Antidepressant Agents Flashcards
What does Antidepressant agents do?
They block the ability of the neurotransmitter to go into the nerve. This increases the levels of neurotransmitters in the synaptic cleft which has therapeutic effect on the patient.
What are the suffixes of Tricyclic Antidepressants?
“Triptyline” & “Pramine”
Amitriptyline Trimipramine
Nortriptyline Imipramine
And outlier drug : Doxepin
What are the names of the generic drugs classified as Monoamine Oxidase Inhibitors?
Isocarboxazid
Phenelzine
Tranylcypromine
Selegiline
(transdermal)
What are the suffixes of the drugs within the drug class Selective Serotonin Reuptake inhibitors?
“Italopram” “Oxetine”
Citalopram Fluoxetine
Escitalopram Paroxetine
Outlier is : Sertraline
What is the suffix of the drug class Serotonin Norepinephrine Inhibitors?
Desvenlafaxine
Venlafaxine
Outlier is : Duloxetine
what drug class is Duloxetine as part of?
Serotonin Norepinephrine Inhibitors
What drug class is Isocarboxazid and Phenelzine a part of?
Monoamine Oxidase Inhibitors
What drug class is Sertraline a part of?
Selective Serotonin Reuptake inhibitors
How does MAOI’s / Monoamine Oxidase Inhibitors work?
Irreversibly inhibit MAO - which allows norepinephrine, Serotonin and dopamine to accumulate in the synaptic cleft.
What is MAO?
Monoamine Oxidase. An enzyme found in the brain and which is thought to be a cause of some types of depression. MAO removes many chemicals from the brain, including serotonin, a chemical that can help people sustain a positive mood.
What would a patient take Phenelzine for?
For depression if no other antidepressants are working. Phenelzine is a MAOI which are not a first choice due to its side effects.
If a patient is on MAOI’s what type of food do they need to avoid?
Food that contain Tyramine. Aged cheeses and meat, soy sauce, red wine.
Tyramine combined with MAOI’s increases hypertensive crisis risk.
What is a Hypertensive crisis?
A hypertensive crisis is a sudden, severe increase in blood pressure. The blood pressure reading is usually above 180/120
Why would a patient be taking Fluoxetine?
Depression, OCD, Panic Attacks, Bulimia, PMDD, PTSD, Social phobias and anxiety.
Fluoxetine is a Selective Serotonin Reuptake inhibitor.
Why would a patient be taking Duloxetine?
Depression, Nerve pain (Neuropathic pain), Fibromyalgia (a chronic condition that causes widespread pain and tenderness in the body) & Anxiety.
Duloxetine is a Selective Norepinephrine Inhibitor.
Why would a patient be taking Doxepin?
Sleep disorders, Depression, Enuresis, Anxiety and Chronic Pain.
Doxepin is a Tricyclic Antidepressant.
How does Selective Serotonin Reuptake Inhibitors work?
By specifically blocking the CNS neuronal uptake of Serotonin. The drugs have little to no known effect of Norepinephrine. The drugs have fever adverse effects due to this fact.
How does Serotonin Norepinephrine Inhibitors work?
Decreases neuronal uptake of BOTH serotonin and norepinephrine and more weakly inhibit dopamine uptake.
How does Tricyclic Antidepressants work?
Reduces uptake of both Serotonin and Norepinephrine into the nerves.
What Antidepressant comes in nasal spray form?
Esketamine
What are the signs and symptoms of depression?
Low Energy Level
Sleep Disturbances
Altered appetite
Altered Libido
Inability to perform activities of daily living
Overwhelming feelings of sadness, despair, hopelessness and disorganization.
What causes depression?
Lack of Norepinephrine, Dopamine and Serotonin.
Monoamine Oxidase may be one of the reasons for this as it breaks them down to be recycled or stored in the neuron.
Rapid fire of neurons may lead to depletion
Number or sensitivity of postsynaptic receptors may increase and deplete neurotransmitter levels.
How are some ways Antidepressants work?
Inhibit the effects of MAO, leading to increased NE or 5HT
in the synaptic cleft
Block reuptake by the releasing nerve, leading to
increased neurotransmitter levels in the synaptic cleft
Regulate receptor sites and breakdown of
neurotransmitters, leading to an accumulation of
neurotransmitters in the synaptic cleft
Which are the 5 classifications of Antidepressants?
Tricyclic antidepressants (TCAs)
MAO inhibitors (MAOIs)
Selective serotonin reuptake inhibitors (SSRIs)
Serotonin norepinephrine inhibitors (SNRIs)
“Others”
What would a patient be prescribed Tricyclic Antidepressants for?
For sleep disorders due to its sedative effect, Depression, Anxiety, Enuresis and Chronic pain
What would a patient be prescribed Monoamine Oxidase Inhibitors for?
