prototype
what is the prototype for Benzodiazepines
diazepam
Benzodiazepines Adverse Effects
Sedation, Drowsiness
Depression,Lethargy, Confusion, Abrupt cessation may cause withdraw syndrome, Dry Mouth, Nausea, Vomiting, Hypotension, May cause paradoxical excitatory reaction in first 2 weeks of therapy
what are the drug to drug for Benzodiazepines
1.Reduce dose of narcotics if given together due to potential sedation
2.Increase CNS depression when taken with alcohol
*****DO NOT TAKE TOGETHER*****
what are the indications for Barbiturates for Anxiolytic and Hypnotic Agents
Relief for signs and symptoms of anxiety,Sedation,Insomnia, Preanesthesia, Seizures, Acute Manic Reactions
what are other Anxiolytic and Hypnotic Drugs
hint there is three
1. Buspirone (generic): Reduces the signs and symptoms of anxiety without severe CNS and adverse effects
2. Eszopiclone (Lunesta): Insomnia
3. zolpidem (Ambien): Short-term treatment of insomnia
what it the prototype for Barbiturates
Phenobarbital
Barbiturates
CNS Depression,Physical Dependency,Drowsiness, Somnolence, Lethargy,Ataxia,Vertigo,Nausea, Vomiting, Constipation, Hallucinations,Paradoxical excitement
Tricyclic Antidepressants
Limit drug access if suicidal
Administer at bedtime (or if taking multiple times a day, give the biggest dose) due to sedation
indications for Benzodiazepines
anxiety disorders, alcohol withdrawal, hyperexcitability and agitation, preoperative relief of anxiety and tension to aid in balanced anesthesia
Feeling of tension, nervousness, apprehension, or fear involving unpleasant reactions to a stimulus
Anxiety
Tricyclic Antidepressants
Prototype-imipramine
Tricyclic Antidepressants
oSedation, sleep disturbances, fatigue, hallucinations, disorientation, visual disturbances, difficulty concentrating, weakness, ataxia and tremors
oCan have withdraw effects with abrupt dessation
SSRI drug to drug
oMAOIs
oCannot take more than 1 SSRI at the same time
oDo not take St Johns Wort—can cause serotonin syndrome
Benzodiazepines considerations
Give IV drugs slowly d/t possible hypotension, bradycardia, and cardiac arrest
Flumazenil is the antidote for benzo’s
Instruct patient not to operate heavy machinery, drive a vehicle while taking this medication
Don’t abruptly discontinue a medication-taper done slowly
Educate patient to not mix these medications with other sedatives or depressant substances
Can be addictive
Vision changes, slurred speech and unsteadiness are common, will subside after first few days. If not, report to healthcare provider
what is the black box warning for Benzodiazepines
continue use with opiods can result in profound sedation, resp depression, coma and/or death
Monoamine Oxidase Inhibitors (MAOIs)
Phenelzine (Nardil)
MAOI
oMay cause hypertensive crisis is taken with lots of other meds (phentolamine or other adrenergic blocker are treatments for hypertensive crisis)
random ***
how long does it take for SSRI to take full therapeutic effect
4 weeks
Tricyclic Antidepressants
oRelief of symptoms of depression-especially those with anxiety and sleep disturbances also
oUsed in patients with sleep disorders
oTreatment of enuresis
oChronic pain
contraindications for Barbiturates
Previous history of addiction due to high risk of addiction-must be very careful in these patients if they are prescribed
Serotonin Norepinephrine Inhibitors
Venlafaxine
SSRI adverse
oSome CNS effects like sedation, dizziness
oChanges in taste
oHyperhidrosis is common
oNausea, vomiting, et loss
Sexual dysfunction
SSRI interventions
Educate that can take up to 4 weeks to reach full effect
Suicide precautions
Administer in am
Barrier contraceptive use is needed
what are the contraindications for Tricyclic Antidepressants
Don’t take with MAOI’s
Black box warning regarding risk of suicidality, especially in kids, adolescents and young adults
what are some signs and symptoms of depression
Low energy level
Sleep disturbances
Lack of appetite
Limited libido
Inability to perform activities of daily living
Overwhelming feelings of sadness, despair, hopelessness, and disorganization