Alprazolam (Xanax) is a benzodiazepine and anxiolytic used for the management of anxiety disorders.

alprazolam (al prah zoe lam) Alprazolam Intensol, Apo-Alpraz (CAN), Niravam, Novo-Alprazol (CAN), Nu-Alpraz (CAN), Xanax, Xanax TS (CAN), Xanax XR Pregnancy Category D Controlled Substance C-IV Drug classes Benzodiazepine Anxiolytic Therapeutic actions Exact mechanisms of action not understood; main sites of action may be the limbic system and reticular formation; increases the effects of GABA, an inhibitory neurotransmitter; anxiety blocking effects occur at doses well below those necessary to cause sedation, ataxia. Indications Management of anxiety disorders, short-term relief of symptoms of anxiety; anxiety associated with depression. Treatment of panic attacks with or without agoraphobia Unlabeled uses: Social phobia, premenstrual syndrome, depression Dosages

Individualize dosage; increase dosage gradually to avoid adverse effects. ADULTS Anxiety disorders: Initially, 0.250.5 mg PO tid; adjust to maximum daily dose of 4 mg/day in divided doses or extendedrelease form once per day in the AM once dosage is established (immediate release, intensol solution). Panic disorder: Initially, 0.5 mg PO tid; increase dose at 3- to 4-day intervals in increments of no more than 1 mg/day; ranges of 110 mg/day have been needed; extended-release form once per day in AM once dosage is established (Xanax products, Niravam). UNLABELED USES Social phobia: 28 mg/day PO. PMS: 0.25 mg PO tid. Adverse effects
CNS: Transient, mild drowsiness initially; sedation, depression, lethargy, apathy, fatigue, light-headedness, disorientation, anger, hostility, episodes of mania and hypomania, restlessness, confusion, crying, delirium, headache, slurred speech, dysarthria, stupor, rigidity, tremor, dystonia, vertigo, euphoria, nervousness, difficulty in concentration, vivid dreams, psychomotor retardation, extrapyramidal symptoms; mild paradoxical excitatory reactions during first 2 wk of treatment CV: Bradycardia, tachycardia, CV collapse, hypertension, hypotension, palpitations, edema Dermatologic: Urticaria, pruritus, rash, dermatitis EENT: Visual and auditory disturbances, diplopia, nystagmus, depressed hearing, nasal congestion GI: Constipation, diarrhea, dry mouth, salivation, nausea, anorexia, vomiting, difficulty in swallowing, gastric disorders, hepatic impairment GU: Incontinence, changes in libido, urinary retention, menstrual irregularities Hematologic: Elevations of blood enzymesLDH, alkaline phosphatase, AST, ALT; blood dyscrasiasagranulocytosis, leukopenia Other: Hiccups, fever, diaphoresis, paresthesias, muscular disturbances, gynecomastia. Drug dependence with withdrawal syndrome when drug is discontinued; more common with abrupt discontinuation of higher dosage used for longer than 4 mo Contraindications Contraindicated with hypersensitivity to benzodiazepines, psychoses, acute narrow-angle glaucoma, shock, coma, acute alcoholic intoxication with depression of vital signs, pregnancy (crosses the placenta; risk of congenital malformations, neonatal withdrawal syndrome), labor and delivery (floppy infant syndrome), lactation (secreted in breast milk; infants become lethargic and lose weight). Use cautiously with impaired liver or kidney function, debilitation. Nursing considerations