Depression when other antidepressants cannot be taken due to its adverse effects
What would a patient be prescribed Selective Serotonin Reuptake Inhibitors for?
Depression, OCD, Panic Attack, Bulimia, PMDD, PSTD, Social phobia and anxiety
What would a patient be prescribed Serotonin Norepinephrine Inhibitors for?
Depression, Neuropathic pain, fibromyalgia and anxiety.
What drug class does Bupropion go under?
Other
What are some important things to remember regarding Bupropion specifically?
Low Dose
Smoking Cessation
Comes in extended and sustained release form.
What drug class is Mirtazapine
Other
What are some important things to remember about Mirtazapine?
Its a atypical antidepressant
It has many anticholinergic effect.
What drug class is Trazadone?
Other
What are some important things to remember about Trazadone?
Causes many CNS effects
Black box warning for suicidality, hypotension, and priapism (prolonged and painful erection)
Part of the “other” category
What drug class is Esketamine a part of?
Other
What are some important things to remember about Esketamine?
o Nasal spray is approved for depression
o CNS effects and increased BP
What are the contraindications when it comes to Trimipramine?
Recent case of myocardial Infarction, could worse or reoccur. This is because tachycardia and arrythmias are adverse effects of Tricyclic Antidepressants.
What are the contraindications of Phenelzine?
If the patient has a Pheochromocytoma which is tumor that forms on the Adrenal gland. This may lead to a hypertensive crisis.
Other contraindications are cardiovascular disease, headaches which may be exacerbated by the drug.
Renal or Hepatic impairment which may lead to toxicity of accumulating drug.
Phenelzine is a MAOI.
what are the contraindications of Desvenlafaxine?
MAOI use because this may cause serotonin syndrome. Serotonin syndrome is a potentially life-threatening condition that occurs when there is too much serotonin in the body.
SNRI’s and MAOI’s should never be mixed due to this fact.
What are some adverse effects of Amitriptyline?
CNS: Sedation, Sleep Disturbance, Fatigue, Hallucinations and Ataxia (loss of muscle control)
GI: Dry mouth, Constipation, nausea and vomiting
CV: Tachycardia, Arrythmias and Hypotension
Amitriptyline is a tricyclic agent.
What are some adverse effects of Tranylcypromine?
CNS: Dizziness, Excitement, Nervousness, Mania, Hyperreflexia, Tremors, Confusion, Insomnia, Agitation.
CV: Hypertension, Tachycardia, Arrythmias
Black Box warning for Suicide in children and young adults
Tranylcypromine is a MAOI ( Monoamine Oxidase Inhibitor)
What are some adverse effects of Sertraline?
CNS: Headache, Drowsiness, Dizziness, Insomnia, Tremor, Agitation
GU: Painful mensuration, Sexual Dysfunction, Impotence, Urgency and increased risk for Serotonin Syndrome.
Sentraline is a SSRI ( Selective Serotonin Reuptake Inhibitor)
What are some adverse reactions to Duloxetine?
Hyperhidrosis (excessive sweating)
Erectile Dysfunction
Cardiac: tachycardia, Palpitations and Hypertension
Abnormal bleeding
Anticholinergic effect : Glaucoma
Urinary Retention and risk for Serotonin Syndrome.
Duloxetine is a SNRI (Serotonin Norepinephrine Inhibitor)
What are some cautions to take into account when a patient is prescribed Imipramine?
CV disease related to CV effect
Anticholinergic conditions
Manic Depression/ Bipolar disorder because a patient can become more manic.
Seizure Disorder because this drug can lower the threshold for seizures.
Imipramine is a Tricyclic Antidepressant.
What are some cautions to take into account when a patient is prescribed Selegiline?
Bipolar disorder
Seizure disorder
Hyperthyroidism
Selegiline is a MAOI
What are some cautions to take into account when a patient is prescribed Venlafaxine?
Severe Depression
Suicidality (Black Box Warning)
Bipolar Disorder
Seizure Disorder
Venlafaxine is a SNRI
What are some cautions to take into account when a patient is prescribed Citalopram?
Impaired renal and hepatic function
Pregnancy/Lactation due to there being congenital abnormalities in animal studies.
Citalopram is SSRI
What are some drug-drug interactions that may cause adverse effects to a patient taking Doxepin?
MAOI’s, Cimetidine, Fluoxetine (SSRI)
(toxicity)
Doxepin is a tricyclic agent
What are some drug-drug interactions that may cause adverse effects to a patient taking Isocarboxazid?
