Psychopharmacology Table NUR355
Anxiety
Anxiolytics
Description
1. Anti-anxiety medications depress the CNS, increasing the effect of gamma(γ)-aminobutryic acid (GABA), which produces relaxation and
may depress the limbic system.
2. Benzodiazepines
have anxiety-reducing (anxiolytic), sedative-hypnotic, muscle-relaxing and anticonvulsant actions.
are contraindicated in clients with acute narrow-angle glaucoma and should be used with caution in children and older adults.
Interact with other CNS medications, producing additive effects
3. Abrupt withdrawal of benzodiazepines can be potentially life-threatening, and withdrawal should occur under medical supervision
Withdrawal more severe with short acting benzodiazepines (such as alprazolam)
Shorter acting benzodiazepines have higher addiction potential
Side Effects
1. Daytime sedation
2. Ataxia (know what this means)
3. Dizziness (vertigo)
4. Headaches
5. Blurred or double vision
6. Hypotension
7. Tremor
8. Amnesia
9. Slurred speech
10. Urinary incontinence
11. Constipation
12. Paradoxical CNS excitement
13. Lethargy
14. Behavioral change
Acute Toxicity Signs & Symptoms
1. Somnolence
2. Confusion
3. Diminished reflexes and coma
,Pharmacological Treatment for Acute Toxicity
1. Flumazenil (Romazicon), a benzodiazepine antagonist administered IV, reverses benzodiazepine intoxication in 5 minutes
2. A client being treated for an overdose of benzodiazepine may experience agitation, restlessness, discomfort, and anxiety
Interventions
1. Monitor for
motor responses such as agitation, trembling, and tension
autonomic responses such as cold clammy hands and sweating
paradoxical CNS excitement during early therapy, particularly in older adults and debilitated clients
visual disturbances because the medications can worsen glaucoma
liver and renal function tests and complete blood cell counts
2. Reduce the medication dose as prescribed for the older adult client at risk for falling when taking the medication for sleep or anxiety
3. Initiate safety precautions because the older adult client is at risk for falling when taking the medication for sleep or anxiety
4. Assist with ambulation if drowsiness or lightheadedness occurs
5. Instruct the client
that drowsiness usually disappear during continued therapy
avoid tasks that require alertness until the response to the medication is established
avoid alcohol
do not take other medications without consulting their physician
do not stop the medication abruptly (can cause seizure activity)
Withdrawal
a. To lessen withdrawal symptoms, the dosage of a benzodiazepine should be tapered gradually over 2 to 6 weeks
b. Abrupt or too rapid withdrawal results in the following:
Restlessness
Irritability
Insomnia
Hand tremors
Abdominal or muscle cramps
Sweating
Vomiting
Seizures
, Benzodiazepines
Alprazolam (Xanax, Niravam) Diazepam (Valium) Oxazepam (Serax) Nonbenzodiazepine Anxiolytic:
Chlordiazepoxide (Librium) Flurazepam (Dalmane) Quazepam (Doral) Buspirone (BuSpar)
Clonazepam (Klonopin) Lorazepam (Ativan) Temazepam (Restoril)
Clorazepate (Tranxene) Midazolam (Versed) Triazolam (Halcion)
What neurotransmitter is involved with anxiety?
How does it work?
What is the brain pathway for anxiety responses?
What part of the nervous system causes the anxiety symptoms?
What part of the nervous system counteracts the anxiety symptoms?
Notes from Class:
MOOD (Depression)
Selective Serotonin Reuptake Inhibitors (SSRIs)
Description
1. Inhibit serotonin uptake and elicit an antidepressant response
2. The potential for medication interactions is high, and complete medication assessments must be obtained and evaluated; inquire about
the use of herbal therapies, especially St. John’s Wort (risk of “serotonin syndrome”)
Side Effects
1. Nausea, vomiting, cramping and diarrhea
2. Dry mouth
3. CNS stimulation, including akathsia (internal sense of restlessness, agitation)
4. Blood pressure changes
5. Photosensitivity
6. Insomnia, somnolence (sleepy, drowsy), apathy
Anxiety
Anxiolytics
Description
1. Anti-anxiety medications depress the CNS, increasing the effect of gamma(γ)-aminobutryic acid (GABA), which produces relaxation and
may depress the limbic system.
