Pharm for Managing Anxiety

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Pharm for Managing Anxiety
2012-02-14 23:33:10
Pharm Managing Anxiety

Pharm for Managing Anxiety
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  1. Drug categories: anti-anxiety or axiolytics
    • Benzodiazepines
    • Non-benzodiazepines
    • Antihistamines
    • Beta blockers
    • Antidepressants
  2. Used in a variety of conditions including anxiety, sleep disorders, acute alcohol withdrawal, preop sedation, seizure disorders, short term for acute mania and muscle relaxants.
  3. Work by depressing subcortical levels of the CNS especially the limbic system
    Work to potentate the action of GABA - resulting in a calming effect.
  4. Determines the time required for a drug to reach it's stead state.
    Half life.
  5. Applies to the amount of time needed to "wash out" a drug once it is discontinued.
    Half life
  6. If a drug has a half life of 4 days, it's "wash out" time is about how many days?
    20 days.
  7. You can determine "wash-out" periods for any drug if you know it's half life.
  8. Drug's half life multiplied by _ at this point, over 96% of the drug is "washed out" of the system.
  9. Valium (diazepam) half life is about 20-50 hours, what is the wash out period?
  10. Special considerations for benzodiazepines:
    Produce tolerance within days and continued use may lead to dependence --cannot discontinue abrubptly-- taper if patient is on drug more than three months.
  11. Special considerations for benzodiazepines:
    • Sedative properties
    • When combined with alcohol, barbiturates, opioids, anti psychotics, antidepressants, antihistamines, muscle relaxation drugs, cimetidine, or disulfiram will potentiate drug.
  12. With abrupt withdrawal, the patient will experience the opposite of the expected effects of the drug (sedative). Some of these symptoms will include:
    • Increased pulse and elevated blood pressure
    • Increased resp rate and elevated temp
    • Hand tremor
    • Insomnia and anxiety
    • Nausea, psychomotor agitation, seizures, hallucinations are rare but can occur.
  13. Tapering is based on the drugs half life.
    The term tapering refers to gradually decreasing the amount of the drug a person receives over a course of days or weeks.
  14. Generally reduce dose by 25% over 2 weeks and then by 10% until completely discontinued.
  15. Precautions with prescribing benzodiazepines:
    • Adverse reactions or toxicity may occur if patient has decreased liver functions.
    • Drug has street value
    • Dangerous if combined with MAOIs.
  16. Precautions with prescribing benzodiazepines:
    • Easy overdose potential if a 2 month supply is prescribed and combined with alcohol.
    • Riskiest drugs are Ativan and Xanex due to their high potency and short duration of action.
  17. Elderly client are more vulnerable to the sedating effects and CNS - the drug is lipophilic and elders have more fat than muscle
    Drugs - benzodiazepines makes elders prone to falls as well as exacerbating memory deficits and may cause urinary incontinence.
  18. Nonbenzodiazepine:
    Buspirone or Buspar
  19. Nonbenzodiazepines are safer and may be prescribed to elders and children.
    May not exert it's antianxiety effect for up to 2 weeks with 3-6 weeks for maximum effectiveness.
  20. Nonbenzodiazepines are not associated with tolerance or dependence
    Exerts its effects on seratonin receptors.
  21. Nonbenzodiazepines - educate client this is for anxiety control, not sedation.
  22. Difficult prescribing scenarios:
    • Patient with anxiety who has taken a benzodiazepine has different expectations of how they should feel on the drug.
    • Benzodiazepines are a quick fix to the patient will not learn to deal with their personal coping skills instead relying on the drug.
  23. The goal in anxiety disorders is to adapt, adjust and improve personal coping skills.
  24. Therapy will focus on a persons' negative thinking and help them to practice alternative thought patterns that lead the healthier behavior.
    A realistic time frame for this is 1-3 months.
  25. Antihistamines such as benadryl, vistaril, and atarax may be used especially with sleeping difficulties.
    Beta blockers such as propanolol and atenolol have been prescribed for social phobia syndrome.