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Alprazolam (Xanax)

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on 26 November 2013

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Transcript of Alprazolam (Xanax)

Alprazolam (Xanax)
Uses
For treatment of anxiety disorders, short-term anxiety symptoms, panic disorders, and depression-associated anxiety.
Unlabeled Use: Children anxiety.
Anxiety
is defined as an uncomfortable state that has psychologic (fear, apprehension, dread, uneasiness) and physical manifestations (tachycardia, palpitations, trembling, dry mouth, sweating, weakness, fatigue, shortness of breath) (Lehne, 2013).
Pharmacokinetics
Route: Oral (PO)
Onset: 1-2 hours
Peak: 1-2 hours
Half-life: 12-15 hours
Duration: up to 24 hours
Absorbed from the GI tract and metabolized by the liver.

Xanax addiction is the most common prescription addiction and the most misused benzodiazepine in the U.S.
According to the 2011 Treatment Episode Data Set Report, 60,200 people obtaining drug abuse treatment were addicted to benzodiazepines
Xanax use for longer than 8 weeks results in withdrawal for 1 in 3 patients
A large portion of people who abuse Xanax, do so with other drugs. Xanax or some other benzodiazepine is taken by at least half of alcoholics, opiate, amphetamine, cocaine users worldwide. Xanax is used to increase the effect from illegal drugs, especially opiates.
XANAX ABUSE
Side Effects
Nursing Considerations
-Alert
: Don't withdraw drug abruptly; withdrawal symptoms, including seizures, may occur. Gradually reduce dosage. Abuse or addiction is possible.

-The optimum duration of therapy is
unknown.

-Don't confuse alprazolam with
alprostadil or lorazepam. Don't
confuse Xanax with Zantac,
Xopenex, or Tenex.
Patient/Family Teaching
Instruct patient to take medication as directed. If a dose is missed, take within 1 hr; otherwise, skip the dose and return to regular schedule.

May cause drowsiness or dizziness. Avoid driving and other activities requiring alertness until response to the medication is known. Teach Geriatric patient and their family on how to reduce fall risks at home.

Don't take with grapefruit juice, alcohol or other CNS depressants. Use of alternative or herbal products should be discussed with health care professional first.

Teach patient alternative methods of reducing anxiety such as exercise, support group, relaxation therapy etc.

Advise patient to not share medication with anyone.
Nursing Implications
Assess degree of anxiety and mental status before and during therapy
Assess patient for drowsiness, light-headedness, and dizziness. Typically these symptoms will subside as therapy progresses. The dose should be reduced if these persist.
prolonged high dose therapy may lead to psychological or physical dependence. Risk is greater in patients taking more than 4 mg/day.
Lab test considerations: may lower hematocrit and and neutropenia. Monitor CBC and liver and renal function periodically during long-term therapy.

