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Ppt chapter 15-1
1.
Chapter 15 Drugs
Relieving Anxiety and Promoting Sleep Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
2.
Copyright © 2012
Wolters Kluwer Health | Lippincott Williams & Wilkins Question • What system in the brain is responsible for emotion? – A. Amygdala system – B. Reticular system – C. Limbic system – D. Ventricular system
3.
Copyright © 2012
Wolters Kluwer Health | Lippincott Williams & Wilkins Answer • C. Limbic system • Rationale: The limbic system in the brain is known to be primarily responsible for emotions.
4.
Emotions and Neurotransmitters
• The limbic system in the brain is known to be primarily responsible for emotions. • The amygdala receives incoming sensory signals and then communicates with the frontal lobes of the brain. • The amygdala can signal the brain that a threat is present and set off a fear response or anxiety. • Another part of the brain, the hippocampus, is responsible for processing threatening or traumatic stimuli. • The brain sends its messages to the body by way of the nervous system. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
5.
GABA Cell Receptors
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
6.
Sleep • Sleep
is a time of bodily rest, although the brain remains active. • There are two phases: – No rapid eye movements (NREM) – Rapid eye movements (REM) Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
7.
Sleep (cont.) •
NREM stages of sleep are further divided into – Stage 1—light sleep; muscles relax; brain waves are irregular and rapid. – Stage 2—brain waves are larger than in stage 1, with bursts of electrical activity. – Stages 3 and 4—deep sleep, with even larger, slower brain waves called delta waves. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
8.
Sleep (cont.) •
A number of physiologic changes occur during sleep. • The amount of sleep needed by a person varies throughout the life span, with infants requiring the most sleep and adults requiring the least. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
9.
Anxiety • Anxiety
is a feeling of unease that something bad or undesirable may happen. • Some anxiety is normal; it is a protective mechanism. • Anxiety becomes pathologic when it is severe and chronic and interferes with a person’s ability to function in normal life. • Anxiety disorders can become progressively worse if they are untreated. • Anxiety commonly occurs in combination with other mental or physical illnesses. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
10.
Sleep Disorders •
Between 50 and 70 million Americans have a sleep disorder. • These disorders are many and may include the following problems: – Narcolepsy—sudden irresistible sleep attacks of unknown origin lasting from seconds to minutes, two to six times a day – Sleep apnea—a group of disorders characterized by cessation of breathing during sleep – Sleepwalking—getting up and walking about while still asleep Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
11.
Sleep Disorders (cont.)
• These disorders are many and may include the following problems (cont.): – Night terrors—occur only in children, with periods of fright, crying, moaning, or screaming after a brief time asleep – Excessive daytime sedation – Insomnia Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
12.
Selective Serotonin Reuptake
Inhibitors • Selective serotonin reuptake inhibitors (SSRIs) are a class of antidepressant drugs, some of which are now considered first-line therapy for anxiety disorders. • Low serotonin levels are known to be present in severe stress and in many mood and anxiety-related disorders. • SSRIs indirectly increase the amount of the neurotransmitter serotonin available in the synapses. • SSRIs are generally well tolerated with few adverse effects. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
13.
Tricyclic Antidepressants •
The tricyclic antidepressants (TCAs) are another class of antidepressants. • TCAs are as effective as the SSRIs in treating most anxiety disorders. • TCAs work by affecting the regulation of serotonin or norepinephrine in the brain. • TCAs have a higher adverse effect profile than SSRIs, which limits their use as antidepressants. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
14.
Monoamine Oxidase Inhibitors
• Monoamine oxidase inhibitors (MAOIs) are the oldest class of antidepressants. • The MAOIs used to treat anxiety disorders are phenelzine (Nardil), tranylcypromine (Parnate), and isocarboxazid (Marplan). • These drugs are occasionally prescribed for panic disorder and social phobia. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
15.
Monoamine Oxidase Inhibitors
(cont.) • Monoamine oxidase is the enzyme that degrades serotonin in the synapse. • By inhibiting the enzyme, higher levels of serotonin can remain in the synapse and be active. • The MAOIs are associated with a significant risk of a serious drug–food interaction. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
16.
