Keltner: Psychiatric Nursing, 6th Edition PSYCHOTROPIC DRUG MONOGRAPHS Alprazolam Xanax (al-pray'-zoe-lam) Functional classification: Antianxiety agent Chemical classif ication: Benzo diazepine Controlled substance schedule IV FDA pregnancy category: D Indications: Anxiety, panic disorders Contraindications: Hypersensitivity to benzodiazepines; narrow-angle glaucoma; psychosis; nursing women; child <18 yr; and use with ketoconazole and itraconazole, because these drugs impair the oxidative metabolism of CYP-450 3A Cautious use: Older adults or debilitated patients; hepatic or renal disease Pharmacologic Effects: Increases the affinity of GABA molecules for their specific receptor, increasing the frequency with which chloride channels open in response to GABA; might also decrease norepinephrin e and serotonin turnover rates Pharmacokinetics • Speed of onset: intermediate • PO: onset 30 min, peak 1 to 2 hr, duration 4 to 6 hr, therapeutic response 2 to 3 days; metabolized by liver; excreted by kidneys; crosses placenta, breast milk; half-life 12 to 15 hr; therapeutic serum level >48 ng/ml Side Effects: CNS: drowsiness, dizziness, confusion, headache, anxiety, tremor, stimulation, fatigue, depression, insomnia; paradoxic agitation can occur; peripheral: photophob ia caused by mydriasis; blurred vision caused by cycloplegia; sleeplike slowing of respirations with therapeutic doses; cough; orthostatic hypotension; tachycardia; hypotension; constipatio n; dry mouth Interactions • Alcohol and other CNS depressants: increased risk for excessive CNS depression • Cimetidine: potentiation of CNS depression • Digoxin: increased risk for cardiac side effects • Levodopa: decreased antiparkinson effect • Phenytoin: increased phenytoin serum levels Implications: For benzodiazep ines Asse ss • Patient’s level of anxiety and method of coping • BP, VS • Establish baseline physical assessment data before medications are started Elsevier items and derived items © 2011, 2007, 2003, 1999, 1995, 1991 by Mosb y, an Imprint of Elsevi er, Inc.
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