Anxiolytic and antipsychotics Flashcards
(37 cards)
what are the neurotranmitters in anxiety
Gaba- aminobutyric (decreased) GABA is the main one!!!
Serotonin (decrease)
Norepeinephine (increased)
What is the action of the Benzodiazepines
Increase the attraction of the GabaA receptor to GABA.
What are the different uses for benzodiazepines
anticonvulsants
sedatives- hypnotics
preoperative drugs
anxiolytics
What are some examples of Benodiazepine
Chlodiazepoxide (Librium) Diazepam (valium) Lorazepam (Ativan) Clorazepat dipotassium (tranxene) alpralozam (Xanax)
how the Benzodiazepines are absorbed, metabolized and excreted?
Absorbed rapidly in the GI tract.Metabolised primarily by the liver and excreted in urine (liver and renal patient should have dosage lowered accordingly)
Why are we concern of the consumption of Etoh with the benzo?
Because since CNS depression is a major side effect of Benzos, Etoh potentiate the CNS depression desptite the wide range of safety (overdose is uncommon)
What is Paradoxical reaction?
It is a reaction that occurs with the geriatric population when administered Benzodiazepines. Elderly will have the opposite effect, be more agitated, talkative, angry and even rage. (to be recognized before putting them in restrain)
Which plant increase the sedative effect and should never be combine with the Benzodiazepines?
Kava-kava
What is the side effect and adverse reaction of Benzos?
HA, dzness, dry mouth, blurred vision, rare urinary incontinence and constipation
Adverse: Leukopenia with symptoms of fever, malaise and sore throat.
Tolerance to the drug dosage with continuous use
Physical dependency.
What other drug potentiate the sedative effect of Benzos?
Etoh, any CNS depressant and anticonvulsant
What are the drug interaction effect of cimetidine/ ativan?
increase ativan plasma level
How long is the Benzo should be prescribed?
no longer than 3-4 months. Beyond 4 month the effectiveness decrease. (Tolerance + cross tolerance + withdrawal–>agitation, insomnia, tremors, mm cramping, sweating, paranoia, delirium, panic, HTN, status epilectus)
How to treat an overdose of Benzodiazepines?
1- administer and emetic followed by charcoal if the pt is conscious. Use gastric lavage if the patient is unconscious.
2- Administer the Benzodiazepine antagonist Flumazenil (Romazicon) IV if required.
3- Maintain an airway and give O2 as needed for decrease resp. and monitor vital signs.
4- Give IV vasopressor for swevere hypotension
5- request a mental health consultation for the client.
What is the Benzodiazepine reversal agent?
Flumazenil (Romazicon)
How can convulsion during withdrawals of benzodiazepine be prevented?
simultaneous substitution of an anticonvulsant
True or false
Tobacco, caffeine, and sympathomimetics increase the effectiveness of benzodiazepines.
False
They decrease the effects of Benzos.
What is rapid tranquilization cocktail?
Haldol 5mg, Ativan 2mg, Benadryl 50mg: 5-2-50 (five to fifty)
In emergency situation
Team approaches
Never solo intervention
What is the relation between GABA and anxiety?
Low GABA leads to increase anxiety;
Benzodiazepine increase the sensitivity of GABA receptors
What serotonin responsible for?
Arousal and activity CNS; SSRIs and MAOI blocks Serotonin reputable to decrease anxiety and depression
What are the TCA (tricyclics Antidepressant)
Imipramine (Trofanil)
Amitriptine (Elavil)
Doxepin (Sinequan)
Trimipramine (Sumontil)
What is the mechanism of action of Phenothiazides?
Blocks dopamine receptors
What are the typical antipsychotic phenothiazides meds? (3)
Thorazine (chlorpromazine)
Prolixin (Fluphenazine)
Mellaril (Thiodazine)
What are the two typical antipsychotic Nonphenothiazide meds?
Haldol (Haloperidol)
Navane (Thiothiexene)
What is tardive dyskinesia?
EPS syndrome with wormy tongue, rapid nose and face associated with long term phenothiazine treatment.
Potentially irreversible unless detected early.
