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ATI Mental Health > 22 Medications for depressive disorder > Flashcards

22 Medications for depressive disorder Flashcards

1
Q

5 main groups of antidepressant meds

A

1 tricyclic antidepressants [TCA]
2 selective serotonin reuptake inhibitors [SSRI]
3 serotonin norepinephrine reuptake inhibitors [SNRI]
4 monoamine oxidase inhibitors [MAOIs]
5 atypical antidepressants

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2
Q

tricyclic antidepressants [TCA]

drug names

A
  • amitriptyline
  • imipramine
  • doxepin
  • nortriptyline
  • amoxapine
  • trimipramine
  • desipramine
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3
Q

tricyclic antidepressants [TCA]

expected pharmacological action

A

block reuptake of norepinephrine + serotonin in synaptic space
»>intensifies effects of neurotransmitters

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4
Q

tricyclic antidepressants [TCA]

onset

A

10-14 or more days before TCA begins to work

-max effects may take 4-8 weeks

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5
Q

tricyclic antidepressants [TCA]

indication

A

-depression

OTHERS: neuropathic pain, fibromyalgia, anxiety, insomnia, bipolar, OCD, ADHD

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6
Q

tricyclic antidepressants [TCA]

A/E

A
  • orthostatic hypotension
  • anticholinergic effects
  • sedation
  • toxicity
  • decr seizure threshold
  • excess sweating
  • incr appetite
  • incr risk of suicide
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7
Q

orthopnea

teaching

A
  • move slow
  • sit/lie down if feeling lightheaded
  • avoid dehydration
  • HOLD if significant decr in BP or incr in HR
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8
Q

anticholinergic effects

A
  • dry mouth
  • blurred vision
  • photophobia
  • urinary hesitancy/retention
  • constipation
  • tachycardia
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9
Q

anticholinergic effects

client teaching

A
  • sugarless gum
  • sip water
  • sunglasses when out
  • high fiber
  • regular exercise (peristalsis)
  • incr fluid 2-3L
  • void before admin of med
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10
Q

sedation

teaching

A
  • usually diminishes over time
  • take at bedtime
  • avoid hazardous activities like driving
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11
Q

tricyclic antidepressants [TCA]

signs of toxicity

A

results in cholinergic blockade + cardiac toxicity

  • dysrhythmia
  • mental confusion
  • agitation
  • followed by seizure, coma, death
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12
Q

tricyclic antidepressants [TCA]

how to prevent toxicity

A
  • no more than 1 wk supply at a a time
  • **obtain baseline ECG + cardiac workup
  • monitor VS frequently
  • monitor/notify for signs of toxicity
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13
Q

excessive sweating

A

frequent linen changes

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14
Q

incr appetite

A
  • self observe wt weekly

- good nutrition + exercise to decr risk

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15
Q

tricyclic antidepressants [TCA]

CI

A 
*seizure disorders
caution:
**older w cardiac disease
-coronary artery disease
-diabetes
-liver/kidney disorder
-resp disorder
-urinary retention/obstruction
-angle-closure glaucoma
-benign prostatic hypertrophy
-hyper-thyroid
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16
Q

TCA + MAOIs

A

can cause severe HTN

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17
Q

TCA + antihistamine

A
  • incr antichol effect

- incr sedative effect

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18
Q

TCA + direct vs indirect acting sympathomimetics

A

D:incr effects of meds bc both block the reuptake
ID:decr effect

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19
Q

TCA should not be used w other CNS depressants such as…

A
  • benzo
  • ETOH
  • opioid
  • antihistamine
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20
Q

SSRI

drug names

A
  • fluoxetine
  • citalopram
  • escitalopram
  • paroxetine
  • sertraline

-ine + pram

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21
Q

SSRI

pharmacological action

A

selectively block reuptake of monoamine neurotransmitter SEROTONIN in synaptic space
-intensifies effects of serotonin

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22
Q

first line of tx for depression

A

SSRI

  • low lethality in case of suicide attempt
  • low A/E
  • good for dprssn w anxiety or psychomotor agitation
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23
Q

SSRI

indication

A
  • depression
  • OCD
  • bulimnia
  • PMS
  • panic.anxiety
  • PTSD
  • bipolar
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24
Q

SSRI

A/E

A
  • sex dysfunction
  • CNS stimulation [insomnia, agitation, anxiety]
  • wt change
  • serotonin syndrome
  • withdrawal syndrome
  • hypo-natremia
  • rash
  • sleepy, faint, lightheaded,
  • GI bleed
  • bruxism
25
Q

if sexual dysfunctions (anorgasmia, impotence, decr libido) become intolerable…

A
  • lower dosage
  • medication holiday
  • adjunct med
  • change med (bupropion)
26
Q

CNS stimulation (insomnia, agitation, anxiety)

