anxiolytics and antidepressants

diazepam, lorazepam class

Benzodiazepines

diazepam use

treatment of anxiety and insomnia/ seizure management

diazepam action

binds to GABA receptor chloride channel molecule

diazepam se

sedation, drowsiness, dizziness, blurred vision and hypotension/bradypnea

benzodiazepines black box warning

respiration depression/ death combined with opioids

benzodiazepines client education

do not take with other CNS depressants, alcohol, rise slowly from sitting/lying position, taper gradually to lessen withdrawal

Benzodiazepines antidote

flumazenil

bupropion class

NDRI(norepinephrine dopamine reuptake inhibitors) antidepressant

bupropion use

depression, smoking cessation, SAD

bupropion action

decreases neuronal reuptake of dopamine in the CNS; diminishes neuronal uptake of serotonin and norepinephrine

bupropion side effects

insomnia, dry mouth, nausea, tremor, anxiety, agitation, SEIZURE RISK

bupropion nursing interventions

assess for SI, mood, anxiety, energy levels, monitor BP

Pregabalin class

GABA analog, anticonvulsant, calcium channel inhibitor

Pregabalin use

neuropathic pain, off-label: anxiety, anticonvulsant

Pregabalin se

dizziness, drowsiness, peripheral edema, weight gain

Pregabalin assessment

monitor si, fluid retention

Pregabalin education

may cause dizziness, avoid alcohol/cns depressants, monitor behavior

Pregabalin action

binds to calcium channels in CNS, which regulate neurotransmitter release

hydroxyzine class

antihistamine, h1 anatagonist

hydroxyzine action

impacts muscarinic, dopaminergic, serotonergic receptors in the brain

hydroxyzine use

relief of anxiety and tension

hydroxyzine se

dry mouth, drowsiness, HA, QT prolongation, torsades de pointes, involuntary motor activity, allergic reaction, pruritus, rash, respiratory depression, seizures

hydroxyzine education

do not take with other CNS depressants/alcohol, may cause drowsiness, taken at bedtime if used for insomnia

Amitriptyline class

tricyclic antidepressants(TCA)

Amitriptyline use

antidepressant, off-label use: anxiety, neuropathic pain, insomnia, migraines

Amitriptyline action

blocks the reuptake of norepinephrine and serotonin at the presynaptic neuron

Amitriptyline side effects

dry mouth, flushing, photosensitivity, tachycardia, dysrhythmias, confusion, agitation, dilation of pupils, weight gain, orthostatic hypotension

Amitriptyline interactions

MAOI's use can cause hypertensive crisis, cardiac toxicity is a risk

Amitriptyline nursing interventions

EKG prior to treatment, monitor VS, maintain patent airway, CBC/WBC/LFT/BG

fluoxetine, citalopram class

SSRI(selective serotonin reuptake inhibitors)

fluoxetine, citalopram use

treatment of depression, anxiety, OCD, PTSD, panic disorders

fluoxetine, citalopram action

inhibits the reuptake of serotonin

fluoxetine, citalopram side effects

nausea, dry mouth, insomnia, photosensitivity, insomnia, CNS stimulation, restlessness, agitation, decreased libido, prolonged QT interval, torsades de pointes

fluoxetine, citalopram interventions

initiate safety precautions if dizziness occurs, admin with snack/meal to reduce dizziness, take meds in AM to avoid sleep interference, monitor for signs of serotonin syndrome

trazodone class

SARI( Serotonin receptor antagonist and reuptake inhibitor)

trazodone use

atypical antidepressant, used to treat insomnia

trazodone action

inhibits serotonin reuptake from the synaptic gap; blocks adrenergic and histamine receptors

trazodone side effects

sedation, dizziness, dry mouth, HA, nausea

trazodone adverse

orthostatic, serotonin syndrome, confusion, excessive sedation, fall risk, QT prolongation

trazodone interventions

assess BP/HR, mental status, SI, serotonin syndrome, renal/hepatic function tests, monitor ECG, monitor/correct sodium level

trazodone education

take in PM, do not stop abruptly, avoid alcohol/other CNS depressants, slow position changes

venlafaxine class

SNRI(Serotonin norepinephrine reuptake inhibitor)

venlafaxine action

inhibits reuptake of serotonin and norepinephrine in the CNS

venlafaxine use

depression, anxiety, neuropathic pain, fibromyalgia, panic disorder

venlafaxine side effects

dizziness, Ha, constipation, drowsiness, insomnia, sexual dysfunction, nausea, changes in appetite