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(2) N231 Pharmacology > Affective Disorders Meds (BY CLASSES) > Flashcards

Affective Disorders Meds (BY CLASSES) Flashcards

1
Q

Tricyclics (TCA’s)

A

Name(s): Amitriptyline (Elavil), Amoxapine (Asendin), Doxepin (Sinequan), Imipramine (Tofranil), Desipramine (Norpramin), Nortriptyline (Pamelor)

Indication(s): Treatment and management of depression

Action(s): Potentiates effect of serotonin and norepinephrine in CNS; has significant anticholinergic properties (blocks acetylcholine)

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2
Q

Client education for TCA’s

A
  • May result in behavioral changes, including SI, depression, anxiety, agitation, restlessness, panic attacks
    • Notify provider immediately if ANY behavioral changes occur
  • May cause dizziness, drowsiness, or blurred vision
    • Use caution while driving or activities that require alertness
  • Caution client to wear sunscreen and protective clothing
    • Prevention of photosensitivity reactions
  • Assess for serotonin syndrome - especially when taking other SSRI’s/SNRI’s/MAOI’s
    • Mental changes - agitation, hallucinations, coma
    • Autonomic instability - tachycardia, labile BP, hyperthermia
    • Neuromuscular abberations - hyperreflexia, incoordination
    • GI symptoms - N/V/D
  • Monitor for persisting urinary retention, dry mouth, or constipation (anticholinergic effects)
    • Encourage sugar-free drinks and hard candy
    • Promote adequate fluid intake
  • Contraindications
    • Angle-closure glaucoma
    • History of recent MI
    • History of HF
    • Pregnancy (Class C)
    • Lactation
    • ETOH - use cautiously
      • May cause dizziness, drowsiness, and cognitive difficulties
    • Certain medications
      • CNS depressants
        • Sedatives/hypnotics
        • Antihistamines
        • Opioids analgesics
      • Concurrent antidepressants
        • MAO’s - AVOID
        • SSRI’s - use cautiously
        • SNRI’s - use cautiously
      • St. John’s wort
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3
Q

Monoamine Oxidase Inhibitors (MAOI’s)

A

Name(s): Isocarboxazid (Marplan), Phenelzine (Nardil), Tranylcypromine (Parnate)

Indication(s): Treatment and management of depression (resistant to other treatments), MDD

Action(s): Inhibits the enzyme monoamine oxidase, resulting in an accumulation of various neurotransmitters (dopamine, epinephrine, norepinephrine, and serotonin) in body

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4
Q

Client education for MAOI’s

A
  • May result in behavioral changes, including SI, depression, anxiety, agitation, restlessness, panic attacks
    • Notify provider immediately if ANY behavioral changes occur
  • May cause dizziness or drowsiness
    • Use caution while driving or activities that require alertness
  • Avoid OTC medications
    • Discuss the use of OTC meds with provider before use
  • Monitor BP and HR before and during therapy
    • Report significant changes promptly
  • Contraindications
    • Liver disease
    • Severe renal disease
    • Cerebrovascular disease
    • CV disease
    • Uncontrolled HTN
    • Pheochromocytoma
    • Severe or frequent HA’s
    • Certain medications
      • Concurrent antidepressants
        • TCA’s - use cautiously
        • SNRI’s - AVOID (HIGHEST RISK OF SS)
        • SNRI’s - use cautiously
      • General anesthetics
      • Diuretics
      • Antihistamines
    • Certain diets
      • Tyramine-rich food
        • Red wine
        • Aspartame
        • Aged cheeses
        • Processed meats
        • Fermented soy products
      • Excessive caffeine consumption
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5
Q

Selective Serotonin Reuptake Inhibitors (SSRI’s)

A

Name(s): Fluoxetine (Prozac)*, Citalopram (Celexa), Escitalopram (Lexapro), Fluvoxamine (Luvox), Vilazodone (Viibryd), Sertraline (Zoloft), Paroxetine (Paxil)

Indication(s): Depression, MDD, *BP I depressive episodes

Action(s): Inhibits the reuptake of serotonin in CNS, thus potentiating activity of serotonin

