SSRI: fluoxetine, first-line use for panic disorders and OCD, teach client to report lethargy, s/sx of serotonin syndrome, abd cramps, diarrhea, nausea, fluoxetine - take in the am, can cause sexual dysfunction, Give dantrolene and cooling measures for serotonin syndrome, Will take 4-6 weeks till effective, If client is experiencing serotonin syndrome: stabilize vital signs (tachycardia, hypotension, increased rr) - stabilize the airway & cool client, Highly specific to serotonin - reduces reuptake into the neuron = more left in the synaptic gap, SNRI: Venlafaxine, Used for social anxiety disorder and generalized anxiety disorder, Adverse reactions = N/V, hypertension, increased risk for suicide, Check client weight - can cause anorexia (lack of appetite) , Client teaching - titrate doses up, take in am, check BP, don't stop abrubtly, Nurse should monitor BP for hypertension and check for tinnitus, Reduces reuptake or serotonin and norepinephrine into the neuron = more left in the synaptic gap, Non-Benzodiazepine: Buspirone, Less risk for dependency or overdose, No sedation effects, No weight gain or sexual dysfunction reported, Not for PRN use, takes 1 -4 weeks to work, use for Generalized anxiety disorder only, Can have paradoxical effects (opposite of desired effects) - insomnia, anxiety, restlessness, May cause orthostatic hypotension, Don't drink grapefruit juice, If SSRi doesn't work, will try this medication next, Benzodiazepine: Alprazolam, Diazepam, Promotes sleep because it increases GABA, Great for PRN use - fast acting, High risk of addiction and overdose, Can cause severe sedation, drowsiness, decreased RR, and cardiac arrest when given IV, Client can build up tolerance/dependence on this medication, Taper this medication over 2 weeks, Client will start on SSRI then take this mediaiton for 2 weeks to bridge gap because this medication works instantly, Avoid kava-kava, chamomile and valerian to decrease risk of oversedation,

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