Antidepressant/ Bipolar Flashcards
5 classes of antidepressant!
- Selective serotonin reuptake inhibitors (SSRIs)
- Serotonin/Norepinephrine Reuptake Inhibitors (SNRIs)
- Tricyclic antidepressants (TCA)
- Monoamine oxidase inhibitors (MAOIs)
- Atypical antidepressants
Antidepressant (general) nursing considerations
- Slow onset (1-3 weeks for sxs change/12 weeks maximal effect)
- Wean off
- *No PRN use
- Start slow and titrate up
- continue drug even when sxs free and 4-9 months after sxs approve
- Better response: drugs+ psychotherapy
- Relapses
- Suicide risk can increase initially: more common in <25 yrs
- —>energy levels increase and have energy to carry out suicide plan without transition in brain to get rid of suicidal thoughts
3 monoamine NT that are linked to depression - why do I care?
- Norepinephrine
- Dopamine
- Serotonin
*all antidepressants increase 1 or more of these monoamine NT
3 theories on how antidepressant treatment works (i doubt she will ask about this)
- If increase amt of NT –> post synaptic receptors decrease/desensitize = downregulation
- -> downregulation is what actually has an effect on the brain and doesn’t have effect until 4-6 weeks - brains adaptation to NT
- New synaptic formations have to form in order for mood/behavior to change
SSRI prototype
fluoxetine (Prozac)
which antidepressant has the best safety profile and it a first line choice?
fluoxetine (Prozac) (SSRI)
how does fluoxetine (Prozac) fxn?
Slow the reuptake of serotonin (5-HT) into presynaptic nerve terminals (accumulation of serotonin in synapse)
Side effects of fluoxetine (Prozac)
sexual dysfunction, nausea, headaches, nervousness, insomnia, anxiety, weight gain
onset of fluoxetine
May take up to 5 weeks to work
admin for fluoxetine (Prozac)- timing?
give in morning b/c of insomnia
can we use SSRI like fluoxetine in preg?
not in LATE preg
____ risk with SSRI (think about population)
Bleeding risk in elderly/someone w/ GI predisposition
Serotonin Syndrome (SES)- onset?
2-72 hours after treatment start
Serotonin Syndrome (SES) treatment?
stop the SSRI, break b/w drugs when transitioning to new med
sxs of Serotonin Syndrome (SES)
mental status changes, hypertension, tremors, fever and sweats, hyperpyrexia, or ataxia
Serotonin Withdrawal Syndrome sxs?
Dizziness, headache, nausea, sensory disturbances, tremor, anxiety, dysphoria
Serotonin Withdrawal Syndrome duration?
Persists 1-3 weeks
Serotonin Withdrawal Syndrome prevention
slowly tapering drug
prototype for Serotonin/Norepinephrine Reuptake Inhibitors (SNRI)
venlafaxine (Effexor)
how does venlafaxine (Effexor) fxn?
Block the uptake of both serotonin and norepinephrine
how are Serotonin/Norepinephrine Reuptake Inhibitors (SNRI) similar to SSRI?
sexual dysfunction, sustained myandriasis, serotonin syndrome, neonates, withdrawal symptoms
Side effects of venlafaxine (Effexor)
sexual dysfxn, Nausea, HA, anorexia, nervousness, sweating, somnolence and insomnia, HTN
prototype for Tricyclic Antidepressants
imipramine (Tofranil)
how does imipramine (Tofranil) fxn?
inhibit the reuptake of both NE and serotonin into presynaptic nerve terminals.
>To varying degrees-block AcH receptors and/or histamine
Side effects of imipramine (Tofranil)
Sedation common initially–> after several weeks tolerance of the sedation develops
- Anticholinergic effects are common, less so if drug is gradually increased over 2-3 weeks
- Orthostatic hypotension : blocks alpha 1 adrenergic receptors on blood vessels
imipramine (Tofranil) admin?
give @ bed time (sedation)
imipramine (Tofranil) serious risk of
OVERDOSE
lethal (❤️), 8X regular dose
- do not give to suicidal patients.
- acute depression –> give only 1 week Rx @ a time
drug drug interactions w/ imipramine (Tofranil)
> MOAI, sympathomimetic drugs, anticholinergic drugs
>Additive effect with other CNS depressants= sedation
prototypes for Monoamine Oxidase Inhibitors
Selegiline (EMSAM) MAO-B at low dose and MAO-A at high doses
Phenelzine (Nardil)
isocarboxiazide (Marplan)
Tranylcypromine (Parnate)
(SPIT)
how do Monoamine Oxidase Inhibitors fxn?
Inhibit the breakdown of NE, dopamine and serotonin in CNS neurons
Whats up with MOA and MOB?
- -MOA –> inactivates norepi and serotonin = inhibiting it keeps norepi/serotonin active for life of enzyme (2 weeks!)
- -MOB –> inactivates dopamine –> parkinson’s (celleduline)
what up with tyramine? what does it cause? who is it not playing nicely with?
(type of monoamine that is not broken down on MOA inhibitor ) if not broken down causes vasoconstriction –> hypertensive crisis
who is our most dangerous antidepressant?
MAOI
onset of MAOI
4-8 weeks
MAOI interacts with
- meperidine (Demerol)= hyperpyrexia
- antidepressant or sympathomimetic = hypertensive crisis
- antihypertensive = excessive hypotension
- diabetic drugs = hypoglycemia
MAAD
Me Peri make me hot
Antidepress= increase BP
Antihypertensive = hypotens (more of the same)
Diabeet= hypoglyc (more of the same)
Must be a ____ interval between the use of MAOI and MAAD drugs
14 day
MAOI + tyramine =
hypertensive crisis
foods with tyramine
Avocados, bananas, raisins, papaya, meat tenderizers, canned figs, fava beans, cheese, sour cream, yogurt, soy sauce, beer, wine-especially red, yeast/yeast extracts, beef or chicken liver, pate, meat extracts, pickled or kippered hearing, pepperoni, salami, sausage, bologna/hot dogs, chocolate
Who is our atypical antidepressant with an unknown mechanism of action?
Bupropion (Wellbutrin)
Benefits of Bupropion (Wellbutrin) compared to other antidepressants?
No weight gain or sexual dysfunction –> increase sexual desire
(stay skinny and get laid!!!)
Side effects of Bupropion (Wellbutrin)
seizures, agitation, HA….psychotic symptoms
what else is Bupropion (Wellbutrin) used for?
smoking cessation
drug for bipolar disease
Lithium
Lets talk ranges for Lithium
safe? best? increase adverse effects? dialysis? toxic?
0.4-1 mEq/L = safe
0.4 - 0.8 = best
–>0.8-1 = increase adverse effects
1.5 = toxic
>2.5 = dialysis
how does lithium treat bipolar disorder
no one knows… #science, but here are some theories
- reduce glutamate
- ion w/ + charge –> effects electrical conduction of nerves
whats up with salt and lithium?
When Na is low (hyponatremia); body holds on to lithium in an attempt to compensate
summer sweating + lithium = Lithium toxicity
s/s of toxicity of lithium
-N/V, tremors, polyuria, muscle weakness, ataxia, EKG changes, convulsions, coma and death
prototype for antidote for lithium?
no antidote! only give symptom management
>2.5 = dialysis
how do we admin lithium?
take 2/day or w/ food to prevent gi upset
adverse effects of Lithium
GI Hypothyroidism & Goiter --> check TSH, T3, T4 before/during therapy Tremors Renal damage Increases risk for toxicity Polyuria Birth defects
drug interactions with lithium?
NSAIDS
Diuretics
