pharm

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Author:
cvillarreal
ID:
27478
Filename:
pharm
Updated:
2010-07-21 18:42:13
Tags:
antianxiety
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Description:
ch 20
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  1. Anxiety
    feeling of apprehension, worry, or ineasiness that may or may not be based on reality

    symptoms can interfere w/ ADL, feeling jitters, acute pain
  2. Antianxiety drugs
    • AKA anxiolytics
    • TX of anxiety & short-term tx of anxiety symptoms
    • they exert their tranquilizing effect by blocking certain neurotransmitters receptor sites

    benzodiazepine- pt takin in long-tern can become physically & psychological dependent, excert effect by potentiating effect of GABA, an inhibitory transmiter

    nonbenzodiazepine- non depentant , actions depend on drug

    • Uses:
    • anxiety disorders & panic attacks
    • preanesthetic sedation & muscle relaxation
    • convulsion or seizures
    • alcohol withdrawal
  3. adverse reaction
    • frequent early reaction:
    • mild drowsiness or sedation
    • lightheadedness or dizziness
    • headache

    • other body system reaction:
    • lethargy, apathy, fatigue
    • disorientation
    • anger
    • restlessness
    • nausea, constipation/diarrhea, dry mouth
    • visual disturbance

    b/c they excrete slow risk 4 toxicity, so start w/ sm. dose
  4. dependance
    • withdrawal seen 4-6wk of therapy w/ benzodiazepine, & when drug taken for 3mon./more & d/c fast
    • tapering- gradually decreasing drug
    • onset of withdrawal w/i 1-10 days after d/c, & duration of withdrawal effects 5days-1mon.

    S/S- increased anxiety, concentration difficulty, tremor, & sensory disturbance like paresthesias, photophobia, hyperinsomnia, & metallic taste, fatigue, headache, numbness in extremities, nausea, sweating, muscle tension & cramps, psychoses, hallucination, memory impairment, possible convulsion
  5. contraidications
    • psychoses
    • acute narrow angle glucoma
    • when in coma, shock, & if v/s of a pt who is in alcoholic toxication

    benzodiazepine- preg. & labor b/c of reports of floppy infant syndrome (sucking difficulties, lethargy, hypotonia) & lactating b/c baby can be lethargic & loss wt

    • Precautions:
    • elders
    • pt impaired liver function
    • impaired kidney function
    • debilitation

    • Inter:
    • alcohol- increased risk 4 CNS drpression or convulsion
    • analgesics- increased risk 4 CNS depression
    • antidepression- increased risk 4 sedation & resp. depression
    • antipsychotics- increased risk 4 sedation & resp. depression
    • digoxin (cardiac)- increased risk 4 digitalis toxicity
  6. herbal alert
    Kava- releive stress, anxiety, & tension, promote sleep, gives releif form menstrual discomfort, may cause liver damage, take occasionally
  7. alprazolam (Niravam)
    benzodiazepines
    • use:
    • anxiety disorders, short-term relief of anxiety, panic attacks

    AR:Transient mild drowsiness,
    lightheadedness, headache, depression, constipation, diarrhea, dry mouth
  8. chlordiazepoxide (Librium)
    benzodiazepines
    • use:
    • anxiety disorders, short-term relief of anxiety, acute alcohol withdrawal

    AR:Transient mild drowsiness, lightheadedness, headache, depression, constipation, diarrhea, dry mouth
  9. diazapam (valium)
    benzodiazepines
    • Use:
    • anxiety disorders, shot-term relief of anxiety, acute alcohol withdrawal, anticonvulsant, preoperative muscle relaxant

    AR:Transient mild drowsiness, lightheadedness, headache, depression, constipation, diarrhea, dry mouth
  10. lorazepam (ativan)
    benzodiazepine
    safe 4 elders

    • uses:
    • anxiety disorders, short-term relief of anxiety, preanesthetic

    • AR:
    • Transient mild drowsiness, lightheadedness, headache, depression, constipation, diarrhea, dry mouth
  11. buspirone (BuSpar)
    Nonbenzodiazepines
    • action: acts on brain serotonin receptors
    • safe 4 elders doesnt cause to much sedation so low risk 4 falls

    • use:
    • anxiety disorder, short term relief of anxiety

    • AR:
    • dizziness & drowsiness
  12. doxepin (Sinequan)
    Nonbenzodiazepines
    • Use:
    • anxiety & depression

    • AR:
    • dizziness, drowsiness
  13. hydroxyzine (Atarax)(vistaril)
    Nonbenzodiazepine
    action: produce its antianxiety effect by acting on hypothalumus & brain stem reticular formation

    • use:
    • anxiety, tension from psychneurosis, pruritis, preanesthetic sedative

    • AR:
    • dry mouth, transitory, drowsiness, involuntary motor activity
  14. assessment
    • medical hx, either from pt. or family member b/c od level of anxiety
    • mental status
    • anxiety level
    • observe pt behaviors indicating axiety(focus, restlessness, facial grimmaces, tense posture)
    • physical assessment (B/P, pulse, resp. rate, wt), eveything increase w/ anxiety incliding muscle tension, may show cool pale skin
    • hx of past drug/alcohol use
  15. ongoing assessment
    • check b/p before giving med, if systolic dropped 20mmg, withhold med & notify DR
    • monitor pt mental status & anxiety level, improvement/worening
    • compare before & after assessments
  16. immplementaion
    • monitor AR
    • postural hypotension
    • drowsiness
    • dry mouth
    • remember not good 4 long-term use, depedence/tolerance/withdrawal not seen when taken 1-2wks
    • monitor signs of dependence like needing higher dose, or complaints of increased anxiety & agitation
  17. monitoring pt needs
    • risk 4 injury b/c of dizziness, lightheadedness, ataxia), instuct pt to call 4 help when getting up
    • check V/S frequetly
    • assist w/ ADL
    • tell pt that meds can reduces thier effect when taken reg.
    • when given parental give IM (gluteus), monitor pt closely for 3hr, keep pt laying down for 30 min, elders & those w/ limited pulmonary reserves req. care b/c they could get apnea & cardiac arrest, resuscitative equip. should be available
    • dry mouth & slower transit could lead to constipation, offer sips of water, increase fluids, hard candy or gum
    • give med w/ meals if GI problems
    • meals should be high in fiber, vegggies, 4 constipation
    • identify ? leads 2 anxiety/panic attacks
  18. flumazenil (remazicon)
    anidote(antagonist) 4 benzodiazepine toxicity (sedation, resp. depression, coma) w/i 6-10min after IV admin.

    • AR:
    • agitation
    • confusion
    • seizures
    • benzodiazepine withdrawal, reversed by giving benazodiazepine
  19. teaching plan
    • take rx as directed
    • dont d/c med fast b/c of withdrawal symptoms
    • dont take nonrx med unless directed
    • inform dr, dentist, about taking meds
    • no alcohol
    • if dizziness occurs when changing position, rise slow, get help if needed
    • if dryness of mouth, sips of water, hard candy, gum
    • prevent constipation with hifh fiber foods, increasing fluids, exercise
    • keeps all appt.
    • report unusual changes or physical effects

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