Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Pharm Chap 22
Pharmacotherapy of Anxiety and Insomnia
| Question | Answer |
|---|---|
| What classification of drugs are used for generalized anxiety disorder and the short-term therapy of insomnia? | Benzodiazepines |
| What schedule of drugs are the benzodiazepines? | Schedule IV |
| How do benzodiazepines work? | Benzodiazepines bind to the gamma-aminobutyric acid (GABA) receptor and intensify the effect of GABA, the natural inhibitory neurotransmitter found throughout the brain. |
| Where are most benzodiazepines metabolized? | the liver |
| Where are most benzodiazepines excreted? | the urine |
| What happens if benzodizepines are taken in excessive amounts? | They do not produce life-threatening respiratory depression or coma. |
| What can cause death due to benzodiazepine overdose? | Death is unlikely unless the benzodiazepines are taken in extreme quantities in combination with other CNS depressants, or if the pt suffers from sleep apnea. |
| How are most benzodiazepines given? | Orally (PO) |
| What should be done for benzodiazepines given parenterally? | They should be monitored carefully owing to their rapid onset of CNS effects and possible respiratory depression. |
| Why are benzodiazepines given parenterally? | Benzodiazepines are given parenterally for serious conditions such as status epilepticus or severe symptoms of acute schizophrenia. |
| How does the margin of safety of benzodiazepines compare with that of barbiturates? | The benzodiazepines have a greater margin of safety. |
| How do benzodiazepines affect sleep time? | Benzodiazepines increase total sleep time, but some reduce stage IV sleep, and some affect REM sleep. |
| What are the benzodiazepines used to treat anxiety? | Lorazepam (Ativan), Alprazolam (Xanax), Chlordiazepoxide (Librium), Clorazepate (Tranxene), Diazepam (Valium), Oxazepam (Serax) |
| What are the benzodiazepines used to treat insomnia? | Lorazepam (Ativan), Estazolam (ProSom), Flurazepam (Dalmane), Quazepam (Doral), Temazepam (Restoril), Triazolam (Halcion) |
| How is Lorazepam given? | Administered as oral tablets, concentrated oral solution, or IM or IV. |
| What is Lorazepam used for? | Manage GAD, reduce anxiety before surgery, insomnia, seizures, ethanol withdrawal, treating status epilepticus. |
| What is the mechanism of action of Lorazepam? | Lorazepam potentiates the actions of GABA (an inhibitory neurotransmitter in the CNS). It is capable of causing all levels of CNS depression, from relaxing, to sleep, to coma. |
| Adverse effects of Lorazepam | Dizzines, ataxia, drowsiness, blurred vision, vertigo, sedation, confusion, hepatotoxicity, alopecia, anaphylaxis, orthostatic hypotension, cardiac changes, constipation, dry mouth, nausea, vomiting, diarrhea, anorexia. |
| Contraindications for Lorazepam | Fetal malformations, drug secreted in breast milk. Hypersensitivity to benzodiazepines, narrow-angle glaucoma, psychosis, COPD. Not for use in children. |
| Drug Interactions with Lorazepam | Oral contraceptives increase the metabolism of Lorazepam - antianxiety effects reduced. |
| Client Teaching for Lorazepam | No breast-feeding, store securely, do not take with other drugs, do not drink alcohol with drug, do not drive or perform hazardous activities, notify health care provider of possible pregnancy, make position changes slowly from lying to standing. |
| Five Primary Classes of Antidepressants | Tricyclic antidepressants (TCAs), Selective serotonin reuptake inhibitors (SSRIs), Serotonin-norepinephrine reuptake inhibitors (SNRIs), Atypical antidepressants, Monoamine oxidase inhibitors (MAOIs) |
| TCAs are prescribed for patients with: | major depressive disorder |
| TCAS were named after: | their molecular structure - a nucleus consisting of 3 rings |
| How do TCAs act? | block the reuptake of norepinephrine and serotonin in neurons |
| Advantages of TCAs: | inexpensive, well-established effectiveness in treating depression, rapidly absorbed when given orally, widely distributed throughout body |
| Adverse effects of TCAs: | dry mouth, blurred vision, constipation, urinary retention, tachycardia, orthostatic hypotension, cardiac dysrhythmias, sedation, sexual dysfunction, weight gain |
| Are tolerance and psychological dependence major problems when using TCAs? | No; therapy may often be conducted for years without requiring a dosage adjustment. |
| Are TCAs drugs of abuse? | No. |
| Examples of TCAs: | Imipramine (Tofranil), Amtriptyline (Elavil), Nortriptyline (Aventyl, Pamelor), Clomipramine (Anafranil), Doxepin (Sinequan), Maprotiline (Ludiomil), Protriptyline (Vivactil), Trimipramine (Surmontil) |
| Selective serotonin reuptake inhibitors treat: | depression |
| Do SSRIs have a high or low incidence of serious adverse effects? | low |
| How do SSRIs work? | They selectively inhibit the reuptake of serotonin into presynaptic nerve terminals. |
