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“Nursing Notes and Community”
Drug Name Dosages Therapeutic Indications Adverse effects Contraindications Nursing considerations
Actions
alprazolam • Individualize dosage; • Exact • Management of • CNS: • Contraindicated CLINICAL ALERT!
(al prah' zoe increase dosage mechanisms of anxiety disorders, Transient, mild with
lam) gradually to avoid action not short-term relief of drowsiness hypersensitivity • Name confusion has
Alprazolam adverse effects. understood; symptoms of initially; to occurred among
Intensol, Apo- main sites of anxiety; anxiety sedation, benzodiazepines Xanax (alprazolam),
Alpraz (CAN), ADULTS action may be associated with depression, , psychoses, Celexa (citalopram),
Niravam, Novo- the limbic depression. lethargy, acute narrow- and Cerebyx
Alprazol (CAN), system and • Treatment of panic apathy, angle glaucoma, (fosphenytoin), and
Nu-Alpraz • Anxiety disorders:
reticular attacks with or fatigue, light- shock, coma, between alprazolam
(CAN), Xanax, Initially, 0.25–0.5 mg
formation; without headedness, acute alcoholic and lorazepam; use
Xanax TS PO tid; adjust to
increases the agoraphobia disorientation, intoxication with caution.
(CAN), Xanax maximum daily dose
effects of GABA, • Unlabeled uses: anger, depression of
XR of 4 mg/day in
an inhibitory Social phobia, hostility, vital signs,
divided doses or Assessment
neurotransmitter; premenstrual episodes of pregnancy
Pregnancy extended-release
anxiety blocking syndrome, mania and (crosses the
Category D form once per day in • History:
effects occur at depression hypomania, placenta; risk of
the AM once dosage Hypersensitivity to
doses well below restlessness, congenital
Controlled is established benzodiazepines;
those necessary confusion, malformations,
Substance C-IV (immediate release, psychoses; acute
to cause crying, neonatal
intensol solution). narrow-angle
sedation, ataxia. delirium, withdrawal
Drug classes • Panic disorder: headache, syndrome), labor glaucoma; shock;
Initially, 0.5 mg PO slurred and delivery coma; acute alcoholic
tid; increase dose at speech, ("floppy infant" intoxication with
• Benzodiaze 3- to 4-day intervals dysarthria, syndrome), depression of vital
pine in increments of no stupor, rigidity, lactation signs; labor and
• Anxiolytic more than 1 mg/day; tremor, (secreted in delivery; lactation;
ranges of 1–10 dystonia, breast milk; impaired liver or
mg/day have been vertigo, infants become kidney function;
needed; extended- euphoria, lethargic and debilitation
release form once nervousness, lose weight). • Physical: Skin color,
per day in AM once lesions; T; orientation,
difficulty in • Use cautiously
dosage is concentration, reflexes, affect,
with impaired
established (Xanax vivid dreams, ophthalmologic
liver or kidney
products, Niravam). psychomotor examination; P, BP;
function,
retardation, debilitation. liver evaluation,
UNLABELED USES extrapyramidal abdominal
symptoms; examination, bowel
• Social phobia: 2–8 mild sounds, normal
mg/day PO. paradoxical output; CBC, LFTs,
• PMS: 0.25 mg PO excitatory renal function tests
tid. reactions
during first 2 Interventions
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wk of
treatment • Arrange to taper
• CV: dosage gradually after
Bradycardia, long-term therapy,
tachycardia, especially in epileptic
CV collapse, patients.
hypertension, • Do not administer with
hypotension, grapefruit juice.
palpitations, • Taper drug slowly;
edema decrease by no more
• Dermatologic: than 0.5 mg every 3
Urticaria, days.
pruritus, rash,
dermatitis
Teaching points
• EENT: Visual
and auditory
disturbances, • Take this drug exactly
diplopia, as prescribed; take
nystagmus, extended-release
depressed form once a day in the
hearing, nasal morning; place rapidly
congestion disintegrating tablet
• GI: on top of tongue,
Constipation, where it will
diarrhea, dry disintegrate and can
mouth, be swallowed with
salivation, saliva.
nausea, • Do not drink grapefruit
anorexia, juice while on this
vomiting, drug.
difficulty in • Do not stop taking
swallowing, drug (in long-term
gastric therapy) without
disorders, consulting health care
hepatic provider; drug should
impairment not be stopped
• GU: suddenly.
Incontinence, • Avoid alcohol, sleep-
changes in inducing, or over-the-
libido, urinary counter drugs.
retention, • You may experience
menstrual these side effects:
irregularities Drowsiness, dizziness
• Hematologic: (these effects will be
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Elevations of less pronounced after
blood a few days, avoid
enzymes— driving a car or
LDH, alkaline engaging in other
phosphatase, dangerous activities if
AST, ALT; these occur); GI upset
blood (take drug with food);
dyscrasias— fatigue; depression;
agranulocytosi dreams; crying;
s, leukopenia nervousness.
• Other: • Report severe
Hiccups, fever, dizziness, weakness,
diaphoresis, drowsiness that
paresthesias, persists, rash or skin
muscular lesions, difficulty
disturbances, voiding, palpitations,
gynecomastia. swelling in the
Drug extremities.
dependence
with
withdrawal
syndrome
when drug is
discontinued;
more common
with abrupt
discontinuatio
n of higher
dosage used
for longer than
4 months

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