22 Medications for depressive disorder Flashcards
5 main groups of antidepressant meds
1 tricyclic antidepressants [TCA]
2 selective serotonin reuptake inhibitors [SSRI]
3 serotonin norepinephrine reuptake inhibitors [SNRI]
4 monoamine oxidase inhibitors [MAOIs]
5 atypical antidepressants
tricyclic antidepressants [TCA]
drug names
- amitriptyline
- imipramine
- doxepin
- nortriptyline
- amoxapine
- trimipramine
- desipramine
tricyclic antidepressants [TCA]
expected pharmacological action
block reuptake of norepinephrine + serotonin in synaptic space
»>intensifies effects of neurotransmitters
tricyclic antidepressants [TCA]
onset
10-14 or more days before TCA begins to work
-max effects may take 4-8 weeks
tricyclic antidepressants [TCA]
indication
-depression
OTHERS: neuropathic pain, fibromyalgia, anxiety, insomnia, bipolar, OCD, ADHD
tricyclic antidepressants [TCA]
A/E
- orthostatic hypotension
- anticholinergic effects
- sedation
- toxicity
- decr seizure threshold
- excess sweating
- incr appetite
- incr risk of suicide
orthopnea
teaching
- move slow
- sit/lie down if feeling lightheaded
- avoid dehydration
- HOLD if significant decr in BP or incr in HR
anticholinergic effects
- dry mouth
- blurred vision
- photophobia
- urinary hesitancy/retention
- constipation
- tachycardia
anticholinergic effects
client teaching
- sugarless gum
- sip water
- sunglasses when out
- high fiber
- regular exercise (peristalsis)
- incr fluid 2-3L
- void before admin of med
sedation
teaching
- usually diminishes over time
- take at bedtime
- avoid hazardous activities like driving
tricyclic antidepressants [TCA]
signs of toxicity
results in cholinergic blockade + cardiac toxicity
- dysrhythmia
- mental confusion
- agitation
- followed by seizure, coma, death
tricyclic antidepressants [TCA]
how to prevent toxicity
- no more than 1 wk supply at a a time
- **obtain baseline ECG + cardiac workup
- monitor VS frequently
- monitor/notify for signs of toxicity
excessive sweating
frequent linen changes
incr appetite
- self observe wt weekly
- good nutrition + exercise to decr risk
tricyclic antidepressants [TCA]
CI
*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
TCA + MAOIs
can cause severe HTN
TCA + antihistamine
- incr antichol effect
- incr sedative effect
TCA + direct vs indirect acting sympathomimetics
D:incr effects of meds bc both block the reuptake
ID:decr effect
TCA should not be used w other CNS depressants such as…
- benzo
- ETOH
- opioid
- antihistamine
SSRI
drug names
- fluoxetine
- citalopram
- escitalopram
- paroxetine
- sertraline
-ine + pram
SSRI
pharmacological action
selectively block reuptake of monoamine neurotransmitter SEROTONIN in synaptic space
-intensifies effects of serotonin
first line of tx for depression
SSRI
- low lethality in case of suicide attempt
- low A/E
- good for dprssn w anxiety or psychomotor agitation
SSRI
indication
- depression
- OCD
- bulimnia
- PMS
- panic.anxiety
- PTSD
- bipolar
SSRI
A/E
- sex dysfunction
- CNS stimulation [insomnia, agitation, anxiety]
- wt change
- serotonin syndrome
- withdrawal syndrome
- hypo-natremia
- rash
- sleepy, faint, lightheaded,
- GI bleed
- bruxism
if sexual dysfunctions (anorgasmia, impotence, decr libido) become intolerable…
- lower dosage
- medication holiday
- adjunct med
- change med (bupropion)
CNS stimulation (insomnia, agitation, anxiety)
- relaxation techniques
- dosage reduction
- take in AM
- avoid caffeine
serotonin syndrome onset
2-72 hr after start of tx
-LETHAL
serotonin syndrome
manifestations
- mental confusion, difficult concentrt,
- sialorrhea (drool)
- ab pain
- diarrhea
- agitation
- fever
- hallucination
- hyperreflexia, incoordination
- diaphoresis
- tremor
serotonin syndrome
nursing action
start symptomatic tx:
- CYPROHEPTADINE
- med that blocks serotonin inhibitor
- muscle rigidity
- cooling blankets
- anticonvulsant
- artificial ventilation
- withhold med! notify provider!