CLINICAL ALERT! Name confusion has occurred among Xanax (alprazolam), Celexa (citalopram), and Cerebyx (fosphenytoin), and between alprazolam and lorazepam; use caution. Assessment History: Hypersensitivity to benzodiazepines; psychoses; acute narrow-angle glaucoma; shock; coma; acute alcoholic intoxication with depression of vital signs; labor and delivery; lactation; impaired liver or kidney function; debilitation Physical: Skin color, lesions; T; orientation, reflexes, affect, ophthalmologic examination; P, BP; liver evaluation, abdominal examination, bowel sounds, normal output; CBC, LFTs, renal function tests Interventions Arrange to taper dosage gradually after long-term therapy, especially in epileptic patients. Do not administer with grapefruit juice. Taper drug slowly; decrease by no more than 0.5 mg every 3 days. Teaching points Take this drug exactly as prescribed; take extended-release form once a day in the morning; place rapidly disintegrating tablet on top of tongue, where it will disintegrate and can be swallowed with saliva. Do not drink grapefruit juice while on this drug. Do not stop taking drug (in long-term therapy) without consulting health care provider; drug should not be stopped suddenly. Avoid alcohol, sleep-inducing, or over-the-counter drugs. You may experience these side effects: Drowsiness, dizziness (these effects will be less pronounced after a few days, avoid driving a car or engaging in other dangerous activities if these occur); GI upset (take drug with food); fatigue; depression; dreams; crying; nervousness. Report severe dizziness, weakness, drowsiness that persists, rash or skin lesions, difficulty voiding, palpitations, swelling in the extremities. GENERIC NAME: alprazolam BRAND NAME: Xanax, Xanax XR, Niravam DRUG CLASS AND MECHANISM: Alprazolam is an anti-anxiety medication in the benzodiazepine family, the same family that includes diazepam(Valium), clonazepam (Klonopin), lorazepam (Ativan), flurazepam (Dalmane), and others. Alprazolam and other benzodiazepines act by enhancing the effects of gamma-aminobutyric acid (GABA) in the brain. GABA is a neurotransmitter (a chemical that nerve cells use to communicate with each other) that inhibits activity in the brain. It is believed that excessive activity in the brain may cause anxiety or other psychiatric disorders. The FDA approved alprazolam in October 1981. PRESCRIPTION: Yes GENERIC AVAILABLE: Yes PREPARATIONS: Tablets: 0.25, 0.5, 1 and 2 mg. Tablets ER (extended release): 0.5, 1, 2 and 3 mg. Tablets (Orally disintegrating): 0.25, 0.5, 1 and 2 mg. Solution: 1 mg/ml STORAGE: Alprazolam should be stored at room temperature, 15 C to 30 C (59 F to 86 F). PRESCRIBED FOR: Alprazolam is used for the treatment of anxiety disorders and panic attacks. Anxiety disorders are characterized by unrealistic worry and apprehension, causing symptoms of restlessness, aches, trembling, shortness of breath, smothering sensation, palpitations, sweating, cold clammy hands, lightheadedness, flushing, exaggerated startle responses, problems concentrating, and insomnia. Panic attacks occur either unexpectedly or in certain situations (for example, driving), and can require higher dosages of alprazolam. DOSING: Alprazolam may be taken with or without food. The starting dose for treating anxiety is 0.25-0.5 mg 3 to 4 times daily using immediate release tablets. The dose may be increased every 3-4 days to a maximum dose of 4 mg daily. The starting dose for treating panic attacks is 0.5 mg 3 times daily. Doses can be increased every 3-4 days but by no more than 1 mg daily. The effective dose for preventing panic attacks may be as high as 10 mg daily for some patients. The starting dose when using extended release tablets to treat panic disorder is 0.5 mg once daily and the average dose is 3-6 mg once daily. DRUG INTERACTIONS: Ketoconazole (Nizoral), itraconazole (Sporanox),nefazodone (Serzone), cimetidine (Tagamet), and fluvoxamine (Luvox) increase concentrations in the blood of alprazolam and therefore may increase the side effects of alprazolam. Alprazolam interacts with alcohol and medications (for example, barbiturates, and narcotics) that suppress activity in the brain by suppressing activity more and causing sedation. Carbamazepine (Tegretol, Tegretol XR, Equetro, Carbatrol) and rifampin reduce the effect of alprazolam by increasing metabolism and elimination of alprazolam in the liver.

PREGNANCY: Benzodiazepines, such as alprazolam, can cause fetal abnormalities and should not be used in pregnancy. NURSING MOTHERS: Alprazolam is excreted in breast milk and can affect nursing infants. Therefore, it should not be used by women who are nursing. SIDE EFFECTS: The most frequent side effects of alprazolam taken at lower doses are drowsiness or lightheadedness, which probably reflect the normal actions of the drug. Side effects of higher dosages (those used for panic attacks) include fatigue, memory problems, speech problems, constipation, and changes in appetite with resultant changes in weight. Alprazolam can lead to addiction (dependency), especially at high doses over prolonged periods of time. Abrupt discontinuation of alprazolam after prolonged use can lead to symptoms of withdrawal such as insomnia,headaches, nausea, vomiting, lightheadedness, sweating, anxiety, and fatigue. Seizures can occur in more severe cases of withdrawal. Consequently, patients on alprazolam for extended periods of time should slowly taper the medication under a doctor's supervision rather than abruptly stopping the medication.