A
  • relaxation techniques
  • dosage reduction
  • take in AM
  • avoid caffeine
27
Q

serotonin syndrome onset

A

2-72 hr after start of tx

-LETHAL

28
Q

serotonin syndrome

manifestations

A
  • mental confusion, difficult concentrt,
  • sialorrhea (drool)
  • ab pain
  • diarrhea
  • agitation
  • fever
  • hallucination
  • hyperreflexia, incoordination
  • diaphoresis
  • tremor
29
Q

serotonin syndrome

nursing action

A

start symptomatic tx:

  • CYPROHEPTADINE
  • med that blocks serotonin inhibitor
  • muscle rigidity
  • cooling blankets
  • anticonvulsant
  • artificial ventilation
  • withhold med! notify provider!
30
Q

hyponatremia is more likely to occur with SSRI when… + nursing actions

A

older adult taking diuretics

-obtain baseline sodium + monitor periodically

31
Q

a rash with SSRI is treatable w…

A

antihistamine or discontinuation of SSRI

32
Q

bruxism

A

is a condition in which you grind, gnash or clench your teeth

33
Q

bruxism

teaching

A
  • report to provider
  • use mouth guard
  • add low dose of buspirone
  • take in AM to avoid sleep disturbnc
  • dont take w food
34
Q

pregnancy risk + SSRI

A
  • fluox/paroxetine incr risk of birth defect

- late inpregnancy, can cause pulmo HTN + withdrawal in bb

35
Q

meds to avoid with SSRI bc incr risk of serotonin syndrome

A

MAOI (discont 14 days prior)
TCA
St Johns wORT
-if starting MAOI, discont SSRI 5 wks prior

36
Q

SSRI + warfarin + NSAID + anticoag

A

incr warfarin level

  • monitor PT + INR
  • assess for bleeding
37
Q

SSRI + TCA + lithium

A

can incr level of meds

38
Q

SNRI

drug name

A
  • venlaxafine
  • duloxefine
  • desvenlaxafine
39
Q

SNRI [venlaxafine, duloxefine, desvenlaxafine, levomilnacipran]
pharm action

A

incr amt of neurotransmitters available in brain

-little effect on other neurotransmitters/receptors

40
Q

SNRI [venlaxafine, duloxefine, desvenlaxafine, levomilnacipran]
A/E

A
  • headache
  • nausea
  • agitation
  • anxiety
  • dry mouth
  • sleep disturbance
  • hypo-natremia
  • wt loss
  • incr BP
  • sex
41
Q

SNRI [venlaxafine, duloxefine, desvenlaxafine, levomilnacipran]
teaching

A
  • avoid ETOH

- gradual discontinuation

42
Q

SNRI [venlaxafine, duloxefine, desvenlaxafine, levomilnacipran]
CI

A
  • hepatic disease

- ETOH addiction

43
Q

TCA should be careful w… and obtain a… before admin

A

older pt or w hx of cardiac issues

-obtain cardiac workup beforehand

44
Q

MAOIs

drug names

A
  • phenelzine
  • isocarboxazid
  • selegiline (patch)
  • tranylcypromine
45
Q

MAOI

pharm action

A
  • black MAO in brain

- incr the amt of norepinephrine, dopamine, + serotonin available

46
Q

MAOI are first line tx for…

A

MDD w atypical features aka atypical depression

-mood lifted/brightened in response to positive events or good news

47
Q

MAOI

A/E

A
  • CNS stim
  • orthostatic hypotension
  • hypertensive crisis
  • rash assoc w selegiline patch
48
Q

hypertensive crisis

A

severe HTN fr intense vasoconstriction + stim of heart

-usually fr intake of dietary tyramine

49
Q

hypertensive crisis

manifestation

A
  • headache
  • N/V
  • incr HR
  • incr BP
  • diaphoresis
  • change in LOC
50
Q

if hypertensive crisis is happening…

A

admin phentolamine IVE or nifedipine

  • —rapid acting, a-adrenergic blocker
  • continuous cardiac monitoring
  • resp support
51
Q

atypical antidepressant

drug name

A

bupropion
trazodone
mirtazapine

52
Q

atypical/bupropion

pharm action

A

inhibits DOPAMINE reuptake

53
Q

atypical/bupropion

indications

A
  • alternative to SSRI bc no sex dysfunction
  • smoking cessation
  • seasonal dprssn
54
Q

atypical/bupropion

A/E

A
  • headache
  • dry mouth
  • GI distress
  • constipation
  • incr HR
  • nausea
  • restlessness
  • insomnia
  • suppress appetite
  • seizures in high dosage
55
Q

atypical/bupropion

CI

A
  • seiuzure disorder
  • MAOI
  • eating disorder
56
Q

trazodone

a/e

A

priaprism

-prolonged erections that continue hours past sexual stimulation

57
Q

mirtazapine

A

SNRI + atypical antidepressant

-stim appetite

58
Q

antidepressants that can cause serotonin syndrome

A
  • MAOI
  • SSRI
  • Lithium
  • TCA

ATI Mental Health (22 decks)

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