studentcnsdrugspart2fall09

studentcnsdrugspart2fall09 - Central Nervous System Drugs...

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Central Nervous System Drugs Anxiety/Insomnia Mood Disorders Susan Hampson Fall 2009
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Anxiety and Sleep Disorders
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Anxiety Disorders Range from mild sense of impending disaster to intense anxiety and panic Panic disorder Generalized anxiety disorder (GAD) Obsessive-compulsive disorder (OCD) Post-Traumatic stress disorder (PTSD) Social phobia
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Anxiety Presentation No symptoms Palpitations, SOB Profuse sweating Dizziness, syncope Restlessness Cannot relate feelings to specific cause s/s increase with exacerbation of anxiety Risk factors: Family predisposition Recent stressor ADHD Substance abuse
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Insomnia What is insomnia? Causes of insomnia Non drug strategies to help insomnia Elders and insomnia
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Treating Anxiety Benzodiazepines Lorazepam (Ativan) Nonbenzodiazepines Buspirone (BuSpar) SSRIs Sertraline (Zoloft) MAOIs Phenelzine (Nardil) TCAs Nortriptyline (Pamelor)
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Benzodiazepines - Action Bind to GABA receptor-chloride channel molecule. Intensify effect of GABA Metabolized in liver Excreted in urine Typical adverse effects: Amnesia, weakness, disorientation, ataxia, blurred/double vision, nausea, vomiting Treatment of choice for anxiety and
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Advantages of Benzodiazepines Little effect on consciousness Safe side effect profile Do not have many drug-drug interactions Overdose – with other CNS depressants: Somnolence Confusion Coma Respiratory depression Treatment for overdose: flumazenil (Romazicon)
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Benzodiazepines Indications ETOH withdrawal ANXIETY Depression (adjunct) Preoperative sedation Muscle spasms Seizure disorders INSOMNIA Common adverse events: CNS: drowsiness , blurred vision, headaches, loss of  coordination , insomnia, excitability, hallucinations GI: N/V, constipation, dry mouth, abdominal cramps
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Other Drugs for Anxiety Buspirone (BUSPAR) (5 mg PO TID initially) Action: inhibits uptake of dopamine, serotonin and NE Half-life: 2-3 days Onset: 7-10 days Peak plasma level: 3-4 weeks Side effects: generally well tolerated Antihistamines, e.g., hydroxyzine (VISTARIL) 50-100mg QID (vs. 25mg TID-QID for
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Nursing Considerations/Teaching Avoid ETOH, other CNS depressants Take as scheduled Avoid driving, other hazardous activity until effects of drug known Take with food if necessary Start with smallest dose, increase slowly If long term use, client may need slow withdrawal of drug
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studentcnsdrugspart2fall09 - Central Nervous System Drugs...

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