Complications: - CNS depression: sedation, ataxia, and decreased cog. function. Avoid hazardous activities, concurrent use of alcohol & CNS dep - Anterograde Amnesia: difficulty recalling events that occur after dosing. Notify provider and withhold med. - Acute toxicity Oral: drowsiness, lethargy, confusion – gastric lavage followed by activated charcoal & saline cathartics. IV: resp. depression, severe hypotension & cardiac arrest – Flumazenil - Paradoxical respo.: insomnia, excitation, euphoria, anxiety, rage - Withdrawal effects: anxiety, insomnia, diaphoresis, tremors & lightheadedness, delirium, and seizures. Contraindications: - Pregnancy Risk Category D - Contraindicated in pts with OSA, resp. depression, glaucoma - Use cautiously in pts with liver disease or hx of substance abuse Nursing admin: - When d/c med, taper over several weeks - Administer med with meals or snacks if GI upset occurs - Advise pt to keep med in a secure place due to abuse potential Atypical/Non-Barbiturate Anxiolytic Pg. 116
Quiz 1 Mental Health Study Guide Brigitte Fernandez Buspirone Binds to serotonin & dopamine, less potential for dependency. - 1 wk for initial response, 2-6 wks to reach full effects Uses: Panic disorder, OCD, Social/Generalized anxiety Complication: - CNS effects: dizziness, nausea, headache, lightheaded, agitation. This med does not cause sedation. Contraindications: - Pregnancy Risk Category B - Do not use with MAOIs (at least 14 days), HTN crisis Interactions: Erythromycin, ketoconazole, St. John’s Wort, & grapefruit juice can increase effects of Buspirone. Nursing admin: administer at the same time each day, take with meals to prevent GI upset irritation. Tolerance, dependence or withdrawal is not an issue with this med. SSRIs – SOLDIERS are OCD, Panic, & often come back with PTSD Pg. 117 Paroxetine, Sertraline, Es/Citalopram, Fluoxetine , Fluvoxamine SSRIs selectively inhibit serotonin reuptake, do not block dop/norepi. Long, effective half-life, up to 4 weeks are necessary for therapeutic levels Use: First-line tx for panic, and trauma - & stressor- related disorders. - Fluoxetine used for panic disorder, OCD, and PTSD. - Also, first line of tx for depression. Complications: - Early A/E: first few days/wks > nausea, diaphoresis, tremor, fatigue, drowsiness. Effects should subside, avoid driving. - Late A/E: After 5-6 weeks > sex dysfunction, wt. gain, headache - GI bleeding – want to avoid warfarin, NSAIDS & anticoagulants - Hyponatremia – older clients taking diuretics - Serotonin Syndrome (low-dose Buspirone, mouth guard) - Bruxism: grinding and clenching of teeth, usually during sleep - Withdrawal Syndrome: do not stop med abruptly - Sex dysfunction, CNS stimulation, wt. changes, serotonin syndrome, withdrawal, hyponatremia, rash, sleepiness, faintness, lightheadedness, GI bleeding, bruxism *green is for the antidepressant use for SSRIs Contraindications: - Pregnancy Risk Category D
Quiz 1 Mental Health Study Guide Brigitte Fernandez - MAOIs, TCA, St. John’s Wort and alcohol should be avoided Nurse administration: - May be taken with food, take in the morning!
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- Fall '16
- Selective serotonin reuptake inhibitor, Major depressive disorder, Antidepressant, Tricyclic antidepressant, Brigitte Fernandez