EAQ Sedatives, Hypnotics and Anxiety
What are the side effects of venlafaxine [Effexor]? Select all that apply. Nausea Anorexia Dry mouth Hypertension Slurred speech
Nausea, anorexia and hypertension - hypertension is a more common side effect with antidepressants than anxiety
A patient asks about treatment for social anxiety disorder and inquires how long medication will be needed. What is the nurse's best response? Why? "This medication will need to be continued for the rest of your life." "It is not recommended that the medication be used for more than a month." "After about a year, your healthcare provider could try to withdraw the medication." "The medication will need to be alternated with different medications in order to continue treatment."
"After about a year, your healthcare provider could try to withdraw the medication." Bc these types of medication can be used for long term and do not need to be switched
The nurse provides patient education to a new mother who has recently been started on lorazepam [Ativan]. What is the nurse's highest priority instruction to the patient? "Take this medication with food." "Take this medication on an empty stomach." "Do not breastfeed while taking the medication." "The drug should be taken with 8 ounces of water."
"Do not breastfeed while taking the medication"
A patient states he takes buspirone daily and has wine with each meal. What is the most appropriate statement for the nurse to make to the patient? "I am going to call an ambulance." "Drink in moderation while taking this medication." "Please let your healthcare provider know immediately." "Stop drinking alcohol as it will depress your central nervous system."
"Drink in moderation while taking this medication"
What are the symptoms of abrupt discontinuation of benzos after long term use?
- Delirium, hypertension, and status epilepticus
What is the speed of onset of benzos?
rapid onset
The nurse is caring for a patient taking buspirone [BuSpar]. Which statement by the patient indicates a need for further teaching about this drug? "This medication may make me feel drowsy." "I will take my medication three times per day." "This medication should help me feel less anxious." "I will drink grapefruit juice instead of coffee with breakfast."
"I will drink grapefruit juice instead of coffee with breakfast"
A patient asks the nurse about treatments for post-traumatic stress disorder (PTSD). Which statement made by the nurse is the most helpful? "The primary treatment is benzodiazepine for anxiety." "The primary treatment is therapy in combination with drugs." "The primary treatment is a combination of multiple medications." "The primary treatment is monotherapy with a selective serotonin reuptake inhibitor (SSRI)."
"The primary treatment is therapy in combination with drugs"
The nurse is teaching a patient with a new prescription for alprazolam [Xanax]. Which statement is the most appropriate to include in the teaching plan? "Protect your skin from the sun to prevent rash and exaggerated sunburn." "Increase your intake of fluid and high-fiber foods to prevent constipation." "Take this medication on an empty stomach at least 2 hours after meals." "When it is time to discontinue this drug, you will need to taper it off slowly."
"When it is time to discontinue this drug, you will need to taper it off slowly"
The nurse is caring for a patient with insomnia. The patient asks if there are medications for sleep that are not controlled substances. Which statement by the nurse is correct? "Yes, but it is not for chronic insomnia." "No, all of the sleep medications are controlled substances." "Yes, there is a medication that works with your body's melatonin and is not a controlled substance." "There are some over-the-counter medications, and you can take those without discussing them with your healthcare provider."
"Yes, there is a medication that works with your body's melatonin and is not a controlled substance"
What interventions does the nurse implement for a patient who is prescribed a benzodiazepine for anxiety? Select all that apply. Teach relaxation methods. Assess for urinary retention. Instruct the patient not to drive during therapy. Instruct the patient to change positions slowly. Teach the patient to avoid alcohol during therapy.
- Teach relaxation methods - Instruct the patient not to drive during therapy - Instruct the patient to change positions slowly - Teach the patient to avoid alcohol during therapy
List the most common side effects of Buspirone? (6)
- dizziness, nausea, headache, nervousness, lightheadedness, and excitement
What do patients often experience with panic disorder?
- fear of losing control and dying - may experience dizziness, nausea, depersonlization and tingling or numbness in the hands
When comparing benzodiazepines to barbiturates, the nurse identifies which statements about benzodiazepines as true? Select all that apply. Benzodiazepines have a higher safety profile. Benzodiazepines are less likely to cause tolerance. Benzodiazepines have a decreased abuse potential. Benzodiazepines are associated with an increased suicide potential. Benzodiazepines are better able to depress central nervous system function.