Beta-Blockers • Beta-blockers
are adrenergic drugs most frequently used for a wide variety of cardiac conditions. • Among other actions, they slow the heart rate. • This helps the patient with some types of anxiety who may be uncomfortable and highly aware of the tachycardia and palpitations. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
17.
Benzodiazepines • Benzodiazepines
are used for a number of therapeutic effects. • As a class, benzodiazepines appear to potentiate the effects of GABA. • The result is more CNS depression than would normally be found. • Benzodiazepines bind to specific receptor sites to produce their effects. • As a drug class, benzodiazepines have a high margin of safety. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
18.
Question • Benzodiazepines
are used to treat which of the following condition(s)? – A. Anxiety – B. Seizures – C. Alcohol withdrawal – D. All of the above Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
19.
Copyright © 2012
Wolters Kluwer Health | Lippincott Williams & Wilkins Answer • D. All of the above • Rationale: Benzodiazepines are used for the following: anxiety relief, sleep promotion, anticonvulsant effects, muscle relaxation, treatment of acute alcohol withdrawal, induction of general anesthesia, preoperative sedation, and conscious sedation.
20.
Lorazepam: Core Drug
Knowledge • Pharmacotherapeutics – Used in treating anxiety disorders and insomnia • Pharmacokinetics – Administered: parenterally or orally. Distribution: body tissues. Metabolism: liver. Excreted: kidneys. • Pharmacodynamics – Increases the effects of GABA Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
21.
Lorazepam: Core Drug
Knowledge (cont.) • Contraindications and precautions – Hypersensitivity, psychoses, acute narrow-angle glaucoma, and use in children younger than 6 months • Adverse effects – Mild drowsiness, ataxia, confusion, respiratory disturbances, bradycardia, and hypotension • Drug interactions – Several drug interactions Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
22.
Lorazepam: Core Patient
Variables • Health status – Asses for renal and hepatic impairment • Life span and gender – Pregnancy Category D • Lifestyle, diet, and habits – Assess the patient for the use of other CNS depressants. • Environment – Oral formulation can be given in any environment. • Culture and inherited traits – Longer T½ in Asians Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
23.
Lorazepam: Nursing Diagnoses
and Outcomes • Risk for Injury related to drowsiness and other adverse effects – Desired outcome: The patient will not sustain an injury while on lorazepam. • Anxiety related to disease process – Desired outcome: The patient will achieve symptom Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins control. • Deficient Knowledge related to newly prescribed drug therapy – Desired outcome: The patient will learn the actions and adverse effects of lorazepam and how to safely self-administer the drug.
24.
Lorazepam: Planning and
Interventions • Maximizing therapeutic effects – Give at scheduled intervals throughout the day. • Minimizing adverse effects – If GI distress occurs, administer lorazepam with food. – Monitor for paradoxical reactions and stop the drug if they occur. – Dilute injectable lorazepam with an equal volume of compatible solution. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
25.
Lorazepam: Teaching, Assessment,
and Evaluations • Patient and family education – Caution against use of alcohol with this drug. – Discuss side effects of medication. • Ongoing assessment and evaluation – Lorazepam therapy is effective if the patient reports a reduction in feelings of anxiety. – Throughout therapy, assess for therapeutic response and onset of adverse effects. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
26.
Copyright © 2012
Wolters Kluwer Health | Lippincott Williams & Wilkins Question • Lorazepam has a ________ duration of action? – A. Short – B. Intermediate – C. Long – D. Varies with route of administration
27.
Answer • A.
Short • Rationale: Lorazepam has a short duration of action; therefore, divide the daily dosage for treating anxiety into two or three doses and administer the drug throughout the day. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
28.
Buspirone • Buspirone
(BuSpar) is an azaspirodecanedione that is not chemically or pharmacologically related to the benzodiazepines. • It is used to treat symptoms of anxiety, although exactly how it works is unknown. • Optimum relief of anxiety usually occurs after 3 to 4 weeks of treatment. • Buspirone is intended for short-term therapy; patients who have been treated with buspirone for up to 1 year have not required a dosage increase to maintain therapeutic effect. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
29.
