the nursing process: antianxiety agents

Question 1

What are the indications for anti-anxiety agents?

Answer 1

anxiety disorders, 
anxiety symptoms,
 acute alcohol withdrawal,
 skeletal muscle spasms,
 convulsive disorders, 
status epilepticus,
 and preoperative sedation.

Question 2

What is the action of anti-anxiety agents?

Answer 2

Depression of the CNS (except Buspirone)

Question 3

what are contraindication/precautions for anti-anxiety medications?

Answer 3

contraindicated in known hypersensitivity 
in combination with other CNS depressants.
in pregnancy and lactation
narrow angle glaucoma
shock
and coma
CAUTION : with the elderly 
 debilitated clients,
 clients with renal failure,
 hepatic dysfunctions, 
those with a history of drug abuse or addiction
those who are depressed or suicidal.

Question 4

what interactions with anti- anxiety medications

Answer 4

INCREASED AFFECTs with 
alcohol
 barbiturates
 narcotic
 antipsychotics
 antidepressants
 antihistamines
 neuromuscular blocking agents
 cimetidine
 disulfiram
 kava kava
  valerian root.
DECREASED EFFECTS; with cigarette smoking and caffeine consumption

Question 5

nursing diagnosis for antianxiety medications

Answer 5

risk for injury
anxiety
risk or activity intolerance
disturbed sleep pattern
deficit knowledge

Question 6

Monitor clients taking anti anxiety medications for the following side effects.

Answer 6

drowsiness
 confusion
 lethargy
 tolerance
 physical and psychological dependence
 potentation of other CNS depressants
 aggravation of depression
 orthosatic hypotension
paradoxical excitement
 dry mouth, nausea
 vomiting
 blood dyscrasias, delayed onset (only with buspirone)

Question 7

Which of the following medications would be an appropriate PRN medication for an individual with anxiety symptoms?
Buspirone
alprazolam
fluoxetine
sertraline

Answer 7

Alprazolam

it is a benzodiazepine hat works as a CNS depressant o produce quick acting effects of relaxation in an individual with anxiety symptoms

Question 8

Buspirone

Answer 8

has a delayed effect (should not be used as a PRN med)

Question 9

Fluoxetine and sertraline

Answer 9

may be used on a long term basis with individuals who have anxiety disorders but are not effective on a PRN basis for anxiety symptoms

Question 10

Indications for anti depressants are?

Answer 10

dysthymia, 
major depressive disorder,
 depression associated with organic disease,
 alcoholism,
 schizophrenia
, intellectual disability,
 depressive phase of bipolar disorder
, depression accompanied by anxiety

Question 11

Action of anti depressants?

Answer 11

increase concentration of norepinepherine, serotonin, and/or dopamine in the body either by blocking their reuptake by the neurons (tricyclics, tetracyclics, SSRIs, SNRIs) or by inhibiting the release of monoamine oxidase inhibitors (MAOIs)

Question 12

Contraindication/Precautions of anti depressants?

Answer 12

CONTRAINDICATED in known hypersensitivity (all), acute phase of recovery from myocardial infarction(MI) and in angle-closure glaucoma(tricyclics) and concomitant with MAOIs (all)
CAUTION: with elderly or debilitated clients
; clients with hepatic cardiac or renal insufficiency;
psychotic clients;
clients with benign prostatic hypertrophy;
and those with a history of seizures.

Question 13

Drug interactions with SSRIs

Answer 13

Buspirone(BuSpar), TCAs (especially clomipramine), selegiline(Eldepryl), St. Johns wart
ADVERSE EFFECTS: SEROTONIN SYNDROME

MAOIs: adverse effects with ssri’s ; HYPERTENSIVE CRISIS

WARFARIN, NSAIDS; adverse effects; INCREASED RISK OF BLEEDING

ALCOHOL, BENZODIAZAPINES; adverse effects; INCREASED SEDATION

ANTIEPILEPTICS; adverse effects; LOWERED SEIZURE THRESHOLD.

