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37 Cards in this Set

  • Front
  • Back
__________ drugs also known as ___________ and __________ promote relaxation and hypotoics produce sleep.
Antianxiety drugs, anxiolytics, sedative
The main drugs used to treat insomnia are the ________ and the ________ hypnotics
Benzodiazepines, nonbenzodiazepine
_________ is a common disorder that may be referred to as nervousness tension worry or other terms that denote and unpleasant feeling.
Anxiety
___________ is a normal response to a stressful situation.
Situational anxiety
______________ is the major inhibitory neurotransmitter in the brain and spinal cord
Gamma aminobutyric acid
___________ prolonged difficulty in going to sleep or staying asleep long enough to fee rested is the most common sleep disorder.
Insommia
The first oral nonbenzodiazepine hypnotic to be approved for long term use.
Eszopiclone
Used clinically as antianxiety hypotic, and anticonvulsant agents
Benzodiazepines
An antihistamine with sedative and antiemetic properties.
Hydroxyzine
Oral nonbenzodiazepine hypnotic approved for the short term treatment of insomnia
Zaleplon
The oldest sedative hypnotic drug relatively safe effective and inexpensive in usual therapeutic doses.
Chloral hydrate
Describe the probable physiological cause for anxiety disorders
The pathophysiology of anxiety disorder is unknown but there is evidence of a biologic basis and possible imbalances among several neurotransmission systems. A simplistic view involves and excess of excitatory neurotransmitters or deficiency of inhibitory neurotransmitters.
Explain the role the serotonin system plays in anxiety
The serotonin system although no as well understood is also thought to play a role in anxiety. Both selective serotonin reuptake inhibitors SSRIs and serotonin receptor agonists are now used to treat anxiety disorders. Research has suggested two possible roles for 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 trough HT1A receptors to reduce anxiety responses.
What is the impact of sleep on the biologic processes of the body.
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 dereased body temperature metabolic rate glucose consumption, and production fo catabolic hormones. Stage IV is followed by a period of 5 to 20 minutes of REM dreaming and increased physiologic activity.
Define insomnia and discuss the impact of insomnia on the patients health and well being.
Insomnia has many causes including such stressors as pain anxiety illness changes in lifestyle or environment and various drugs Occasional sleeplessness is a normal response to many stimuli and is not usually harmful. Insonmia is said to be chronic when it last longer than 1 month. As in anxiety several neurotransmission systems are apparently involved in regulating sleep wake cycles and producing insomnia.
Explain the psychological impact that an excessive amount of norepinephrine may have on a clients psychologic well being.
The noradrenergic system is associated with the hyperarousal state experienced by clients with anxiety feelings of panic restlessness tremulousness palpitations hyperventilation which is attributed to excessive norepinephrine.
Jane a college student is diagnosed with insomnia by her physician. Her prescribes eszopiclone for sleep. Jane asks you if she will develop a tolerance to the medication. What is your response?
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. What is the correct explanation?
Eszopiclone is rapidly absorbed after oral administration reaching peak plasma levels 1 hr after administration.
Patient experiances nausea and vomiting whenever she undergoes general anesthesia. Which medication would you expect the physician to order before surgery.
Hydroxyzine is an antihistamine with a sedative and antiemetic properties. Clinical indications for use include anxiety preoperative sedation, nausea and vomiting associated with surgery or motion sickness, and prurtius 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 normal response to a stressful situation. It may be beneficial when it motivates the person toward constructive problem solving coping activities. Symptoms may be quite severe but they usually last only 2 to 3 weeks.
Mr. Nickolosons anxiety is interfering with his ability to perform basic activities of daily living and return to work. What will the physicians diagnoses be?
Anxiety disorder
Judy S. is prescribed a benzodiazepine for anxiety. She asks you if she can stop the drug when she feels better. What is your response?
Benzodiazepine may cause physiologic dependence and withdrawal symptoms will occur if the drug is stopped abruptly.
What is the prototype for Benzodiazepine?
Diazepam (Valium)
Alprazolam is?
Xanax
Lorazepam is?
Ativan
Clonazepam is?
Klonopin
The physician orders eszopiclone (Lunesta) for Mr. Jude as a treatment for intermittent insomnia. He states that he feels the prescription works well as a sleep aid but he is having difficulty with short term memory loss. What is the patient experiencing?
An adverse reaction
Patient asks How long before sleep should I take ramelton?
45 Minutes.
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 this behavior that could be interfering with the absorption of his prescription.
A late heavy meal. Zaleplon is well absorbed but bioavailability is only about 30%because of extensive presystemic or first pass hepatic metabolism. Action onset is rapid and peaks in 1 hr a high fat heavy meal slows absorption and may reduce the drugs effectiveness in inducing sleep.
A combination of zaleplon and alcohol may cause?
Zalplon 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 OTC drug cimetidine may affect his zaleplon dosage. You state that the physician may need to do which of the following?
Decrease the dose of the zaleplon to 5mg.
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 patient asks what makes this form of the drug different. What explanations would you give the patient?
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.
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 what adverse reactions may occur with zolpidem?
Rebound insomnia
Mrs Rodrigues physician prescribes alprazolam in addition to the clients antidepressant fluvoxamine. The nurse knows that the physician will modify the benzodiazepine dose by doing what?
Reducing the dose by 50%
Mr. anspa age 70 asks why he is receiving a lower dose of zaleplon than his son. As part of your teaching plan what explanation would you give?
Older adults metabolize the drug more slowly and the half lives are longer than in younger adults.
As a medication nurse you know that when benzodiazepines are used with opioids analgesics the analegsic dose should be adjusted how?
It should be reduced initially and increased gradually. When benzodiazepines are used with opioid analgesics the analgesic dose should be reduced initially and increased gradually to avoid excessive CNS depression.
________ is a specific antidote that competes with benzodiazepines for benzodiazepine receptors and reveres toxicity.
Flumazenil (Romazicon)