DRUG CLASS AND MECHANISM: Amiodarone is an oral and injectable drug that is used to correct abnormal rhythms of the heart. (It is an antiarrhythmic medication.) Although amiodarone has many side effects, some of which are severe and potentially fatal, it has been successful in treating many arrhythmias when other antiarrhythmic drugs have failed. Amiodarone is considered a "broad spectrum" antiarrhythmic medication, that is, it has multiple and complex effects on the electrical activity of the heart which is responsible for the heart's rhythm. Among its most important electrical effects are: 1. a delay in the rate at which the heart's electrical system "recharges" after the heart contracts (repolarization); 2. a prolongation in the electrical phase during which the heart's muscle cells are electrically stimulated (action potential); 3. a slowing of the speed of electrical conduction (how fast each individual impulse is conducted through the heart's electrical system); 4. a reduction in the rapidity of firing of the normal generator of electrical impulses in the heart (the heart's pacemaker); 5. a slowing of conduction through various specialized electrical pathways (called accessory pathways) which can be responsible for arrhythmias. In addition to being an antiarrhythmic medication, amiodarone also causes blood vessels to dilate (enlarge). This effect can result in a drop in blood pressure. Because of this effect, it also may be of benefit in patients withcongestive heart failure. Amiodarone was discovered in 1961 and approved by the FDA in December 1985. PRESCRIPTION: Yes GENERIC AVAILABLE: Yes PREPARATIONS: Tablets: 200 mg. Injection: 50 mg/ml STORAGE: Tablets and injection should be kept at room temperature, 20-25 C (68-77 F). PRESCRIBED FOR: Amiodarone is approved for recurrent ventricular fibrillation and hemodynamically unstable ventricular tachycardia. DOSING: The recommended dosing schedule is an initial loading dose of 800-1600 mg daily for 1 to 3 weeks, followed by 600800 mg daily for 1 month, then 400 mg daily for maintenance. Response should be closely monitored and dosing is individualized for each patient. Amiodarone may be administered once daily or given twice daily with meals to minimize stomach upset which is seen more frequently with higher doses. DRUG INTERACTIONS: Amiodarone may interact with beta-blockers such as atenolol (Tenormin), propranolol (Inderal), metoprolol (Lopressor), or certain calcium channel blockers, such as verapamil (Calan, Isoptin, Verelan, Covera-HS) or diltiazem (Cardizem, Dilacor, Tiazac), resulting in an excessively slow heart rate or a block in the conduction of the electrical impulse through the heart. Amiodarone increases the blood levels of digoxin (Lanoxin) when the two drugs are given together. It is recommended that the dose of digoxin be cut by 50% when amiodarone therapy is started. Flecainide (Tambocor) blood concentrations increase by more than 50% with amiodarone. Procainamide(Procan-SR, Pronestyl) and quinidine (Quinidex, Quinaglute) concentrations increase by 30%-50% during the first week of amiodarone therapy. Additive electrical effects occurs with these combinations, and worsening arrhythmias may occur as a result. Some experts recommend that the doses of these other drugs be reduced when amiodarone is started. Amiodarone can result in phenytoin (Dilantin) toxicity because it causes a two- or three-fold increase in blood concentrations of phenytoin. Symptoms of phenytoin toxicity including unsteady eye movement (temporary and reversible), tiredness and unsteady gait. SIDE EFFECTS: Amiodarone has many side effects and several that are serious. This is only a partial list. Common side effects include fatigue, eye deposits, tremor, unsteady gait, nausea, vomiting, constipation, weight loss,dizziness, and visual changes. Amiodarone is also associated with heart block, low blood pressure, pulmonary fibrosis (scarring of the lungs), heart failure, cardiac arrest, hypo or hyperthyroidism, blue skin discoloration, liver failure, and cardiogenic shock.

Brand Name: Serc Generic Name: Betahistine Dihydrochloride Classification: Antiemetic and Antivertigo Availability: Tablet: 8mg, 16mg, 24mg Action: It has a histamine-like action. It is readily absorbed from the gastrointestinal tract. It is converted to two metabolites and peak concentrations in blood of the two metabolites are achieved within 3 to 5 hours. Most of a dose is excreted in the urine, in the form of the metabolites, in about 3 days. The mechanism of action of betahistine is not known. Pharmacological testing in animals has shown that the blood circulation in the striae vascularis of the inner ear improves, probably by means of a relaxation of the precapillary sphincters of the microcirculation of the inner ear. In pharmacological studies, betahistine was found to have weak H1 receptor agonistic and considerable H3 antagonistic properties in the central nervous system and autonomic nervous system. Betahistine was also found to have a dose dependent inhibiting effect on spike generation of neurons in lateral and medial vestibular nuclei. The importance of this observation in the action against Menieres syndrome or vestibular vertigo, however, remains unclear. Indication: 1. Menieres Disease 2. Vertigo 3. Tinnitus 4. Sensorineural deafness. Contraindications: Previous hypersensitive reaction to the drug components. Cautious Use: Pheochromocytoma, bronchial asthma, peptic ulcer, pregnancy and lactation. Route & Dosage Adult: 8mg 1-2 tab; 16 mg -1 tab. To be taken TID. 24 mg 1 tab. To be taken BID. Adverse effects: 1. Urticaria 2. Pruritus 3. Mild gastric complaints 4. False heartbeat 5. Insomnia Patient & Family Education 1. This drug should be taken with food. 2. Advise relatives to support patients ambulation. 3. Protect medication from moisture. 4. Do not give this medication to children. 5. Swallow tablet whole with one full glass of water. 6. Never take a double dose if you missed one medication. If you missed one, take medication immediately. Source: http://home.intekom.com/pharm/schering/serc.html