2. Benzodiazepines
have anxiety-reducing (anxiolytic), sedative-hypnotic, muscle-relaxing and anticonvulsant actions.
are contraindicated in clients with acute narrow-angle glaucoma and should be used with caution in children and older adults.
Interact with other CNS medications, producing additive effects
3. Abrupt withdrawal of benzodiazepines can be potentially life-threatening, and withdrawal should occur under medical supervision
Withdrawal more severe with short acting benzodiazepines (such as alprazolam)
Shorter acting benzodiazepines have higher addiction potential
Side Effects
1. Daytime sedation
2. Ataxia (know what this means)
3. Dizziness (vertigo)
4. Headaches
5. Blurred or double vision
6. Hypotension
7. Tremor
8. Amnesia
9. Slurred speech
10. Urinary incontinence
11. Constipation
12. Paradoxical CNS excitement
13. Lethargy
14. Behavioral change
Acute Toxicity Signs & Symptoms
1. Somnolence
2. Confusion
3. Diminished reflexes and coma
,Pharmacological Treatment for Acute Toxicity
1. Flumazenil (Romazicon), a benzodiazepine antagonist administered IV, reverses benzodiazepine intoxication in 5 minutes
2. A client being treated for an overdose of benzodiazepine may experience agitation, restlessness, discomfort, and anxiety
Interventions
1. Monitor for
motor responses such as agitation, trembling, and tension
autonomic responses such as cold clammy hands and sweating
paradoxical CNS excitement during early therapy, particularly in older adults and debilitated clients
visual disturbances because the medications can worsen glaucoma
liver and renal function tests and complete blood cell counts
2. Reduce the medication dose as prescribed for the older adult client at risk for falling when taking the medication for sleep or anxiety
3. Initiate safety precautions because the older adult client is at risk for falling when taking the medication for sleep or anxiety
4. Assist with ambulation if drowsiness or lightheadedness occurs
5. Instruct the client
that drowsiness usually disappear during continued therapy
avoid tasks that require alertness until the response to the medication is established
avoid alcohol
do not take other medications without consulting their physician
do not stop the medication abruptly (can cause seizure activity)
Withdrawal
a. To lessen withdrawal symptoms, the dosage of a benzodiazepine should be tapered gradually over 2 to 6 weeks
b. Abrupt or too rapid withdrawal results in the following:
Restlessness
Irritability
Insomnia
Hand tremors
Abdominal or muscle cramps
Sweating
Vomiting
Seizures
, Benzodiazepines
Alprazolam (Xanax, Niravam) Diazepam (Valium) Oxazepam (Serax) Nonbenzodiazepine Anxiolytic:
Chlordiazepoxide (Librium) Flurazepam (Dalmane) Quazepam (Doral) Buspirone (BuSpar)
Clonazepam (Klonopin) Lorazepam (Ativan) Temazepam (Restoril)
Clorazepate (Tranxene) Midazolam (Versed) Triazolam (Halcion)
What neurotransmitter is involved with anxiety?
How does it work?
What is the brain pathway for anxiety responses?
What part of the nervous system causes the anxiety symptoms?
What part of the nervous system counteracts the anxiety symptoms?
Notes from Class:
MOOD (Depression)
Selective Serotonin Reuptake Inhibitors (SSRIs)
Description
1. Inhibit serotonin uptake and elicit an antidepressant response
2. The potential for medication interactions is high, and complete medication assessments must be obtained and evaluated; inquire about
the use of herbal therapies, especially St. John’s Wort (risk of “serotonin syndrome”)
Side Effects
1. Nausea, vomiting, cramping and diarrhea
2. Dry mouth
3. CNS stimulation, including akathsia (internal sense of restlessness, agitation)
4. Blood pressure changes
5. Photosensitivity
6. Insomnia, somnolence (sleepy, drowsy), apathy
