anti depressive meds (329 E2) Flashcards
general antidepressant medication education
-May not see symptom improvement until 4-6 weeks.
-Physiological symptoms improve before psychological symptoms. with increased energy danger of SI
-Look for improved sleep; less daytime fatigue and crying; & increased frustration tolerance.
-Side effects may occur but handled by adjusting dosage or switching to different med in same class.
-Discontinuing meds as soon as you feel better may result in relapse. Meds usually needed for 6-9 months past symptom relief- up to 12 -24 months.
-Antidepressants are not addictive.
-Abrupt stopping of meds will result in withdrawal- nausea, anxiety, insomnia, flu-like symptoms
-Do not drink alcohol
SSRIs
fluoxetine
paroxetine
sertraline
citalopram
escitalopram
vortioxetine
vilazodone
SNaRIs
venlafaxine
duloxetine
SNRIs
desvenlafazine
all the SRIs
-more serotonin in the blood stream
-less anticholinergic effects
-really good for depression w/ anxiety or psychomotor agitation
SE of the SRIs
-drowsiness
-N/D
-dry mouth*
-insomnia
-nervousness, agitation, restlessness
-dizziness
-sexual problem*
-headache*
-blurred vision*
SE diminish in 4-6 wks
* = most common
SRIs nursing considerations
-take at night w/ food
-increase fluids & fibers
-takes 4 to 8 wks for effect
-monitor for SI, fever, inc BP, manic sx
-improve sleep hygiene
-avoid caffeine if anxious
-teach relaxation techniques
-abrupt discontinuation may be mild or severe
serotonin syndrome
rare SE of SRIs
-Mental Status Changes: Agitation, confusion, restlessness, lethargy, delirium, irritability, dizziness, hallucinations
-ANS: Diaphoresis, flushing, fever, tachycardia, mydriasis
-Neuromuscular: Myoclonus (muscle twitching or jerks), hyperreflexia, tremors
-GI: N/V/D
-If serotonergic med not discontinued may progress to worsening myoclonus, hypertension, rigor, acidosis, respiratory failure, rhabdomyolysis
60% of pts that get SS develop symptoms within 6 hours of either first dose of new medication, a change in dosing, or intentional overdose
-Can be fatal
treatment of serotonin syndrome
-Stop or reduce medications contributing to SS depending on severity of symptoms as directed by the prescriber.
-Benzodiazepines such as diazepam or lorazepam can help control agitation, seizures and muscle stiffness.
-Oxygen: maintain normal oxygen levels
-Intravenous (IV) fluids: to treat dehydration and fever
-Provide symptomatic and supportive care
-Symptoms usually resolve within 24 hours but can take several weeks to go away completely
-drugs for HR and BP (lol or phrines if hypo)
-cyprohepatidine HCL
cyprohepatidine HCL
a Serotonin-production blocking agents. If other treatments aren’t working, can help by blocking serotonin production.
tricyclic antidepressants
imipramine
desipramine
doxepin
amitriptyline
tricyclic SE
-anticholinergic effects
-orthostatic hypotension
-tachycardia
-dizziness / falls
-sedative
_cardiac issues
deadly in overdose or when taken with other central nervous system depressants
tricyclic nursing considerations
-more affordable
-10 to 14 days until start to see effect, 4 to 8 wks until full effect
-start w/ a low dose and increasing slowly
-give at night
-check to make sure no seizure or cardiac hx
tricyclics are contraindicated for people who have
-hx of MI
-seizure disorders
-narrow angle glaucoma
-women who are pregnant or trying
MAOIs
isocarboxazid
phenelzine
tranycypromine
selegiline
3rd choice treatment
MAOI moa
blocks the enzyme monoamine oxidase which is used to metabolize the monoamines SE, NE and dopamine
MAOI SE
dry mouth
nausea
diarrhea or constipation
headache
drowsiness
insomnia
dizziness
most serious reaction when taking an MAOI
increase in blood pressure that can develop into intracranial hemorrhage
MAOI nursing considerations
avoid tyramine rich foods to prevent HTN crisis (aged, smoked, fermented marinated or processed meats, aged cheeses, overripe fruits and vegetables, beans, alc)
how we treat a hypertensive crisis
-regitine (phentolamine): alpha andrenergic blocker, vasodilator
-procardia: a CCB, relaxes cardiac muscle
-symptomatic & supportive
other antidepressants: buproprion
-contraindicated in eating disorder and hx of seizures
-less sexual side effects
-considered “energizing”
-used in smoking cessation
other antidepressants: trazodone
very often given at hs for sedative effect as adjunct w/ another AD
other antidepressants: mirtazapine
good for sleep
black box warning for SSRIs in children & teens
increased risk of SI
but less of a risk to not take then to take
other treatments for depression
-Phototherapy/Light Therapy
-ECT
-Vagal nerve stim or deep brain stim
-transcranial magnetic stim
-acupuncture or massage therapy
-St.John’s wort, SAMe, omega
-exercise
-relaxation techniques
advanced practice interventions for depression
-CBT
-IPT
-time limited focused psychotherapy
-group therapy
