misc
situational- normal resp to stressful situations, last 2-3 wks
anxieity disorder- severe/prolonged, impairs ability to function in ADLS
why is propanol used to help w anxiety
it helps block the sns response, helpful for symptoms of increase HR and palptiations, sweating,SOB
A 28-year-old female with generalized anxiety disorder is started on an SSRI (sertraline).
After 10 days, she calls the clinic saying:
“I feel MORE anxious, I’m sweating, my heart is racing, and I can’t sleep. I thought this medicine was supposed to help!”
She denies taking other medications except a St. John’s Wort supplement.
What is the nurse’s PRIORITY concern, and what should the nurse ask/advise?
The priority concern is early SSRI overstimulation or possible serotonin excess.
The nurse should tell her to stop St. John’s Wort immediately and notify the provider.
During the first 1–2 weeks, patients may experience increased anxiety, insomnia, restlessness before therapeutic effects start.Combining SSRIs with St. John’s Wort can increase serotonin levels dangerously.Serotonin excess can lead to agitation, tachycardia, sweating — early warning symptoms.
A 54-year-old male who takes diazepam for acute anxiety presents with:
RR 8/min
HR 52
BP 88/56
Cannot stand, slurred speech
Pupils sluggish
His wife says he took extra because he was stressed.
What is the FIRST action by the nurse?
Prepare to administer flumazenil, the benzodiazepine antidote, and support airway/breathing.
this patient matches nearly every sign, indicating a severe benzodiazepine overdose.
Flumazenil reverses CNS depression but must be used cautiously due to withdrawal risk.
Airway/breathing are always the first priorities.
A patient using zolpidem (Ambien) for insomnia reports taking diphenhydramine (Benadryl) and two glasses of wine before bed because “the Ambien wasn’t strong enough.”
He woke up with bruises on both legs and doesn’t remember walking around the house.
What is the MOST important teaching for this patient?
Avoid alcohol and other CNS depressants, as they greatly increase the risk of dangerous sleep behaviors and injury.
Zolpidem has a Black Box Warning for sleepwalking and sleep-related injuries; alcohol + antihistamines intensify CNS depression and amnesia
This hormone rises at night and helps regulate the sleep-wake cycle.
Melatonin
These three neurotransmitter problems contribute to anxiety disorders.
↑ norepinephrine, ↓ GABA, and ↓ serotonin
What is some pt eduaction and Contra for benzos-
can cause OH and dizzy-get up slowly
caution w activties that require alertness
MUST be tapered off to avoid withdrawal
contra:
preg/breastfeeding
severe resp disorders
etoh abuse
narrow angel glaucoma
A 78-year-old female is admitted for acute anxiety. She was given alprazolam (Xanax) 0.5 mg PO in the ED.
One hour later, she becomes extremely agitated, pacing, shouting, and trying to remove her IV.
BP 96/58, RR 12, speech slurred, unable to follow commands.
What is the MOST likely explanation for her symptoms, and what should the nurse do first?
She is experiencing a paradoxical reaction to benzodiazepines; the nurse should hold further doses and notify the provider immediately.
Elderly patients (Beers List) may have paradoxical agitation instead of sedation. Additional doses would worsen respiratory depression and confusion
Explain Busprirone advantages and disadvantages
advantages: less se, no signficatant sedation, does not produce tolerance
disadvantage: Delayed onset of 2 weeks, not for acute pain, has SE of potential dizzy, muscle weakness
What is the drug therapies for anxiety... 1st line , 2nd line and others?
ssri/snri-first line
benzodiazipine-2nd line
nonbenzo
barbuites- last option
propanol
antihistamine
what is the patho of anxiety
imbalance of nuerotransmittor, too much excess excitatory norepi, defienct of inhbitory gaba/seratonin
what drug is no used much for anxiety due to its dangerous SE profile, and extremly sedating and high risk of overdose?
phenobarbital
Cuation w driving when using this drug, binds to GABA, has dose dependent SE, used for acute anxiety attacks, and good for preop sedation, can cause antergrade amnesia and parodoxial effects. Fall risk AND AVOID OTHER DEPRESSANTS, has an antidote
Benzo-midazolam
symtoms of seratonin symtom? mild and severe?
mild: agitation, confusion, tremor, fever, tachy, diarhea
severe: hypertensicve crisis, hyperexxia, extreme agitagion, delerium, increased fever, muscle ridigity, seizures
this drug is also used to treat anxiety and depression but has more SE due to its increase levels of NE, Increases level of norepi and seratonin in the brain.
SNRI-venlafaxine
what are common drug therapies for insomnia?
nonbenzo sedative hypnotics, melatonin, antihistamine
this is used for anxiety and depression, blocks reabsorbtion of seratonin in the brain, allows for increase level of seratonin in brain to elevate mood. doesnt effect norep/epi
has early and late SE
risk of suicdal ideation in children
SSRI-fluoxtetine
What is seratonin syndrome?
serious reaction caused by comb of ssri and other drugs that increase seratonin
fatal, too much seratonin in system
A 32-year-old female with GAD takes buspirone (Buspar) daily for 3 weeks.
She arrives with severe restlessness, dizziness, and muscle weakness.
She says, “This medicine isn’t working. I feel like I’m going to jump out of my skin.”
What is the PRIORITY nursing response?
Reassure her that buspirone does not provide immediate relief and assess for worsening anxiety—but do NOT discontinue it.
Buspirone requires 2–3 weeks to reach effect; it does not work for acute panic. These symptoms may be anxiety-related, not drug toxicity
which drug for insomnia has the hormone produced by the pineal gland, can be used for jet lag, can cause headache, dizzy, Nausau, sedation and vivid dreams?
melatonin
this class is used for insomnia, has 2 types of drugs involved, one for short term use and long term use. acts on gaba so slows everything down. need to avoid ETOH on these meds, cns depression
Eszopiclone and zolpidem
This therapy is considered a first-line non-drug intervention for anxiety
Cognitive Behavioral Therapy
which medication for anxiety is allowed for use in elderly long term because it doesnt affect GABA so no risk of resp depression?
Busprione
what does antihistamine do for insomnia?
acts on h1/h2 receptor in the brain, regulation of wakefullness, promotes sleep and causes drowsyness