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6
Q

Client education for SSRI’s

A
  • May result in behavioral changes, including SI, depression, anxiety, agitation, restlessness, panic attacks
    • Notify provider immediately if ANY behavioral changes occur
  • May cause dizziness or drowsiness
    • Use caution while driving or activities that require alertness
  • Assess for serotonin syndrome - especially when taking other TCA‘s/SNRI’s/MAOI’s
    • Mental changes - agitation, hallucinations, coma
    • Autonomic instability - tachycardia, labile BP, hyperthermia
    • Neuromuscular abberations - hyperreflexia, incoordination
    • GI symptoms - N/V/D
  • Contraindications
    • History of seizures - use cautiously
    • History of mania - use cautiously
    • Angle-closure glaucoma (including risk of)
    • Pregnancy (Class C-D)
    • Lactation
    • ETOH - use cautiously
      • May cause dizziness, drowsiness, and cognitive difficulties
    • Certain medications
      • CNS depressants
        • Sedatives/hypnotics
        • Antihistamines
        • Opioids analgesics
      • Concurrent antidepressants
        • MAO’s - AVOID (HIGHEST RISK OF SS)
        • TCA’s - use cautiously
        • SNRI’s - use cautiously
      • St. John’s wort
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7
Q

Serotonin-Norepinephrine Reuptake Inhibitor (SNRI’s)

A

Name(s): Venlafaxine (Effexor), Desvenlafaxine (Pristiq), Duloxetine (Cymbalta), Levomilnacipran (Fetzima)

Indication(s): Treatment and management of MDD

Action(s): Inhibits serotonin and norepinephrine reuptake in CNS, thus potentiating the activity of serotonin and norepinephrine

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8
Q

Client education for SNRI’s

A
  • May result in behavioral changes, including SI, depression, anxiety, agitation, restlessness, panic attacks
    • Notify provider immediately if ANY behavioral changes occur
  • May cause dizziness or drowsiness
    • Use caution while driving or activities that require alertness
  • Assess for serotonin syndrome - especially when taking other TCA’s/SSRI’s/MAOI’s
    • Mental changes - agitation, hallucinations, coma
    • Autonomic instability - tachycardia, labile BP, hyperthermia
    • Neuromuscular abberations - hyperreflexia, incoordination
    • GI symptoms - N/V/D
  • Monitor BP before and periodically during therapy
    • Sustained HTN may be dose-related
      • Decrease dose or discontinue therapy if it occurs
  • Do NOT discontinue medication abruptly - must taper off slowly
  • Contraindications
    • History of seizures - use cautiously
    • History of mania - use cautiously
    • Pregnancy (Class C-D)
    • Lactation
    • ETOH - use cautiously
      • May cause dizziness, drowsiness, and cognitive difficulties
    • Certain medications
      • CNS depressants
        • Sedatives/hypnotics
        • Antihistamines
        • Opioids analgesics
      • Concurrent antidepressants
        • MAO’s - AVOID
        • TCA’s - use cautiously
        • SSRI’s - use cautiously
      • St. John’s wort
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9
Q

Antipsychotics/Mood Stabilizers

A

Name(s): Aripriazole (Abilify), Olanzapine (Zyprexa), Risperidone (Ripserdal), Quetiapine (Seroquel)

Indication(s): Acute/short-term treatment of BP I manic, mixed, or depressive episodes; management of BP I

Action(s): Antagonizes dopamine and serotonin in CNS

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10
Q

Client education for antipsychotics/mood stabilizers

A
  • May result in behavioral changes, including SI, depression, anxiety, agitation, restlessness, panic attacks
    • Notify provider immediately if ANY behavioral changes occur
  • May cause dizziness or drowsiness
    • Use caution while driving or activities that require alertness
  • Advise patient to change positions slowly to minimize orthostatic hypotension
    • Assess for fall risks
  • Monitor patient for onset of extrapyramidal side effects - requires dose adjustment
    • Akathisia
      • Restlessness or desire to keep moving
    • Dystonia
      • Involuntary muscle contractions that cause slow repetitive movements or abnormal postures
    • Tardive dyskinesia
      • Uncontrolled rhythmic movement of mouth, face, and extremities
      • Lip-smacking or puckering
      • Puffing of cheeks
      • Uncontrolled chewing
      • Rapid or worm-like movements of tongue
    • Anxiety, distress, paranoia
    • Bradyphrenia
      • Slowed thinking and processing of information
  • Contraindications
    • History of seizures - use cautiously
    • DM - may ↑ risk of hyperglycemia
    • CV disease - use cautiously
    • Cerebrovascular disease - use cautiously
    • Conditions that cause HotN
      • Dehydration
      • Antihypertensives
      • Diuretics
    • Pregnancy (Class C)
    • Lactation
    • ETOH - use cautiously
      • May cause dizziness, drowsiness, and cognitive difficulties
    • Certain medications
      • CNS depressants
        • Sedatives/hypnotics
        • Antihistamines
        • Opioids analgesics
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11
Q

