NSG 116 CNS Stimulants and Depressants

What is anxiety

Un please feeling of impending danger,panic, or doom

When do we seek treatment for anxiety

When it’s effects ADL and impaires function

Signs and Symptoms of anxiety

Nervousness

Muscle tension

Sweating or shaking

Irritable and restless

Worry

Heart palpitations

Difficulty sleeping

Trouble concentrating

Nausea and diarrhea

Anxiety leads to decreased

Ability to function with ADLs

Treatment for anxiety

Antidepressant

Benzodiazepines

What is the first line of treatment for anxiety

Antidepressants

Antidepressant are given

If the symptoms have been there at least 2 weeks or more

Benzodiazepines are

Habit forming

Benzodiazepines are mostly

Short term

Long term treatment of anxiety used benzodiazepines as a

Second line

Don’t stop benzodiazepines

Abruptly, taper off gradually

Categories of benzodiazepines used to treat anxiety

Diazepam (Valium)

Alprazolam(Xanax)

Lorazepam (Ativan)

Midazolam (Versed)

What is the drug prototype for anxiety benzodiazepines

Diazepam ( Valium)

Benzodiazepines have a. Long half life meaning

It remains in your body longer

If you have an older patient start at the

Smallest dose of benzodiazepines

Diazepam (Valium) is used for

Treating anxiety and other indications

Adverse of effects of benzodiazepines used for anxiety

CNS

Memory

Depression

Dizziness

Shallow breathing

Restless ness

Benzodiazepines are available in

PO

PR

IM

IV

Benzodiazepines have a wide margin of safety between thearapeuric /toxic doses meaning

You can take a lot to be fatal

Benzodiazepines are a

Schedule IV

Controlled substance so long term use can cause dependence

Contraindications of benzodiazepines used for anxiety

Flumazenil (romazicon) is given to reverse

Overdose of benzodiazepines

Flumazenil (romazicon) Can lead to seizures so monitor closely for

Seizure activity

When administering fumazenil (romazicon) what equipment should you have at the bedside

Black box warning for benzodiazepines taken for anxiety

Do not combine with opioid analgesic because the combo increases risk of serious adverse reactions including difficulty breathing and death ( respiratory depression)

Other uses for diazepam ( Valium)

What is depression

Who does depression effect

It doesn’t discriminate

Depression is 50% more common in

Women

What factors can lead to depression

Depression can affect all ages and can

Interfere with every day life

Clinical manifestations of depression

What does serotonin effect

Mood

Sleep

Appetite

Energy level

Cognitive and psychomotor functions

Hostility can lead to

Impulsive behavior

Mania

Akathisia

Complete numbness of emotions and can’t remain still

When is drug therapy indicated for depression

Treatments for depression

Characteristics of antidepressants

Other uses of antidepressants

You have to be completely off your antidepressant to start

A new antidepressant

Schedule surgery months out for

Tricyclic antidepressants

What are the selective reputake inhibitors (SSRIs)

Sertraline

Black box warning for SSRIs

Suicidal ideation

Adverse effects of SSRIs

Contraindications of SSRI’s

What is serotonin syndrome

What happens when combine MAOIRs can SSRIs

Serotonin syndrome

Don’t drink alcohol on any

Antidepressant

Low sodium can lead to

Seizures

Atypical antidepressants

Bupropion (Wellbutrin)

Mirtazapine (Remeron)

Trazodone

What is the black box warning for atypical antidepressants

What other uses are there for atypical antidepressants

If pt is prescribed Venlafaxine (Effexor) capsules for depression and can’t swallow what do nurses advice

pour the contents in applesauce to help with swallowing

Don’t chew the granules just swallow whole

What is psychosis

Drug therapy goals for psychosis within the first week

Goals for Drug therapy for psychosis after the first week

Increase ability for self-care

Increase socialization

Takes 1-2 months

Long term goals for drug therapy for psychosis

To increase coping and prevent acute episodes or hospitalizations

Drug therapy for psychosis takes

1-2 months

Drugs used for psychosis

First generation antipsychotics: Haloperidol (Haldol

: Haloperidol (Haldol) adverse effects

Haloperidol (Haldol) contraindications

: Haloperidol (Haldol) implications

: Haloperidol (Haldol) black box warning