Apo-Oxazepam, Novoxapam, Serax
Therapeutic: antianxiety agents, sedative/hypnotics
Management of anxiety, anxiety associated with depression. Symptomatic treatment of alcohol withdrawal.
Depresses the CNS, probably by potentiating gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter. Therapeutic Effects: Decreased anxiety. Diminished symptoms of alcohol withdrawal.
Adverse Reactions/Side Effects
CNS: dizziness, drowsiness, confusion, hangover, headache, impaired memory, mental depression, paradoxical excitation, slurred speech. EENT: blurred vision. Resp: respiratory depression. CV: tachycardia. GI: constipation, diarrhea, drug-induced hepatitis, nausea, vomiting, weight gain (unusual). GU: urinary problems. Derm: rashes. Hemat: leukopenia. Misc: physical dependence, psychologic dependence, tolerance.
PHYSICAL THERAPY IMPLICATIONS
Examination and Evaluation
Be alert for signs of respiratory depression, including dyspnea, shortness of breath, and cyanosis. Monitor pulse oximetry and perform pulmonary function tests (See Appendices I, J, K) to document suspected changes in ventilation and respiratory function.
Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report a rapid heart rate (tachycardia) or signs of other arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.
Watch for signs of leukopenia including fever, sore throat, and other signs of infection. Report these signs to the physician.
Monitor daytime drowsiness and “hangover” symptoms (headache, nausea, irritability, lethargy, dysphoria). Repeated or excessive symptoms may require change in dose or medication.
Report any behavioral or personality changes such as confusion, forgetfulness, slurred speech, decreased mental acuity, or excessive excitation.
Assess dizziness and drowsiness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.
Guard against falls and trauma (hip fractures, head injury, and so forth). Implement fall prevention strategies, especially in older adults or if drowsiness and dizziness carry over into the daytime (See Appendix E).
Because of the risk of arrhythmias and respiratory depression, use caution during aerobic exercise and other forms of therapeutic exercise. Assess exercise tolerance frequently (blood pressure, heart rate, fatigue levels), and terminate exercise immediately if any untoward responses occur (See Appendix L).
Help patient explore nonpharmacologic methods to decrease anxiety and depression (relaxation techniques, regular exercise, support groups, and so forth).
Instruct patients on prolonged treatment not to discontinue medication without consulting a health care professional. Long-term use can cause tolerance and physical/psychologic dependence, and abrupt withdrawal can cause insomnia, unusual irritability or nervousness, and seizures.
Advise patient to avoid alcohol and other CNS depressants because of the increased risk of sedation and adverse effects.
Advise patient about the likelihood of GI problems such as nausea, vomiting, ...