Question 14

drug interactions with TCAs

Answer 14

MAOIs: adverse effects; HIGH FEVER, CONVULSIONS, DEATH

ST. JOHNS WART, TRAMADOL(ultram); adverse effects; SEIZURES, SEROTONIN SYNDROME

CLONIDINE(catapres), EPINEPHRINE; adverse effects; SEVERE HYPERTENSION

ACETYLCHOLINE BLOCKERS; adverse effects, PARALYTIC ILEUS

ALCOHOL, CARBAMEZIPINE; adverse effects; BLOCKS ANTIDEPRESSANT ACTION, INCREASES SEDATION

CIMETIDINE(tagamet) BUPROPION(BuSpar); adverse effects; INCREASED TCA BLOOD LEVELS, INCREASED SIDE EFFECTS.

Question 15

drugs interaction with MAOIs

Answer 15

SSRIs, TCAs, atomoxetine (Strattera), duloxetine (Cymbalta), dextromethorphan (an ingredient in many cough syrups), venlafaxine (Effexor), St. John’s Wort, ginkgo adverse effects Serotonin syndrome

All other antidepressants, pseudoephedrine, amphetamines, cocaine cyclobenzaprine (Flexeril), dopamine, methyldopa, levodopa, epinephrine, buspirone (BuSpar) ADVERSE EFFECTS;Hypertensive crisis (these side effects can occur even if taken within 2 weeks of stopping MAOIs)
Morphine and other narcotic pain relievers,
antihypertensives ADVERSE EFFECTS; Hypotension
Buspirone (BuSpar); ADVERSE EFFECTS; Psychosis, agitation, seizures
Antidiabetics; ADVERSE EFFECTS; Hypoglycemia

Tegretol; ADVERSE EFFECTS; Fever, hypertension, seizures

Question 16

Nursing diagnosis for antidepressants

Answer 16

Risk for suicide
Risk for injury
Social isolation
Risk for constipation
Insomnia

Question 17

Planning/implementation for antidepressants

Answer 17

Monitor client for the following side effects:
May occur with all chemical classes
Dry mouth, sedation, nausea
Discontinuation syndrome

Question 18

Most commonly occur with tricyclics and heterocyclics

Answer 18

Blurred vision, constipation, urinary retention, orthostatic hypotension, reduction of seizure threshold, tachycardia, arrhythmias, photosensitivity, weight gain

Question 19

Most commonly occur with SSRIs and SNRIs

Answer 19

Insomnia, agitation, headache, weight loss, sexual dysfunction, serotonin syndrome

Question 20

Most commonly occur with MAOIs

Answer 20

Hypertensive crisis
 Site reactions (selegiline transdermal system)

Question 21

Miscellaneous side effects

Answer 21

Priapism (with trazodone)
 Hepatic failure (with nefazodone)

Question 22

Educate client and family about the medication.

Answer 22

and side effects

Question 23

Indications:Mood-Stabilizing Agents

Answer 23

Prevention and treatment of manic episodes associated with bipolar disorder

Question 24

Examples:Mood-Stabilizing Agents

Answer 24

Examples: Lithium carbonate, clonazepam, carbamazepine, valproic acid, lamotrigine, topiramate, oxcarbazepine, verapamil, various antipsychotics

Question 25

Action:Mood-Stabilizing Agents

Answer 25

Lithium is thought to modulate the effects of norepinephrine, serotonin, dopamine, glutamate, and GABA, which may contribute to the symptomatology of bipolar disorder, the role of anticonvulsants, verapamil, and antipsychotics in the treatment of bipolar mania is not fully understood.

