Therapeutic: antianxiety agents
Binds to serotonin and dopamine receptors in the brain. Increases norepinephrine metabolism in the brain. Therapeutic Effects: Relief of anxiety.
Adverse Reactions/Side Effects
CNS: dizziness, drowsiness, excitement, fatigue, headache, insomnia, nervousness, weakness, personality changes. EENT: blurred vision, nasal congestion, sore throat, tinnitus, altered taste or smell, conjunctivitis. Resp: chest congestion, hyperventilation, shortness of breath. CV: chest pain, palpitations, tachycardia, hypertension, hypotension, syncope. GI: nausea, abdominal pain, constipation, diarrhea, dry mouth, vomiting. GU: changes in libido, dysuria, urinary frequency, urinary hesitancy. Derm: rashes, alopecia, blisters, dry skin, easy bruising, edema, flushing, pruritus. Endo: irregular menses. MS: myalgia. Neuro: incoordination, numbness, paresthesia, tremor. Misc: clamminess, sweating, fever.
PHYSICAL THERAPY IMPLICATIONS
Examination and Evaluation
Assess blood pressure (BP) and compare to normal values (See Appendix F). Report changes in BP, either a problematic decrease in BP (hypotension) or a sustained increase in BP (hypertension).
Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report rapid heart rate (tachycardia) or symptoms of other arrhythmias, including palpitations, chest discomfort, shortness of breath, syncope, and fatigue/weakness.
Monitor any breathing problems, and report shortness of breath, rapid shallow breathing, or abnormal breath sounds that might indicate pulmonary congestion (See Appendix K).
Monitor personality changes, including excitement and nervousness. Notify physician if these changes become problematic.
Assess any muscle aches or pain to rule out musculoskeletal pathology; that is, try to determine if pain is drug induced rather than caused by anatomic or biomechanical problems.
Assess signs of paresthesia (numbness, tingling), tremors, or incoordination. Perform objective tests, including electroneuromyography and sensory testing to document any drug-related neuropathic changes.
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 nursing staff, 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 abnormal BP responses, use caution during aerobic exercise and other forms of therapeutic exercise. Assess exercise tolerance frequently (BP, heart rate, fatigue levels), and terminate exercise immediately if any untoward responses occur (See Appendix L).
Help patient explore nonpharmacologic methods to reduce anxiety, such as relaxation techniques, exercise, counseling, support groups, and so forth.
To minimize orthostatic hypotension, patient should ...