Apo-Meprobamate, Equanil, Miltown
Therapeutic: antianxiety agents, sedative/hypnotics
Anxiety disorders (provides sedation).
Produces CNS depression by acting at multiple sites in the CNS. Therapeutic Effects: Sedation.
Adverse Reactions/Side Effects
CNS: drowsiness. EENT: blurred vision. CV: hypotension. GI: anorexia, diarrhea, nausea, vomiting. Derm: pruritus, rashes, urticaria. Neuro: ataxia. Misc: hypersensitivity reactions, physical dependence, psychological dependence, tolerance.
PHYSICAL THERAPY IMPLICATIONS
Examination and Evaluation
Monitor daytime drowsiness and “hangover” symptoms (headache, nausea, irritability, dysphoria). Repeated or excessive symptoms may require change in dose or medication.
Assess balance and risk of falls (See Appendix E), especially in older adults, or in patients exhibiting sedation, dizziness, blurred vision, or ataxia.
Monitor signs of hypersensitivity reactions, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria). Notify physician immediately if these reactions occur.
Assess blood pressure periodically and compare to normal values (See Appendix F). Report low blood pressure (hypotension), especially if patient experiences dizziness, fatigue, or other symptoms.
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).
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 move slowly when assuming a more upright position.
Instruct patients on prolonged treatment not to discontinue medication without consulting their physician. Abrupt withdrawal may cause insomnia, unusual irritability or nervousness, and seizures.
Advise patient about the risk of daytime drowsiness and decreased attention and mental focus. These problems can be severe in certain people. Use care if driving or in other activities that require quick reactions and strong concentration.
Advise patient to avoid alcohol and other CNS depressants because of the increased risk of sedation and adverse effects.
Instruct patient to report other bothersome side effects such as severe or prolonged skin reactions (rash, hives, itching), blurred vision, or GI problems (nausea, vomiting, diarrhea, loss of appetite).
Absorption: Well absorbed after oral administration.
Distribution: Widely distributed. Crosses the placenta; enters breast milk in high concentrations.
Metabolism and Excretion: Metabolized by the liver.