hyponatremia is more likely to occur with SSRI when… + nursing actions
older adult taking diuretics
-obtain baseline sodium + monitor periodically
a rash with SSRI is treatable w…
antihistamine or discontinuation of SSRI
bruxism
is a condition in which you grind, gnash or clench your teeth
bruxism
teaching
- report to provider
- use mouth guard
- add low dose of buspirone
- take in AM to avoid sleep disturbnc
- dont take w food
pregnancy risk + SSRI
- fluox/paroxetine incr risk of birth defect
- late inpregnancy, can cause pulmo HTN + withdrawal in bb
meds to avoid with SSRI bc incr risk of serotonin syndrome
MAOI (discont 14 days prior)
TCA
St Johns wORT
-if starting MAOI, discont SSRI 5 wks prior
SSRI + warfarin + NSAID + anticoag
incr warfarin level
- monitor PT + INR
- assess for bleeding
SSRI + TCA + lithium
can incr level of meds
SNRI
drug name
- venlaxafine
- duloxefine
- desvenlaxafine
SNRI [venlaxafine, duloxefine, desvenlaxafine, levomilnacipran]
pharm action
incr amt of neurotransmitters available in brain
-little effect on other neurotransmitters/receptors
SNRI [venlaxafine, duloxefine, desvenlaxafine, levomilnacipran]
A/E
- headache
- nausea
- agitation
- anxiety
- dry mouth
- sleep disturbance
- hypo-natremia
- wt loss
- incr BP
- sex
SNRI [venlaxafine, duloxefine, desvenlaxafine, levomilnacipran]
teaching
- avoid ETOH
- gradual discontinuation
SNRI [venlaxafine, duloxefine, desvenlaxafine, levomilnacipran]
CI
- hepatic disease
- ETOH addiction
TCA should be careful w… and obtain a… before admin
older pt or w hx of cardiac issues
-obtain cardiac workup beforehand
MAOIs
drug names
- phenelzine
- isocarboxazid
- selegiline (patch)
- tranylcypromine
MAOI
pharm action
- black MAO in brain
- incr the amt of norepinephrine, dopamine, + serotonin available
MAOI are first line tx for…
MDD w atypical features aka atypical depression
-mood lifted/brightened in response to positive events or good news
MAOI
A/E
- CNS stim
- orthostatic hypotension
- hypertensive crisis
- rash assoc w selegiline patch
hypertensive crisis
severe HTN fr intense vasoconstriction + stim of heart
-usually fr intake of dietary tyramine
hypertensive crisis
manifestation
- headache
- N/V
- incr HR
- incr BP
- diaphoresis
- change in LOC
if hypertensive crisis is happening…
admin phentolamine IVE or nifedipine
- —rapid acting, a-adrenergic blocker
- continuous cardiac monitoring
- resp support
atypical antidepressant
drug name
bupropion
trazodone
mirtazapine
atypical/bupropion
pharm action
inhibits DOPAMINE reuptake
atypical/bupropion
indications
- alternative to SSRI bc no sex dysfunction
- smoking cessation
- seasonal dprssn
atypical/bupropion
A/E
- headache
- dry mouth
- GI distress
- constipation
- incr HR
- nausea
- restlessness
- insomnia
- suppress appetite
- seizures in high dosage
atypical/bupropion
CI
- seiuzure disorder
- MAOI
- eating disorder
trazodone
a/e
priaprism
-prolonged erections that continue hours past sexual stimulation
mirtazapine
SNRI + atypical antidepressant
-stim appetite
antidepressants that can cause serotonin syndrome
- MAOI
- SSRI
- Lithium
- TCA
