Comprehensive exams for Mental Health Q 83
The nurse correctly teaches a client taking the Benzodiazepine Oxazepam (Serax) to avoid excessive intake of:
A. Cheese
B. Coffee
C. Sugar
D. Shellfish
Correct Answer: B. Coffee
Coffee contains caffeine, which has a stimulating effect on the central nervous system that will counteract the effect of the antianxiety medication oxazepam. None of the remaining foods is contraindicated. These drugs may act as depressants to the CNS, specifically inhibiting respiratory drive. Therefore, careful monitoring of all vitals, especially blood pressure and respiratory rate, should be performed after the administration of benzodiazepines. Waveform capnography, if available, should be seriously considered to monitor respiratory status.
Option A: The FDA strongly reminds providers that extreme care should be taken when administering benzodiazepines with other central nervous system depressants such as alcohol, barbiturates, and opioids. The activated charcoal administration is contraindicated in benzodiazepine (BZ) ingestion toxicity/overdose. This is due primarily to altered mental status commonly associated with BZ overdose, which lends itself to aspiration of the activated charcoal.
Option C: Flumazenil is a GABA-A receptor antagonist, acting to reverse the sedative effects of benzodiazepines. Flumazenil functions through competitive inhibition of the alpha-gamma subunit of the GABA-A receptor. Administration of flumazenil should be carried out judiciously, as it may precipitate withdrawal seizures. Of note, one multi-center trial found that patients with excessive benzodiazepine ingestion could become “re-sedated” after flumazenil began to wear off.
Option D: Contraindications include known hypersensitivity to benzodiazepines and angle-closure glaucoma. Glaucoma occurs when the intraocular pressure rises, thereby causing compression of the optic nerve near the posterior surface of the eye. This compression of the lamina cribrosa can lead to axonal damage with subsequent disruption of anterograde and retrograde axonal transport. This results in numerous issues, including ocular pain, nausea/vomiting, blurred vision, an intraocular pressure greater than 21 mmHg, edema of the corneal epithelium, and non-reactive pupils.