NRSG 220 Week 12: Anxiety, Insomnia and Depression

symptoms of anxiety disorders

apprehension, worry, fear, palpitations, SOB, heartburn, dry mouth, excess sweating

what can high level of anxiety be confused with

- misconstrued with heart attack

- use out MI first (dx tests and ECG)

for accurate anxiety disorder dx

- nurses need to take complete hx

- consider meds that can worsen/cause anxiety

- medications conditions that may be associated with anxiety

- consider non pharmacological interventions that will reduce environmental, physical and emotional stressors prior to rx intervention

benzodiazepines end with

"azepam"

cautions with benzodiazepines

- change dose gradually - do not stop abruptly

- watch for suicide ideation

- may cause mania or psychosis

- watch in use with dysfunctional kidneys, liver, CV or pulmonary system

- use cautiously when using with elderly

lorazepam considerations

- aspirate prior to injection (IM)

- assess for paradoxical CNS excitement

- advise patient to stop smoking

- watch CBC, liver function and renal functions

- does the patient need anti anxiety drugs?

- assess for s/s OD or abuse

- teach nonpharmacological methods of sleep and relaxation

- assess for suicide ideation

Phenobarbital drug class

Barbiturate

Phenobarbital ADR

- oversedation

- "hangover" effect, lethargy

- hallucinations

- blood dyscrasia

- hypocalcemia

- hepatic disease

- n/v/d/c

- paradoxical excitation in children, older adults

Phenobarbital serious ADR

coma, SJS, angioedema, periorbital edema, thrombophlebitis

phenobarbital considerations

- monitor for respiratory depression

- ax IV barbiturates q15min

- monitor for s/s blood dyscrasias

- aspirate prior to injections

- monitor for therapeutic serum concentrations of drug

- teach non pharmacological methods of relaxation and sleep

- ax baseline hepatic and renal function and monitor during therapy

- if pt develops fever, angioedema and body rash hold med and call MD

depression

- mood disorder

- include depression and bipolar

- causes are environment, situational, hereditary

- co-exist with anxiety, substance abuse and hypertension

assessment of depression

- majority of people who commit suicide have been dx with depression

- 3+ weeks of antidepressant therapy may require before patient mood begins to improve

- 6-8 weeks to reach maximal benefit

- risk of attempted suicide highest in the month before pharmacotherapy

nurses role in depression

- carefully monitor talk of suicide

- weekly or daily patient contact '

- carefully monitoring of medications

disadvantages of tricyclic antidepressants

- SE: anticholinergic effects/sympathomimetic effects, orthostatic hypotension, sedation, sexual dysfunction

- withdrawal if not tapered - do not stop suddenly

- may take 3 weeks to see effect and 6 weeks for benefits

Imipramine drug class

tricyclic antidepressant

Imipramine contraindications

- heart attack, heart block, dysrhythmias

- asthma, GI disorders, alcoholism, schizophrenia, bipolar disorder

- avoid use with alcohol

- seizure disorders

precautions with imipramine

- suicidal tendencies

- urinary retention

- prostatic hyperplasia

- cardiac/hepatic disease

- increased intraocular pressure

- hyperthyroidism

- PD

imipramine considerations

suicide ideation, be sure patient swallows each dose, encourage compliance, monitor for urinary retention or constipation, treat dry mouth

Fluoxetine ADR

- n/v/d/c

- anorexia

- cramping/flatulence

- fluctuation with weight

- sexual dysfunction

- seizures

- poor concentration

- nightmares

- hot flashes

- palpitations

- nervousness

- serotonin syndrome

- pediatric patients (personality disorders or hyperkinesia)

fluoxetine contraindications/precautions

- bipolar disorder

- cardiac dysfunction

- DM

- seizures disorders

- carefully observe paediatric patient for hyperkinesia and personality changes/disorders

- late pregnancy

Monoamine Oxidase Inhibitors (MAOIs)

- rare use

- high incidence of ADR

What should be avoided when taking MAOIs?

No foods with tyramine, aged or fermented.

What amino acid should be avoided when taking MAOIs?

Avoid L-tyrosine.

What stimulant should be avoided when taking MAOIs?

Avoid caffeine.

What are some off-label uses for MAOIs?

OCD, panic disorder, social anxiety, migraine prophylaxis.

What effect do MAOIs have on insulin and diabetic drugs?

They potentiate the effect of insulin and diabetic drugs.

MAOI ADR

- dizziness, orthostatic hypotension

- drowsiness/HA

- sexual dysfunction

- anorexia/diarrhea

MAOI serious ADR

- hypertensive crisis (foods with tyramine)

- dysrhythmias

- SIADH-like symptoms

- high incidence of ADR

MAOI precautions

- epilepsy, severe and frequent headaches

- HTN

- dysrthymias

- suicidal tendencies

MAOI considerations

- ax for suicidal ideations

- encourage compliance

- avoid foods containing tyramine

- avoid tyrosine

- avoid caffeine

5 Bs of benzos

1. brain (sedation, relaxation)

2. BP (drop BP)

3. bile (CYP, watch liver function)

4. blood (blood dyscracias)

5. bonkers (esp old population, opposite effect)

5S's and 2C's SSRI and tricyclic antidepressants

1. seizures

2. suicide ideation

3. sexual dysfunction

4. don't Stop Suddenly

5. see (narrow angle glaucoma)

6. cirrhosis (liver function/no ETOH)

7. CNS depressant + interactions

(and anticholinergic s/s)