- have a higher safety profile - are less liley to cause tolerance - have a decreased abuse potential
What are the following used to treat - Temazepam [Restoril] - Quazepam [Doral] - Clonazepam [Klonopin] - Diazepam [Valium]
- insomnia - insomnia - treat seizures and anxiety - anxiety, msucle spasms and spasticity
Which statements about zaleplon [Sonata] does the nurse identify as true? Select all that apply. Zaleplon [Sonata] is a benzodiazepine. Zaleplon [Sonata] is used to maintain sleep throughout the night. Zaleplon [Sonata] is indicated for long-term management of insomnia. Zaleplon [Sonata] should be administered with a reduced dose of cimetidine [Tagamet]. Zaleplon [Sonata] interacts with the neurotransmitter gamma-aminobutyric acid (GABA).
- should be adminstered with a reduced dose of cimetidine - interacts with the neurotransmitter GABA - has a rapid onset, short duratiom
How long may benzo withdrawal symptoms take to appear and how long may they last?
2 to 10 days to appear and may last for several weeks depending on the drug half life
How long does it take an antianxiety drug to become therapeutic?
2 to 12 weeks
A patient is prescribed lorazepam [Ativan] for the treatment of anxiety. What is the typical safe dose range of the drug that can be taken by the patient in a day? 2-6 mg 3-20 mg 4-24 mg 1.5-18 mg
2-6 mg/day
The nurse is caring for a patient who has obsessive-compulsive disorder (OCD). The patient is prescribed citalopram [Celexa]. What dosing schedule is appropriate? 100 mg daily in the morning 20 mg in the morning, increased to 80 mg/day 20 mg once daily, increased to a maximum of 40 mg/day 10 mg once daily, increased to a maximum of 20 mg/day
20 mg once daily, increased to a maximum of 40 mg/day Citalopram is an SSRI used for OCD
A patient who has been taking alprazolam [Xanax] and has been compliant with the therapeutic regimen for 6 weeks is now complaining of adverse effects of the medication. Which substances will the nurse instruct the patient to avoid to help prevent intensification of this medication's adverse effects? Select all that apply. Why? Alcohol Opioids Tobacco Antihistamines Muscle relaxants Caffeinated drinks
ALcohol Opioids Antihistamines Muscle relaxants Can cause CNS depression, including respiratory depression
List the first line approved choices for generalized anxiety disorder: (6)
Benzos buspirone Anitdepressants: - venlafaxine, paroxetine, escitalopram and duloxetine
The nurse is caring for a patient whose medication regimen includes the benzodiazepine chlordiazepoxide [Librium]. The patient denies a history of anxiety. The nurse recognizes that this drug may also be prescribed for which condition? Seizures Insomnia Depression Alcohol withdrawal
Alcohol withdrawal
The selective serotonin reuptake inhibitors (SSRIs) are recommended therapy for a number of psychologic disorders. The nurse identifies the SSRIs as effective for the treatment of patients with which psychologic disorders? Select all that apply. Depression Panic disorder Social anxiety disorder Post-traumatic stress disorder (PTSD) Obsessive-compulsive disorder (OCD)
All - depression - panic disorder - social anxiety disorder - PTSD - OCD
The nurse is caring for a patient with severe generalized anxiety disorder. Which agent would be most effective for immediate stabilization? Paroxetine [Paxil] Buspirone [BuSpar] Alprazolam [Xanax] Venlafaxine [Effexor]
Alprazolam [Xanax]
What will happen if a patient takes a benzo with alcohol?
respiratory failure since benzos already cause respiratory depression and alcohol only potentiates the effects of benzosB
A patient prescribed buspirone complains of "feeling spacey." What is the nurse's best action? Why? Assess the patient's lungs Call the healthcare provider. Reassure the patient that this is normal. Ask the patient what he has had to eat and drink today.
