Exam 2

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vermen01
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139301
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Exam 2
Updated:
2012-03-03 13:35:33
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Pharmacology Anxiety Disorders
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Pharmacology and Anxiety Disorders
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  1. What are some Pharmacology considerations when treating Anxiety Disorders?
    • —Drug categories—antianxiety or anxiolytics —Benzodiazepines —
    • Non-benzodiazepines
    • —Antihistamines
    • —Beta blockers—
    • Antidepressants
  2. What are Benzodiazepines used for?
    • —Used in a variety of conditions including anxiety, sleep disorders, acute alcohol withdrawal, preoperative sedation, seizure disorders, short-term for acute mania, and as muscle relaxants—
    • Work by depressing subcortical levels of the CNS especially the limbic system. Work to potentiate the action of GABA—resulting in a calming effect.
  3. What are some Benzodiazepines with quick onset of action?
    • —Diazepam (Valium) onset is very fast—half-life is 30-100 hours—
    • Flurazepam (Dalmane) fast onset and half-life is 47-100 hours—
    • Chlorazepate (Tranxene) fast onset and half-life is 30-200 hours.—
    • Triazolam (Halcion) has a fast onset and half-life of 2-4 hours
  4. What is the meaning of a Drug’s half-life?
    • —Determines the time required for a drug to reach its steady state—
    • Applies to the amount of time needed to “wash out” a drug once it is discontinued—
    • If a drug has a half-life of 4 days it’s “wash out” time is about 20 days.—
    • You can determine “wash-out” periods for any drug if you know its half-life
  5. What is the Formula for determining a drug’s wash-out time?
    • —What is the drug’s half-life?—
    • Drug’s half-life multiplied by 5—at this point, over 96% of the drug is “washed out” of the system.—
    • Valium (diazepam’s) half-life is 20-50 hours.—
    • What is the wash-out period?
  6. What are some Benzodiazepines with intermediate onset of action?
    • —Alprazolam (Xanex) has a half-life of 12-15 hours—
    • Chlordiazepoxide (Librium) has a half-life of 50-100 hours—
    • Clonazepam (Klonipin) has a half-life of 18-50 hours—
    • Moderately fast in it’s action is the drug Temazepam or Restoril and its half-life is 15-30 hours
  7. What are some Benzodiazepines with a moderately slow onset?
    • —Oxazepam (Serax) has a half-life of 3-21 hours—
    • Lorazepam (Ativan) has a half-life of 10-20 hours
  8. What are some Special considerations with Benodiazepines?
    • —Adverse reactions or toxicity may occur if patient has decreased liver functions
    • —Drug has street value—
    • Dangerous if combined with MAOI’s —
    • 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
  9. What are some Concepts of drug-tapering versus abrupt withdrawal?
    • —With abrupt withdrawal, the patient will experience the opposite of the expected effects of the drug (sedative): —Increased pulse and elevated blood pressure
    • Increased respiratory rate and elevated temperature—
    • Hand tremor—
    • Insomnia and anxiety
    • —Nausea, psychomotor agitation—seizures, hallucinations are rare but can occur
    • Drug tapering considerations: —Tapering is based on the drug’s half-life—
    • The term tapering refers to gradually decreasing the amount of the drug a person receives over a course of days or weeks.—
    • Generally, reduce dose by 25% over 2 weeks and then by 10% until completely discontinued.
  10. What are some Precautions with prescribing benzodiazepines?
    • —Adverse reactions or toxicity may occur if patient has decreased liver functions—
    • Drug has street value—
    • Dangerous if combined with MAOI’s —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
    • —Elderly clients are more vulnerable to the sedating effects and CNS—the drug is lipophilic and elders have more fat than muscle—
    • Drugs-BZA’s makes elders prone to falls as well as exacerbating memory deficits and may cause urinary incontinence
  11. Nonbenzodiazepine—Buspirone or Buspar
    • —Safer and may be prescribed to elders and children—
    • May not exert its antianxiety effect for up to 2 weeks with 3-6 weeks for maximum effectiveness
    • —Not associated with tolerance or dependence—Exerts its effects on seratonin receptors—
    • Educate the patient that this drug is for anxiety control—not sedation
  12. 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 and the patient will not learn to deal with their personal coping skills instead relying on the drug.—
    • The goal in anxiety disorders is to adapt, adjust, and improve personal coping skills
  13. What is the importance of “therapy” to improve outcome?
    • —Therapy will focus on a person’s negative thinking and help them to practice alternative thought patterns that lead to healthier behavior.—
    • A realistic time frame for this is 1-3 months
  14. Other medications used to treat anxiety are?
    • —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 symptoms

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