Exam 2- Nsg 552 Wilkes University| 75 questions and answers.

Acute anxiety First line for acute panic may be short term benzo use. short acting benzos cause rebound anxiety and are the most abused Benzodiazepines Withdrawal can be dangerous, even deadly. Stopping abruptly is not advised. Symptoms of agitation, tension, irritability, and sz. may occur anxiety disorders psychological disorders characterized by distressing, persistent anxiety or maladaptive behaviors that reduce anxiety anxiety disorders treatment -non-activating antidepressants area good place to start. for this disorder first line treatment anxiety disorders SSRI- Fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil) TCAs often effective but with riskier SE may interfere with psychotherapy in TX of AD Benzodiazepines- short acting Alprazolam are most abusable Rapid onset BZD used for acute panic disorder BZD with long half- life (20-80 hours) Diazepam (avoid in elderly) BEERS criteria A list of medications that are generally considered inappropriate when given to elderly people BEERS criteria Identifies High Risk Meds to Generate Wide List of Meds That Should be Avoided The "Beers Criteria for Potentially Inappropriate Medication Use in Older Adults", commonly called the Beers List, are guidelines for healthcare professionals to help improve the safety of prescribing medications for older adults. concomitant with pharmacological tx in AD Psychotherapy First line for specific phobias like clowns, blood, animals Psychotherapy medications not all that helpful for specific phobias OCD treatment SSRI and CBT BZD in treatment of OCD Xanax, Valium, Klonipin Trauma and Dissociative Disorders Consider and treat and comorbid disorders as well Trauma and Dissociative Disorders first line pharmocology Antidepressants Psychotherapy are treatment of choice Dissociative disorders the degree of insight the patient has is crucial to the outcome of psychotherapy DID- Dissociative identity disorder may consider multi pronged approach to treatment but strongly linked to childhood trauma so treating underlying PTSD s/s is often helpful DID discourage use of BZD DID beta blockers and alpha blockers useful for reducing sympathetic nervous system activation Prazosin alpha 1 blocker helpful for nightmares and flashbacks anorexia nervosa An eating disorder characterized by an obstinate and willful refusal to eat, a distorted body image, and an intense fear of being fat Meds for anorexia Prozac Anafranil Pariactin Thorazine Zyprexa Used in anorexia nervosA atypical antipyschotics binge eating disorder significant binge-eating episodes, followed by distress, disgust, or guilt, but without the compensatory purging, fasting, or excessive exercise that marks bulimia nervosa treatment of binge eating disorder Antidepressants and other medication, cognitive behavioral and interpersonal therapy. psychosomatic goal reduce discomfort, improve depression, improve anxieties or obsessive thoughts SSRI indications Major depression, OCD, GAD, panic disorder, social anxiety disorder and premenstrual dysphoric disorder SSRI side effects BAD SSRI B - Body weight increase; A - Anxiety/Agitation; D - Dizziness; Dry mouth S - Serotonin syndrome; S - Stimulated CNS; R - Reproductive/Sexual dysfunction I - Insomnia; antidepressants used in eating disorders SSRIs (high doses), TCAs TCAs tricyclic antidepressants TCA side effects 3Cs - cardiotoxicity, coma, convulsions antihistamine - weight gain, sedation anti adrenergic - orthostasis, reflex tachy, arrythmias, wide QRS/QT/PR anti-muscarinic - dry mouth, constipation, urinary retention, blurred vision, tachycardia, narrow angle glaucoma serotoninergic side effects - erectile/ejaculatory dysfunction in males, anorgasmia in females lethal in overdose weight gain seizures meds to treat Binge Eating Disorders Vyvanse (lisdexamfetamine) pharmacology indications for anorexia nervosa No medications are approved to treat anorexia because none has been found to work very well. However, antidepressants or other psychiatric medications can help treat other mental health disorders you may also have, such as depression or anxiety. pharmacotherapy indications for bulimia nervosa The only antidepressant specifically approved by the Food and Drug Administration to