| What is serotonin syndrome? | a serious medical condition that can occur when a patient is taking multiple medications that affect the metabolism, synthesis, or reuptake of serotonin, causing this neurotransmitter to accumulate in neuron in the CNS |
| Are SSRIs as effective in treating depression as the TCAs? | yes |
| Common adverse effects of SSRIs: | weight gain, nausea, headache, nervousness, insomnia, sexual dysfunction |
| Fluoxetine is commonly referred to as: | Prozac |
| Fluoxetine is pharmacologically classified as an: | SSRI |
| Fluoxetine is used to treat: | depression, anxiety, bulimia nervosa, anorexia nervosa, obesity, alcohol dependence, fibromyalgia, autism, refractory orthostatic hypotension, premature ejaculation, premenstrual dysphoric disorder, and menopausal hot flashes |
| Adverse effects of fluoxetine: | nausea, vomiting, diarrhea, anorexia, cramping, flatulence, sexual dysfunction, seizures, cramping, constipation, poor concentration, hot flahses, palpitations, nervousness |
| Contraindications for fluoxetine use: | bipolar disorder, suicidal; caution used with peds patients, person with cardiac dysfunction, diabetes, seizure disorders, late in pregnancy |
| Interactions with fluoxetine: | Inhibits multiple CYP450 isozymes, sedation if given with other CNS depressants, concurrent use with NSAIDs may increase risk of bleeding, concurrent use with antipsychotic agents may lead to increased extrapyramidal symptoms |
| Overdose of fluoxetine can result in: | seizures, somnolence, death |
| Client teaching about fluoxetine: | Take the last dose before 4 pm to avoid insomnia; immediately report suicidal thoughts, palpitations, major changes in sexual function, and excessive drowsiness to health care provider. |
| Bupropion HCl (Wellbutrin) is classified as an: | atypical antidepressant |
| Sertraline (Zoloft) is classified as an: | SSRI |
| Amitriptyline (Elavil) is classified as a: | TCA |
| Alprazolam (Xanax) is classified as a: | benzodiazepine |
| Diazepam (Valium) is classified as a: | benzodiazepine |
| What is the most common adverse effect of dantrolene therapy? | muscle weakness |
| What is a pharmacologic treatment for excessive perspiration? | botulinum toxin, type A |
| What is the drug of choice to assist in counteracting amphetamine overdosage? | Chlorpromazine |
| Neuropathic pain is most likely to respond to an: | adjuvant analgesic |
| Gabapentin (Neurontin) is classified as an: | adjuvant analgesic |
| Do opioids increase or decrease peristalsis? | decrease |
| Common adverse effects of opioids: | Respiratory depression, constipation, nausea, urinary retention, & hypotension |
| Dihydroergotamine (Migranal)is classified as an: | ergot alkaloid |
| Ergot alkaloids are one of the two drugs of choice for aborting: | migraines |
| These clients are at highest risk for hypotension, respiratory depression, and increased incidence of adverse CNS effects such as confusion. | Who are elderly clients? |
| Is pain tolerance increased or decreased in chronic pain? | decreased |
| What is the mechanism of action for opioid analgesics? | Opioid analgesics stimulate endorphin receptors. |
| Hydromorphone (Dilaudid) is classified as an: | opioid analgesic |
| What type of drug is given to counter the effects of the opioid? | opioid antagonist |
| Naloxone (Narcan) is classified as an: | opioid antagonist |
| What do diuretics treat? | Hypertension, heart failure, accumulation of edema fluid, and renal failure. |
| How do diuretics increase urine output? | by blocking sodium reabsorption |
| The most effective diuretics are: | loop diuretics that block sodium reabsorption in the loop of Henle |
| What is the most commonly prescribed class of diuretics? | the thiazides |
| How do the thiazides act? | by blocking sodium reabsorption in the distal tubule of the nephron |
| Potassium-sparing diuretics can help prevent: | hypokalemia (a lower than normal amount of K+ in blood) |
| Osmotic diuretics cause diuresis by: | increasing the osmolality of the filtrate |
| Carbonic anhydrase inhibitors are rarely used as diuretics due toL | lack of effectiveness & high potential for adverse effects |
| Diuretics may dramatically reduce the client’s circulating blood volume thus producing episodes of: | orthostatic hypotension |
| Loop diuretics are notorious for producing a significant loss of: | potassium |
| Muscle cramps and weakness may represent: | hypokalemia |
| Clients prescribed spironolactone (Aldactone) are often at risk for electrolyte imbalance. The nurse assesses for this adverse effect because this drug: | retains potassium |
| clients should not take Lasix prior to bedtime to avoid: | nocturia |
| A client who is taking furosemide (Lasix) for the treatment of congestive heart failure asks a nurse how the medication works. The nurse's response should be based on an understanding that Lasix: | inhibits the reabsorption of sodium |
Created by:
Hil
Popular Nursing sets