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Benzos can cause fetal harm and harm infants due to

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Benzos can cause fetal harm and harm infants due to transmissionthrough milk.Schedule IV Controlled Substance – potential for dependencyContraindicated in pt’s w/ sleep apnea, COPD/Asthma respiratory depression, glaucoma.Be careful in older pts and those w/ liver & renal disease and substance abuseSHORT TERM!!!Don’t drink the juice of the grapefruitAvoid alcoholA.Nursing Actions, Education, and AdministrationTaper Benzos over several weeks if stopping Tx and the pt has been taking regularly and inhigh dosesAdminister with food if GI upset occursAdminister at bedtime if possible due to sedationDo not take in larger amounts than prescribedDependency can occur during or after TxAtypical Anxiolytics/ Non-barbiturate Anxiolytics
Prototype drug(Buspirone)NOT FOR ACUTE ANXIETY ATTACKSA.Pharmacological ActionsBinds to serotonin and dopamineDependency is significantly less likely than other anxiolyticsNo sedation or CNS depressionNo risk of misuseAnti-anxiety effects develop slowly. (Initial response is a week, 2-4 weeks for full effects)Taken on a scheduled basis, Not PRNA.Therapeutic usesPanic DisorderSocial AnxietyOCD and related disordersPTSDGeneralized anxiety disorderA. ComplicationsDizziness, nausea, HA, lightheadedness, agitationTake with food to avoid nauseaAvoid activities that require alertness until effects are knownMost are self-limitingConstipationFiber and fluidSuicidal IdeationA.Contraindications/ PrecautionsPregnancy risk category BNot recommended for pregnant or breastfeedingCautiously with older adults or pts w/ liver or renal disfunctionCI in use of MAOI antidepressants or 14 days after discontinuation of MAOIs.Can result in Hypertensive CrisisErythromycinSt. John’s WortGrapefruit JuiceA.Nursing administration and educationLabeled as short term Tx of anxiety, but can be therapeutic for up to a yearTake with meals to avoid gastric irritationEffects don’t occur immediatelyTolerance, dependence, and withdrawal effects are not an issue*Selective Serotonin Reuptake Inhibitors (SSRI Antidepressants)Prototype Drug(Paroxetine)—PaxilOther drugs (Sertraline(Zoloft), Citalopram, Escitalopram, Fluoxetine, Fluvoxamine)A.Pharmacological ActionsSelectively inhibits serotonin reuptake allowing more serotonin to stay at junction of neurons
Does not block uptake of dopamine or norepinephrineLong half-life, time frameup to LONG TIME (weeks) is necessary to produce therapeuticlevelsB. ComplicationsEarlyComplicationsNausea, Diaphoresis, tremor, fatigue, drowsinessShould subside soonLateradverse effects (5-6 weeks of therapy)Insomnia, HA, sexual disfunctionWeight changesEarly weight loss followed by weight gain in long term therapyGI BleedingHyponatremiaMore likely with older clientsSerotonin SyndromeAgitated, confused, disoriented, difficulty concentrating, anxiety, hallucinations,myoclonus (spastic, jerky muscles), hyperreflexia, incoordination, tremors, fever,diaphoresis, hostility, delirium, seizures, tachycardia, nausea, vomiting, diarrhea,abdominal pain, coma, death(Basically just and angry, confused person)2-72 hours after TxResolves with medication discontinuationBruxismGrinding teeth during sleepTreated withBusprioneWithdrawal syndromeNausea, sensory disturbances, anxiety, tremor, malaise, uneaseTaper medPostural hypotension

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