Question 26

Nursing diagnosis for mood stabilizing agents

Answer 26

Risk for injury Risk for self-directed or other-directedviolence Risk for activity intolerance

Question 27

Therapeutic range | for Lithium

Answer 27

1. 0–1.5 mEq/L (acute mania) | 0. 6–1.2 mEq/L (maintenance)

Question 28

Initial symptoms of Lithium toxicity include

Answer 28

Blurred vision, ataxia, tinnitus, persistent nausea and vomiting, and severe diarrhea

Question 29

what should be ensured when a client is taking Lithium

Answer 29

Ensure that client consumes adequate sodium and fluid in diet.

Question 30

INDICATIONS FOR ANTIPSYCHOTICS

Answer 30

Used for the treatment of schizophrenia and other psychotic disorders; selected agents are also used in the treatment of bipolar mania, as antiemetics, in the treatment of intractable hiccoughs, and for control of tics and vocal utterances in Tourette’s disorder.

Question 31

Action | Typical antipsychotics

Answer 31

Block postsynaptic dopamine receptors in the basal ganglia, hypothalamus, limbic system, brainstem, and medulla. Demonstrate varying affinity for cholinergic, alpha-1-adrenergic, and histaminic receptors. Inhibit dopamine-mediated transmission of neural impulses at the synapses.

Question 32

Action | Atypical antipsychotics

Answer 32

Weaker dopamine receptor antagonists than the typical antipsychotics Potent antagonists of the serotonin type 2A (5HT-2A) receptors Exhibit antagonism for cholinergic, histaminic, and adrenergic receptors

Question 33

Contraindications/precautions (atypicals)

Answer 33

Contraindicated in hypersensitive, comatose, or severely depressed patients; elderly patients with dementia-related psychosis; certain medications are contraindicated in patients with a history of QT prolongation or other heart issues. Caution with elderly or debilitated patients; patients with cardiac, hepatic, or renal insufficiency; those with a history of seizures; patients with diabetes or risk factors for diabetes; clients exposed to temperature extremes under conditions that cause hypotension; and pregnant clients or children.

Question 34

Nursing diagnosis | for antipsychotics

Answer 34

Risk for other-directed violence Risk for injury Risk for activity intolerance Noncompliance

Question 35

The Nursing Process: Antipsychotics Planning/implementation Monitor client for the following side effects:

Answer 35

Anticholinergic effects, nausea, gastrointestinal upset, skin rash, sedation, orthostatic hypotension, photosensitivity, hormonal effects, electrocardiogram changes, reduction of seizure threshold, agranulocytosis (especially with clozapine), hypersalivation (with clozapine), extrapyramidal symptoms, tardive dyskinesia, neuroleptic malignant syndrome, hyperglycemia and diabetes, increased risk of mortality in elderly patients with NCD-related psychosis

Question 36

Sedative-Hypnotics | Indications:

Answer 36

Short-term management of various anxiety states and treatment of insomnia; selected agents are used as anticonvulsants, as preoperative sedatives, and to reduce anxiety associated with alcohol withdrawal.

Question 37

Sedative-Hypnotics Action

Answer 37

Depression of the CNS

Question 38

Sedative-Hypnotics Exception:

Answer 38

Ramelteon’s sleep-promoting properties are the result of agonist activity on selective melatonin receptors.

Question 39

Sedative-Hypnotics | Contraindications

Answer 39

Contraindicated in known hypersensitivity, pregnancy, and lactation, and in severe hepatic, cardiac, respiratory, or renal disease. Chloral hydrate is contraindicated in persons with esophagitis, gastritis, or peptic ulcer disease.

Question 40

Sedative-Hypnotics precautions

Answer 40

Caution is advised with clients with hepatic, cardiac, renal, or respiratory insufficiency. Caution is also advised with those who are suicidal and those who have been addicted to drugs. Chloral hydrate should be used with caution in clients susceptible to acute intermittent porphyria.