Side Effects
Contraindications/Precautions
Many recreational Xanax users become dependent and show typical withdrawal symptoms, which can be severe. The tragedy of recreational Xanax abuse is that it is largely the result of rampant over prescription and unadvised extended therapy, making them readily available. The biggest source of illegal Xanax are from doctors prescriptions and thefts from pharmacies. They are also very easily obtained on the internet.
CV
: palpitations, chest pain, hypotension.
EENT
: allergic rhinitis, blurred vision, nasal congestion.
GI:
diarrhea, dry mouth, constipation, nausea, increased or decreased appetite, anorexia, vomiting, dyspepsia, abdominal pain.
GU:
dysmenorrhea, sexual dysfunction, premenstrual syndrome, difficulty urinating.
Metabolic:
increased or decreased weight.
(Docucare,2013)
Contraindicated in patients hypersensitive to drug or other benzodiazepines
and in those with acute angle-closure glaucoma.
Use cautiously in patients with hepatic, renal, or pulmonary disease or history of substance abuse.
Overdose Signs & Symptoms
: Somnolence, confusion, impaired coordination, diminished reflexes, coma.
(Docucare)
Drug to Drug Interactions
Drug-drug
Anticonvulsants, antidepressants, antihistamines, barbiturates, benzodiazepines, general anesthetics, narcotics, phenothiazines: May increase CNS depressant effects. Avoid using together.
Azole antifungals (including fluconazole, itraconazole, ketoconazole, miconazole): May increase and prolong alprazolam level, CNS depression, and psychomotor impairment. Avoid using together.
Carbamazepine: May induce alprazolam metabolism and may reduce therapeutic effects. May need to increase dose.
Cimetidine, fluoxetine, fluvoxamine, hormonal contraceptives, nefazodone: May increase alprazolam level. Use cautiously together, and consider alprazolam dosage reduction.
Tricyclic antidepressants: May increase levels of these drugs. Monitor patient closely.
Drug-herb
Kava, valerian root: May increase sedation. Discourage use together.
St. John's wort: May decrease drug level. Discourage use together.
Drug-food
Grapefruit juice: May increase drug level. Discourage use together.
Drug-lifestyleAlcohol use: May cause additive CNS effects. Discourage use together.
Smoking: May decrease effectiveness of drug. Monitor patient closely.
(Docucare)
More side effects
Musculoskeletal:
arthralgia, myalgia, arm or leg pain, back pain, muscle rigidity, muscle cramps, muscle twitch.
Respiratory:
upper respiratory tract infection, dyspnea, hyperventilation.
Skin:
pruritus, increased sweating, dermatitis.
Other:
influenza, injury, emergence of anxiety between doses, dependence, feeling warm.
(Docucare,2013)
CNS
: insomnia, irritability, dizziness, headache, anxiety, confusion, drowsiness, light-headedness, sedation, somnolence, difficulty speaking, impaired coordination, memory impairment, fatigue, depression, suicide, mental impairment, ataxia, paresthesia, dyskinesia, hypoesthesia, lethargy, vertigo, malaise, tremor, nervousness, restlessness, agitation, nightmare, syncope, akathisia, mania.
(Docucare,2013)
Retrieved from: http://memeshare.net/memes/15/14704.pnga
References
(2013). Aprazolam Monograph. Lippincott’s DocuCare. Retrieved from lnareference.wkhpe.com/ref/view.do?
key=4ebf4b9189e17990729a8001b7502a31087e066c&nmn=openMonographFromGlobalId&monographId=mono_alprazolam&cssUrl=http://download.lww.com/docucare/assets/lns_branding/docucare-lns.css
(2013). Aprazolam: Drug Information Lexicomp. UpToDate, Topic 8453, Version 65.0. Retrieved from http://
www.uptodate.com/contents/alprazolam-drug-information?detectedLanguage=en&source=search_result&search=alprazolam&selectedTitle=1~47&provider=noProvider#F132087
Dickenson, B., et. al. 1990. Alprazolam Use and Dependence. The Western Journal of Medicine. Addiction Medicine and the
Primary Care Physician. Retrieved October 27, 2013 from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1002418/pdf/westjmed00117-0412.pdf .
Rueters, T. (2013). Drugpoints system. Greenwood Village, CO: Truven Health Analytics Inc. Retrieved from http://
online.statref.com/Document.aspx?docAddress=72HiFFFsnQdK_ItuUl3uRA==&goBestMatch=true&Index=3&Scroll=1&searchContext=flumazenil|c0||10|1|0|0|0|0||c0&SessionId=1BE697EDTIOOIUWE
Lehne, R. 2013. Pharmacology for Nursing Care (8th Ed.) St. Louis, MO: Elsevier Saunders.
Mechanism of Action
Alprazolam (Xanax) is in the category of drugs called Benzodiazepines
Benzodiazepines affect the central nervous system, specifically a neurotransmitter called gamma-aminobutyric acid (GABA), enhancing its effect on inhibition of excitation in the brain, in order to treat anxiety
Neurotransmitters send signals to initiate a response on the body, in the case of GABA, an inhibiting effect.

Retrieved from Google
Retrieved from Google
Retrieved from Google
Antidote: Flumazenil (Romazicon)

Class: • Benzodiazepine Antagonist
Flumazenil can cause seizures and it is more frequent in patients taking benzodiazepines for long-term sedation.
Antagonizes the effects of benzodiazepines in the CNS by inhibiting their actions at the binding site of GABA-benzodiazepine receptor complex.
Retrieved from Google
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