Antidepressant Drugs Flashcards
Tricyclics (5)
-triptyline
Tricyclics • amitriptyline HCL (Elavil) • desipramine HCL (Norpramin) • imipramine HCL (Tofranil) • nortriptyline HCL (Aventyl) • protriptyline HCJ (Vivactil)
Tricyclics - indications
• Depression.
• Clients with morbid fantasies
do not respond well to these
drugs
Tricyclics - ADRs
• Anticholinergic effects: dry mouth, blurred vision, constipation, and urinary retention • CNS effects: sedation, psychomotor slowing, and poor concentration • Cardiovascular effects: tachycardia, orthostatic hypotension, quinidine-like effect on the heart (assess history of MI) • GI effects: nausea and vomiting • Narrow therapeutic index (can be lethal in overdose
Tricyclics - Nursing implications
• Administer @ bedtime to minimize sedative effect • Takes 2-6 weeks to achieve therapeutic affects • 1-3 weeks should elapse between discontinuing tricyclics and initiating MAO inhibitors • Teach client to avoid alcohol • Avoid concurrent use of antihypertensive drugs • Carefully evaluate suicide risk
MAOIs (3)
(Monomine Oxidase Inhibitors) • isocarboxazid (Marplan) • phenelzine sulfate (Nardil) • tranylcypromine sulfate (Parnate)
MAOIs - indications
- Depression
- Phobias
- Anxiety
MAOIs - ADRs
• Tachycardia • Urinary hesitancy, constipation • Impotence • Dizziness • Insomnia • Muscle twitching • Drowsiness • Dry mouth • Fluid retention • Hypertensive crisis: Hypertension, severe headache, chest pain, fever, sweating, nausea and vomitin
MAOIs - Nursing implications
• Must not be used with
tricyclics (causes
hypertensive crisis)
• Major concern is need for dietary restrictions – certain drug and food interactions can cause hypertensive crisis • Instruct client not to eat foods with high tyramine content: aged cheese, red wine, beer, beef/chicken, live, yeast, yogurt, soy sauce, chocolate, bananas • Teach client not to take over-the-counter drugs without doctor approval, the warning signs of hypertensiive crisis, and to use caution around machinery
SSRIs (5)
• fluoxetine HCL (Prozac) • paroxifine (Paxil) • sertraline (Zoloft) • fluvoxamine (Luvox) • citalopram (Celexa
SSRIs - indications
- Depression
- Anxiety
- Panic disorder
- Aggression
- Anorexia Nervosa
- OCD
SSRIs - ADRs
• Drowsiness • Dizziness, light-heartedness • Headache • Insomnia • Depressed appetite • Serotonin syndrome • Sexual dysfunction • allergic reaction or rash – withhold drug if occurs
SSRIs - Nursing implications
• Effective in 2-4 weeks
• DO NOT use with MAOIs;
cause hyperactive crisis
• Wait 14 days between
discontinuing MAOI
and starting Prozac
• Wait 5 weeks between
stopping Prozac and starting
an MAOI
• May be given in evening if
sedation occurs
• Monitor for serotonin
syndrome (defined by at
least 3 symptoms):
- rapid onset of altered
mental status
- agitation
- myoclonus
- hyper reflexia
- fever
- shivering
- diaphoresis
- ataxia
- diarrhea
• Caution client about OTC
use of St. John’s Wort
Newer Antidepressants (7)
- Depression
- Trazadone: insomnia, dementia, with agitation
- Safer than tricyclics and MAOIs in terms of side effects
• Effective 2-4 weeks after treatment is initiated
- trazadone (Desyrel)
- mitrazapine (Remeron)
- maprotiline (Ludiomil)
- buprobion (Wellbutrin)
- amoxapine (Asendin)
- nefazodone (Serzone)
- venlafaxine (Effexor)
SNRI
other uses
Cymbalta (venlafaxine)
Good for GAD, panic disorder, OCD, social phobia, PTSD, Bulemia
Depakote
anticonfulsant/mood stablizier
valproic acid
hair loss, weight gain, insulin resistance, risk of birth defects