Question 41

Nursing diagnosis Sedative-Hypnotics

Answer 41

Risk for injury Disturbed sleep pattern/insomnia Risk for activity intolerance Risk for acute confusion

Question 42

Planning/implementation Sedative-Hypnotics | Monitor client for the following side effects

Answer 42

Drowsiness, confusion, lethargy, tolerance, physical and psychological dependence, potentiation of other CNS depressants, aggravation of depression, orthostatic hypotension, paradoxical excitement, dry mouth, nausea, vomiting, and blood dyscrasias Abnormal thinking and behavioral changes

Question 43

ADHD Agents | Indications:

Answer 43

Attention deficit/hyperactivity disorder (ADHD) in children and adults

Question 44

ADHD Agents Actions

Answer 44

The CNS stimulants increase levels of norepinephrine, dopamine, and serotonin in the CNS.

Question 45

Their effectiveness in the treatment of ADHD is thought to be based on the activation of

Answer 45

dopamine D4 receptors in the basal ganglia and thalamus, which depress, rather than enhance, motor activity.

Question 46

Atomoxetine inhibits ?

Answer 46

the reuptake of norepinephrine, and bupropion blocks the neuronal uptake of serotonin, norepinephrine, and dopamine.

Question 47

Clonidine and guanfacine stimulate what?

Answer 47

central alpha-adrenergic receptors in the brain resulting in reduced sympathetic outflow from the CNS. The exact mechanism by which these nonstimulant drugs produce the therapeutic effect in ADHD is unclear.

Question 48

CNS stimulants: Contraindicated in clients with?

Answer 48

hypersensitivity to sympathomimetic amines; clients with advanced arteriosclerosis, cardiovascular disease, hypertension, hyperthyroidism, glaucoma, agitated or hyperexcitability states; clients with a history of drug abuse; clients during or within 14 days of receiving therapy with MAOIs; in children younger than 3 years of age; and in pregnancy and lactation

Question 49

Atomoxetine and bupropion: Contraindicated in clients

Answer 49

with hypersensitivity to the drugs, in lactation, and in concomitant use with or within 2 weeks of using MAOIs

Question 50

Atomoxetine: Contraindicated in clients with

Answer 50

narrow-angle glaucoma

Question 51

Bupropion: Contraindicated in clients with

Answer 51

known or suspected seizure disorder, acute phase of MI, and in clients with bulimia or anorexia nervosa

Question 52

Alpha agonists: Contraindicated in clients with

Answer 52

known hypersensitivity to the drugs

Question 53

CNS stimulants: Use caution in

Answer 53

children with psychoses; clients with Tourette’s disorder, anorexia, or insomnia; elderly, debilitated, or asthenic clients; and clients with history of suicidal or homicidal tendencies; prolonged use may result in tolerance and physical or psychological dependence.

Question 54

Atomoxetine and bupropion: Use caution in clients with

Answer 54

urinary retention; hepatic, renal, or cardiovascular disease; suicidal clients; pregnancy; and elderly and debilitated clients.

Question 55

Alpha agonists: Caution in clients with

Answer 55

cerebrovascular coronary insufficiency, recent MI, or disease; in chronic renal or hepatic failure; the elderly; and in pregnancy and lactation

Question 56

Nursing diagnosis | ADHD agents

Answer 56

Risk for injury Risk for suicide Insomnia Imbalanced nutrition: less than body requirements Nausea related to side effects of atomoxetine or bupropion Pain related to side effects of abdominal pain with atomoxetine or bupropion or headache (all agents) Risk for activity intolerance

Question 57

Planning/implementation ADHD agents Monitor client for the following side effects:

Answer 57

Overstimulation, restlessness, insomnia, palpitations, tachycardia, anorexia, weight loss, tolerance, physical and psychological dependence, nausea and vomiting, constipation, dry mouth, sedation or rebound syndrome (alpha agonists), potential for seizures (bupropion), liver damage (atomoxetine), and new or worsened psychiatric symptoms (CNS stimulants and atomoxetine)