Brand Name: Xanor

Generic Name: Alprazolam

Classification: Therapeutic: Antianxiety drugs
Pharmacologic: Benzodiazepines
Indications:
 Treatment of GAD (General Anxiety Disorder)
 Panic Disorder
 Management of anxiety associated with depression.
 Insomia
 Irritable bowel syndrome

Contraindication:
 sensitivity to this drug or other benzodiazepines.
 Pre-existing CNS Depression
 Severe uncontrolled pain
 Pulmonary Disease

Action: Alprazolam is a triazolobenzodiazepine, that is, a benzodiazepine with a triazolo-ring

attached to its structure. Alprazolam binds to the GABAA subtype of the GABA
receptor, increasing inhibitory effects of GABA within the central nervous system.
The ionotropic GABAA receptor protein complex is also the molecular target of the benzodiazepine (BZ)
class of tranquilizer drugs. Once bound to the benzodiazepine receptor, the benzodiazepine ligand (it is
a signal triggering molecule, binding to a siteon a target protein)  locks the benzodiazepine receptor into
a conformation in which it has a greater affinity (the force by which atoms are held together in
chemical compounds.) for the GABA neurotransmitter. This increases the frequency of the opening of
the associated chloride ion channel and hyperpolarizes the membrane of the associated neuron
therefore, a decrease in excitability. This reduces the communication between neurons and, therefore,
has a calming effect on many of the functions of the brain. The inhibitory effect of the available GABA is
potentiated, leading to sedatory and anxiolytic effects.

Side Effects:
 drowsiness or light-headedness
 blurred vision
 N/V, constipation, diarrhea
 Physical and psychological dependence

Nursing Responsibility:
 Asses degree and manifestations of anxiety and mental status prior to and periodically during
therapy
 Asses for drowsiness, light-headedness and dizziness
 Maybe administered with food if GI upset occurs
 Administer at bedtime to avoid daytime sedation
 Teach other methods to decrease anxiety
Brand Name:
Generic Name: Lactulose
Classification: Therapeutic: Laxatives
Pharmacologic: Osmotic
Indications:
 Treatment of chronic costipation

Contraindication:
 Patients on low-galactose diets

Action:
Lactulose is a synthetic sugar used in the treatment of constipation and liver disease. It consists
of the monosaccharides fructose and galactose. The bacterial degradation of lactulose resulting in an
acidic pH inhibits the diffusion of NH 3into the blood by causing the conversion of NH 3 (ammonia) to NH4
(ammonium)+ ; also enhances the diffusion of NH 3 from the blood into the gut where conversion to NH 4+
occurs;  produces an osmotic effect in the colon with resultant distention promoting peristalsis. In the
colon, lactulose is broken down primarily to lactic acid, and also to small amounts of formic and acetic
acids, by the action of via evolved-beta galactosidase from colonic bacteria, which results in an increase
in osmotic pressure and slight acidification of the colonic contents. This in turn causes an increase in
stool water content and softens the stool.  In treating heptic diseases (hepatic encephalopathy) it is
thought that lactulose draws out ammonia from the body in the same way that it draws out water into
the colon.

Side Effects:
 Gastrointestinal: Abdominal discomfort, cramping, diarrhea (excessive dose), flatulence, nausea,
vomiting

Nursing Responsibility:
 Assess patient for abdominal distention, presence of bowel sounds and normal pattern of
bowel function.
 Asses for color, consistency, and amount of stool produced.
 Darkening of stool doesn’t alter potency.
 Assess for color, consistency and amount of stool produced.
 Monitor serum electrolytes periodically when used chronically. May cause diarrhea with
resulting hypokalemia and hypernatremia.