.

Rationale: When benzodiazepines are used with opioid analgesics the analgesic dose should be reduced initially and increased gradually to avoid excessive CNS depression.
________ are widely used for anxiety and insomnia and are also used for several other indications.
Benzodiazepines
Benzodiazepines are schedule _________ drugs.
IV
All Benzodiazepines are effective sedative hypnotics but only _________, ___________, and _____________ are marketed for the treatment of insomnia.
Flurazepam, Temazepam, Triazolam
Benzodiazepines differ mainly in there plasma half lives. Which ones do we need to be very cautious using because there half lives are longer than 24hr?
Chlordiazepoxide, Diazepam, Clorazepate, Flurazepam
When using the Benzodiazepines what do we as nurses need to look for?
1. Chlordiazepoxide, Diazepam,Clorazepate, Flurazepam have long half lives and tend to a accumulate especially in older adults with impaired liver function.
Name the Benzodiazepines.
Alprazolam
Chlordiazepoxide
Clonazepam
Clorazepate
Diazepam
Flurazepam
Lorazepam
Midazolam
Oxazepam
Temazepam
Triazolam
What Benzodiazepines are used for anxiety?
1. Alprazolam
2. Chlordiazepoxide
3. Clorazepate
4. Diazepam
5. Lorazapam
6. Oxazepam
What Benzodiazepines are used for the treatment of alcohol withdrawal?
1. Chlordiazepoxide (Librium)
2. Diazepam (Valium)
3. Oxazepam (Serax)
What Benzodiazepines are used for the treatment of panic disorder?
1. Alprazolam (Xanax, Xanax XR)
2. Clonazepam (Klonopin, Klonopin wafers)
What Benzodiazepines are used for the treatment of seizures?
1. Clonazepam (Klonopin, Klonopin wafers)

2. Clorazepate (Tranxene)

3. Diazepam (Valium)
What Benzodiazepine is used for the treatment of muscle spasms?
Diazepam (Valium)
What Benzodiazepines are used for the treatment of preoperative sedation?
1. Diazepam (Valium)
2. Lorazepam (Ativan)
3. Midazolam (Versed)