Ask the patient what he has had to eat and drink today bc grapefruit causes an interaction, elevates drug levels and can cause the patient o have a dysphoric reactio ("feeling spacey")
A patient with a history of abusing opioid analgesics needs an antianxiety agent. Which medication should the nurse expect to administer? Diazepam [Valium] Buspirone [BuSpar] Venlafaxine [Effexor] Escitalopram [Lexapro]
Buspirone [BuSpar]
The patient received a benzodiazepine intravenously. What is the nurse's priority action? Why? Neurologic assessment Assessment of blood levels Cardiovascular assessment Assessment of complete blood count
Cardiovascular assessment bc Bennzos taken IV can produce profound hypotension and even cardiac arrest
The nurse notes in the patient's chart that the healthcare provider is considering adding a tricyclic antidepressant to the patient's treatment regimen. The nurse recognizes that the healthcare provider may select which drug? Doxepin [Sinequan] Trazodone [Desyrel] Maprotiline [Ludiomil] Amoxapine [Asendin]
Doxepin [Sinequan]
The nurse is working with a patient who asks for medication for anxiety and a drug to relieve muscle spasms. Which benzodiazepine does the nurse anticipate will be ordered for the patient? Quazepam [Doral] Diazepam [Valium] Temazepam [Restoril] Clonazepam [Klonopin]
Diazepam [Valium]
The nurse obtains a medication history from a patient diagnosed with generalized anxiety disorder who is prescribed buspirone. The nurse recognizes that teaching is needed when the nurse notes that the patient is taking which medication with buspirone? Garlic Ginseng Erythromycin St. John's wort
Erythromycin
How is generealized anxiety disorder characterized?
Excessive worrying about events - includes trembling, muscle tension, restlessness, palpitations, tachycardia, sweating and clammy hands
Why i should grapefruit be avoided with Buspirone?
Greatly increases buspirone levels
The nurse teaches a patient who is prescribed a benzodiazepine to avoid abrupt discontinuation of the drug. Which withdrawal symptom is a result of abrupt discontinuation of benzodiazepines after short-term use? Delirium Insomnia Hypertension Status epilepticus
Insomnia
The nurse is caring for a patient who is being treated with a tricyclic antidepressant. What is the most important nursing responsibility for ensuring patient safety? Why? Monitor the postural blood pressure. Instruct the patient not to miss doses. Teach the patient about the side effects. Monitor the patient's response to therapy.
Monitor the postural blood pressure bc tricyclic antidepressants tend to affect the blood pressure causing postural hypotension which may cause dizziness in the patient and increase th risk of falls
The nurse is caring for a patient with a seizure disorder who takes phenobarbital at bedtime each night to control seizures. Which symptom, if present, would most likely indicate an adverse effect of this drug? Constipation Morning sedation A blood pressure of 160/88 mm Hg A respiratory rate of 30 breaths/min
Morning sedation Other side effects include repsiratory depression, risk of suicide, risk of ause,impaired judgment and reduced motor skills
The nurse is assessing a patient who has been prescribed buspirone [BuSpar] to treat general anxiety disorder. Which adverse effects will the nurse monitor for in the patient? Select all that apply. Nausea Anxiety Sedation Dizziness Lightheadedness
Nausea, dizziness and lightneadedness
The nurse is assessing a patient diagnosed with a panic disorder. What symptoms indicate the medications have not yet started to be therapeutic? Select all that apply. Nausea Trembling Palpitations Orthostatic hypotension Dry mouth and constipation
Nausea, trembling, palpitations and other symptoms resembling a heart attack
The patient has been started on a treatment regimen that includes imipramine [Tofranil]. The patient tells the nurse that he also is being treated with diazepam [Valium] for a separate condition. What is the nurse's highest priority action? Notify the healthcare provider because central nervous system depression may result. Notify the healthcare provider because the patient may experience an anaphylactic reaction. Notify the pharmacy because the dosage of the imipramine [Tofranil] will need to be increased. Notify the pharmacy because the dosage of the imipramine [Tofranil] will need to be decreased.
Notify the hcp bc central nervous system depression may result Imipramine is a tricyclic antidepressants with its most common side effect being sedation and Diazepam will also cause sedation. Thecombination will potentiate CNS depression
The nurse notes that the patient is prescribed venlafaxine for generalized anxiety disorder. What will the nurse teach the patient? Side effects are very rare. This medication will not help depression. The medication has been ordered by mistake. Nausea is very likely but will eventually subside.