treat bulimia is fluoxetine (Prozac), a type of selective serotonin reuptake inhibitor (SSRI), which may help even if you're not depressed. Binge Eating Disorder Treatment -responds more rapidly to treatment than other eating disorders -self-help groups -learn to eat only when hungry -idenify personal needs -find healthful ways to express its emotions Binge Eating Disorder Treatment CBT Contraindicated in eating disorders due to eating disorders having elevated risk of sz Buproprion- "poor man's cocaine" hallmark of toxicity is sz. Buproprion contraindications increases risk of seizures, anorexia, bulimia. avoid with any condition that increases seizure-- abrupt etoh withdrawl, head injuries. antidepressants in binge eating disorders SSRI are first line if you are going to choose an antidepressant to treat as they are often very co-morbid with depression and anxiety disorders If a patient has both eating disorder and comorbid depression or anxiety, treatment should follow indications for the comorbidity- ex. if they have OCD comorbid with anorexia nervosa then what ( ?) would be indicated for the OCD should be your choice SSRI Insomnia treatment nonpharmacologic treatments for insomnia include sleep hygeine, stimulus control, relaxation, sleep restriction, and cognitive behavioral therapy. Stimulus control focuses on eliminating stimulating bedroom activities and getting into bed only when sleepy. benzodiazepine hypnotics (tx of insomnia) Diazepam, Midazolam, Zolazepam, Triazolam, flurazepam, temazepam Potentiates the inhibitory action of GABA ( inhibitory neurotransmitter that reduces feelings of fear and anxiety). Activation of the receptor causes an influx of Cl- ion movement into the neuron and hyperpolarization and inhibition of membrane depolarization Benzodiazepine hypnotics affect REM sleep, tolerance, risk of abuse, rebound insomnia Non-BZD hypnotics for insomnia Zolpidem (Ambien) Zaleplon (Sonata) Eszopiclone (Lunesta) non-benzo and OTC for insomnia tolerance to sedative effects can develop half life meds for insomnia in elderly pay particular attention, Ambien contraindications hypersensitivity zaleplon N considerations (Sonata) used in short-term insomnia treatment; Zalepion (Sonata) does not prolong sleep time or decrease awakenings; elderly patients generally benefit the most; because of rapid onset, patients should take immediately before bedtime; avoid alcohol while using this med; may be habit-forming; "sleep driving" may occur; Rx; C-IV; Preg Cat C Eszopiclone Contraindications (Lunesta) -Hypersensitivity reaction -Pregnancy -Lactation -Depression -Impaired hepatic function -Impaired respiratory function -Elderly with hepatic impairment or debilitating conditions *Not recommended for children Ramelteon side effects (meletonin) fatigue and dizziness Headache Long term use can increase prolactin = sex dysfunction Narcolepsy treatment Modafinil (Provigil) Cataplexy (narcolepsy) loss of muscle control & sudden REM sleep during waking hours emotionally triggered GHB sodium oxybate CIII What is GHB Sodium oxybate, sold under the brand name Xyrem among others, is a medication used to treat two symptoms of narcolepsy: sudden muscle weakness and excessive daytime sleepiness. Treatment of restless leg syndrome Mild/intermittent sxs: - Supplementation iron when serum ferritin < 75 - use supportive measures (leg massage, heating pads, exercise) - avoid aggravating factors (sleep deprivation, meds) Persistent/moderate severe sxs: First line: Dopamine agonists (pramipexole) (antiparkinson therapy) Alternate: Alpha-2-delta calcium channel ligands (gabapentin enacarbil) What is pramipexole? Dopamine receptor agonist Ropinerole (Requip) dopamine agonist (PD) Ropinerole in restless leg syndrome Ropinirole is used alone or with other medicines to treat Parkinson's disease. Ropinirole tablets are also used to treat a condition called Restless Legs Syndrome (RLS). RLS is a neurologic disorder that affects sensation and movement in the legs and causes the legs to feel uncomfortable psychopharmacologic treatment in sleep/ wake disorders Be mindful of the onset and half lives of these meds Benzodiazepine half life alprazolam Xanax 12-15 hours lorazepam Ativan 10 to 20 hours oxazepam 6 to 20 hours Flurazepam half life 2.3 hours