Anticonvulsants

A

Name(s): Gapabentin (Neurontin)*, Divalproex (Depakote)*, Lamotrigine (Lamictal)**, Carbamazepine (Equetro)**

Indication(s): Acute treatment of BP I manic, or mixed episodes; management of BP I

Action(s): Stabilizes neuronal membranes by *increasing levels of GABA, or **inhibiting Na+ transport

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12
Q

Client education for anticonvulsants

A
  • May result in behavioral changes, including SI, depression, anxiety, agitation, restlessness, panic attacks
    • Notify provider immediately if ANY behavioral changes occur
  • May cause dizziness or drowsiness
    • Use caution while driving or activities that require alertness
  • Change positions slowly to minimize orthostatic hypotension
  • Monitor for rashes or fevers periodically during therapy
    • May cause SJS, TEN, or DRESS
  • Contraindications
    • HF
    • Ischemic heart disease
    • 2nd/3rd-degree heart block
    • Pregnancy (Class C-D)
      • Gabapentin is unclassified
    • ETOH - use cautiously
      • May cause dizziness, drowsiness, and cognitive difficulties
    • Certain medications - CNS depressants
      • Sedatives/hypnotics
      • Centrally-acting analgesics
      • Opioids analgesics
      • Antidepressants - use cautiously
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13
Q

Atypical Antidepressants

A

Name(s): Buproprion (Wellbutrin)*, Mirtazapine (Remeron)**

Indication(s): Treatment of depression*, MDD**

Action(s): *Decreases neuronal reuptake of dopamine in CNS and diminished neuronal uptake of serotonin and norepinephrine; **potentiates the effects of norepinephrine and serotonin

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14
Q

Client education for atypical antidepressants

A
  • May result in behavioral changes, including SI, depression, anxiety, agitation, restlessness, panic attacks
    • Notify provider immediately if ANY behavioral changes occur
  • May cause dizziness or drowsiness*
    • Use caution while driving or activities that require alertness
    • Change positions slowly to minimize orthostatic hypotension
  • May impair judgment or motor and cognitive skills*
    • Caution patient to avoid driving and other activities requiring alertness
  • Caution client to wear sunscreen and protective clothing*
    • Prevention of photosensitivity reactions
  • Monitor for rashes or fevers periodically during therapy**
    • May cause SJS, TEN, or NMS
  • Contraindications
    • History of seizures - use cautiously
    • DM - may ↑ risk of hyperglycemia
    • CV disease - use cautiously
    • Cerebrovascular disease - use cautiously
    • Angle-closure glaucoma - use cautiously
    • Pregnancy (Class C)
    • Lactation
    • ETOH - use cautiously
      • May cause dizziness, drowsiness, and cognitive difficulties
    • Certain medications - CNS depressants
      • Sedatives/hypnotics
      • Centrally-acting analgesics
      • Opioids analgesics
      • Antidepressants - AVOID MAOI’s**

* = Buproprion

** = Mirtrazapine

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15
Q

Lithium

A

Name(s): Lithobid

Indication(s): Acute treatment of BP I manic or mixed episodes; management of BP I

Action(s): Alters cation transport in nerve and muscle; may also influence reuptake of neurotransmitters

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16
Q

Client education for lithium

A
  • May cause drowsiness or drowsiness
    • Use caution while driving or activities that require alertness
  • Low lithiums may predipose client to toxicity
    • Ensure adequate fluid intake (2-3L/day)
      • Avoid excessive coffee/tea/cola (caffeine) due to diuretic effects
    • Maintain consistent, moderate Na+ intake;
      • Avoid activities that cause excessive ↓Na+
    • Notify provider of fever, vomiting, and diarrhea
      • May also cause excessive ↓Na+
  • Emphasize importance of periodic labs to monitor for toxicity
    • Monitor serum levels x2/wk during initiation and q2mo during chronic therapy
      • Therapeutic lithium levels: 0.6-1.2 mmol/L
        • >1.2 mmol/L is toxic and may result in s/s
    • Toxicity s/s - if present, hold dose and report to provide
      • V/D
      • Slurred speech
      • Drowsiness, lightheadedness
      • Decreased coordination
      • Muscle weakness, tremor, twitching
  • Contraindications
    • Brugada syndrome
    • Products containing ETOH
    • Pregnancy (Class D
    • Lactation
    • Conditions that increase risk of lithium toxicity
      • Significant CV disease
      • Renal impairment
      • Dehydration
      • Fever
      • Hyponatremia
    • DM - use cautiously

(2) N231 Pharmacology (6 decks)

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