Nuasea is very likely but will eventually subside
Which patient is a poor candidate for therapy with diazepam [Valium] to treat generalized anxiety disorder? One with a history of aloholism One with type 2 diabetes mellitus One who had convulsions as a child One who has had a myocardial infarction
One with a history of alcoholism
What is very common for patients taking MAO's for panic disorder to experience?
Orthostatic hypotension
A distraught patient is admitted to the emergency department with symptoms of palpitations, tachycardia, chest pain, and shortness of breath that started 30 minutes ago. The physical examination reveals no physiologic basis for the symptoms. Which diagnosis is most likely? Panic disorder Bipolar disorder Clinical depression Generalized anxiety disorder
Panic Disorder
Which medication should be prescribed to a patient who is diagnosed with social anxiety disorder? Fluvoxamine [Luvox] Amoxapine [Asendin] Paroxetine HCl [Paxil] Bupropion HCl [Wellbutrin]
Paroxetine HCI [Paxil]
The nurse identifies which antidepressant as effective in the treatment of generalized anxiety disorder (GAD)? Select all that apply. Paroxetine [Paxil] Fluoxetine [Prozac] Duloxetine [Cymbalta] Escitalopram [Lexapro] Venlafaxine [Effexor XR]
Paroxetine [Paxil] Duloxetine [Cymbalta] Escitalopram [Lexapro] Venlafaxine [Effexor XR]
The patient has an order to be treated with alprazolam [Xanax]. The nurse recognizes that this drug may be indicated for which condition? Seizures Insomnia Alcohol withdrawal Performance anxiety
Performance anxiety
The nurse is caring for a group of patients who have been prescribed sedative-hypnotic agents. Which agent has the greatest abuse potential? Why? Zolpidem [Ambien] Diazepam [Valium] Triazolam [Halcion] Phenobarbital (Luminal Sodium)
Phenobarbital [Luminal Sodium] bc this is a barbiturate drug which carries a higher abusde potential than the benzo and benzo-like drugs
A patient has been diagnosed with performance anxiety. The nurse anticipates the use of which drug to treat this psychologic disorder? Sertraline [Zoloft] Alprazolam [Xanax] Propranolol [Inderal] Clonazepam [Klonopin]
Propranolol
What four drugs are evidence-based effective for treatment of PTSD? Out of the four which ones are FDA approved?
SSRIs - fluxoxetine - paroxetine (FDA approved) - sertraline (FDA approved) SNRI - venlafaxine
Does Zolpidem [Ambien] treat insomnia long term or short term?
Short term treatment
The nurse is reviewing a patient's medication history and notes that the patient recently began taking citalopram for obsessive-compulsive disorder (OCD). What intervention is a priority for this patient? Assessing drug levels every other week Monitoring for the recurrence of seizure activity Asking the patient if he or she has ringing in the ears Teaching the patient that beneficial effects develop slowly
Teaching the patient that beneficial effects develop slowly
A patient has been prescribed a beta blocker for performance anxiety. What will the nurse teach the patient about this therapy? The medication is taken daily at the same time. The medication is only taken together with other medications. The medication should be taken 1 to 2 hours before a scheduled event. The medication has many side effects and is not a recommended therapy.
The medication should be taken 1 or 2 hours before a scheduled event
What information will the nurse include on the care plan for a patient taking fluvoxamine [Luvox]? This medication will interact with caffeine. This medication must be given intravenously. This medication might not become therapeutic for 4 weeks. This medication is safe in those with liver disease unlike other selective serotonin reuptake inhibitors.
This medicatio might not become therapeutic for 4 weeks Takes between 1 to 4 weeks to become therapeutic
What types of drugs are Amitriptyline, doxepin and imipramine?
Tricyclic antidepressants
What is the onset speed of buspirone and antidepressants?
delayed onset
How is bipolar disorder characterized?
mood swings with periods of mania and depression
Besides alcohol what do benzos also interact with?
other sedative drugs and caffeine