Hydroxyzine • Hydroxyzine
(Vistaril) is a miscellaneous antianxiety drug. • It exerts CNS depressant activity in subcortical areas. • It rapidly produces a feeling of calm and relieves anxiety without impairing mental alertness. • It may be coadministered with a narcotic to control pain while minimizing the nausea that may be an adverse effect from the narcotic. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
30.
Meprobamate • Meprobamate
(Equanil) is also used for short-term management of anxiety symptoms. • Meprobamate has selective effects at multiple sites within the CNS, including the thalamus and the limbic system. • It may also inhibit multineuronal spinal reflexes. • It has mild tranquilizing properties and some anticonvulsant and muscle-relaxant properties. • Meprobamate can produce several CNS adverse effects. • Meprobamate is a Pregnancy Category D drug. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
31.
Eszopiclone • Eszopiclone
(Lunesta) is a nonbenzodiazepine hypnotic. • The drug induces sleep quickly, prevents waking during the night. • Eszopiclone is believed to achieve its therapeutic effect from interaction with GABA-receptor/benzodiazepine-receptor complexes. • It is the only drug for insomnia that is approved for long-term use (up to 6 months of use). • Eszopiclone has a rapid onset (within 1 hour) and is metabolized in the liver and excreted in the urine. • The most common adverse effects of eszopiclone after 6 weeks of use were headache, prolonged drowsiness, and an unpleasant taste. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
32.
Copyright © 2012
Wolters Kluwer Health | Lippincott Williams & Wilkins Zaleplon • Zaleplon (Sonata) is a sedative for short-term use (up to 28 days). • Although a nonbenzodiazepine and not chemically related to the benzodiazepines, it does interact with the GABA– benzodiazepine (BZ) complex. • The most common adverse effects of zaleplon are drowsiness, dizziness, light-headedness, and difficulty with coordination. Zaleplon is a Pregnancy Category C drug. • Zaleplon may lead to dependency, and rebound insomnia is possible.
33.
Zolpidem • Zolpidem
(Ambien) is used for short-term treatment of insomnia—generally not for more than 7 to 10 days. • It induces sleep rapidly and should be taken immediately before going to bed. • Although zolpidem is not chemically related to the benzodiazepines, it does interact selectively with the GABA–BZ receptor complex and shares some pharmacologic properties with the benzodiazepines. • Zolpidem generally preserves all of the sleep stages and has only minor effects on REM sleep. • The most common adverse effects from zolpidem are headache, prolonged drowsiness, and dizziness. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
34.
Copyright © 2012
Wolters Kluwer Health | Lippincott Williams & Wilkins Ramelteon • Melatonin receptor agonists stimulate the same receptor sites as endogenous melatonin. • Ramelteon (Rozerem) is used in the treatment of insomnia when the patient has difficulty falling asleep. • Ramelteon has high affinity at two specific melatonin receptors. • Common adverse effects of ramelteon include headache, daytime sleepiness, dizziness, tiredness, nausea, worsening insomnia, and colds.
35.
Copyright © 2012
Wolters Kluwer Health | Lippincott Williams & Wilkins Trazodone • Trazodone (Desyrel) is an atypical antidepressant. • This drug causes significant sedation as an adverse effect. • Trazodone is most commonly used to promote sleep.
36.
Chloral Hydrate •
Chloral hydrate is a nonbarbiturate hypnotic used to induce sleep and to cause preoperative sedation. • It can be used as an adjunct to opiates and analgesics in pain control. • In therapeutic doses, chloral hydrate has little effect on respirations, blood pressure, or reflexes. • It does produce numerous adverse effects in the CNS. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
37.
Barbiturates • Barbiturates
such as phenobarbital (Bellatal), secobarbital (Seconal), and pentobarbital (Nembutal) were used to treat insomnia before the availability of the benzodiazepines. • Although they are effective for short-term treatment of insomnia, they are also highly habit forming. • Patients can develop tolerance and physical and psychological dependence on the drugs. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
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