Other antidepressants as the combination may lead to a Hypertensive crisis, coma, convulsion, serotonin syndrome,
Sympathomimetics (a class of drugs that mimic the effects of the sympathetic nervous system)
as CV effect could increase
Antidiabetics as they could increase the risk of hypoglycemia
Iscocarboxazid is a MAOI
What are some drug-drug interactions that may cause adverse effects to a patient taking Fluoxetine?
MAOI’s due to increase risk of Serotonin Syndrome
TCA’s
SNRI’s
St Johns Wort
Fluoxetine is a SSRI
What are some drug-drug interactions that may cause adverse effects to a patient taking Venlafaxine?
MAOI’s due to increase risk of Serotonin Syndrome
TCA’s
SNRI’s
St Johns Wort
Venlafaxine is a SNRI
For all the drug classes what would you, as a nurse, assess for during the nursing process?
History :
Allergy
Depression
Suicidality
Bipolar Disorder
Contraindications and Cautions
Existing conditions that could be worsened by anticholinergic effects
Impaired liver functions
Pregnancy and lactation
Physical: Vital & Weight. CNS incl vision and abdomen
Lab: Renal and Hepatic, ECG
What nursing diagnosis would you expect to make?
Impaired comfort
Altered thought processes and sensory perception
Malnutrition risk
Knowledge deficit
What implantations would you expect to make with a a patient taking SSRI’s and SNRI’s?
Establish suicide precautions for severely depressed patients, and limit the
quantity of the drug dispensed
◦ Administer the drug once a day in the morning to achieve optimal therapeutic
effects unless the patient benefits from a sedative effect by taking at night
◦ If dose is increased or if the patient is having severe GI effects, the dose can
be divided
What implantations would you expect to make with a a patient taking MAOI’s?
Limit drug access to a potentially suicidal patient
◦ Monitor blood pressure and orthostatic blood pressure
◦ Discontinue drug and monitor patient carefully at any complaint of severe headache
◦ Have phentolamine or another adrenergic blocker on standby due to risk of hypertensive crisis
Provide teachings regarding Drug-food interactions of tyramine
What Implementations would you expect to make with a patient taking Tricyclic Antidepressants?
- Limit drug access if the patient is suicidal
- Parenteral form only if oral not feasible
- Reduce dose if minor adverse effects occur
- Discontinue slowly if major or life-threatening adverse effects occur
- Provide comfort and safety measures
- Drowsy/anticholinergic effects: administer dose at bedtime
- Provide thorough patient teaching
What are some considerations and awareness that are important for children taking antidepressants?
We don’t always know how children will respond so we would want to monitor the child closely.
It could cause possible long-term effects
Not always efficient
Black Box Warnings due to increased suicidal ideation and behavior
MAOIs should be avoided due to severity of drug-food interactions
Some TCAs have established pediatric doses.
Drug classes tried first: SSRIs and SNRIs
Rule out medical reasons for mood before starting medication
What are some considerations and awareness that are important for adults taking antidepressants?
Rule out medical reasons for mood first
Effects may not be seen for four weeks
Caution during pregnancy and lactation (Some drugs can be taken during pregnancy but may still have adverse effects. Risk vs Benefit)
What are some considerations and awareness that are important for older adults taking antidepressants?
Rule out medical reasons for mood first
More susceptible to adverse effects especially CNS effects
Renal and hepatic impairment
Start low, go slow
TCAs can worsen benign prostatic hyperplasia
Decreases bladder contractions
What is ‘affect’?
A patient’s immediate expression of emotion, which can be observed through their non-verbal language.
Tip to remember that “triptyline” is a suffix to Tricyclic antidepressants.
I take a “trip” on my Tricycle
Tip to remember that “pramine” is a suffix to Tricyclic antidepressants
The toddler travelled in the ‘pram” instead on the tricycle.
Why do we need to be careful with administering tricyclic agents and MAOI’s to a patient who has bipolar disease?
Because it may shift the patient into a more manic phase.
Why do we need to be careful with administering Trimipramine and Phenelzine to a patient who suffers/have suffered from seizures?
Because Tricyclic antidepressants and MAOI’s may lower the seizure threshold.
Why is cardiac disease/ dysfunction a concern when a patient have been given TCA’s?
The increase in Norepinephrine may exacerbate these symptoms.
This is why an EKG may be needed before administrating TCA’s to a patient.
Which class of drugs should be administered at bed time due to its sedative effect?
TCA’s
Which MAOI drug class is transdermal?
Selegiline
What drug would we use to treat a Hypertensive Crisis?
Phentolamine or other Adrenergic blockers
What are the 5 categories of Antidepressants?
Tricyclic antidepressants (TCAs)
MAO inhibitors (MAOIs)
Selective serotonin reuptake inhibitors (SSRIs)
Serotonin norepinephrine inhibitors (SNRIs)
“Others”
