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Nursing 3 > Antidepressant Meds > Flashcards

Antidepressant Meds Flashcards

1
Q

Antidepressants – How they work

A 
•Restore neurotransmitters while client learns coping
•May have other indications:
–Anxiety/ Anxiety disorders
–Chronic pain
–Eating disorders
•Affects:
–Serotonin (5-HT2)
–Norepinephrine
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2
Q

Norephinephrine affects…

A

Alertness

energy

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3
Q

Serotonin affects…

A

Obsessions and compulsions

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4
Q

Dopamine affects…

A

Attention
Motivation
Pleasure
Reward

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5
Q

Antidepressant categories

A

• Selective Serotonin Reuptake Inhibitors
(SSRI’s)
• Selective Serotonin-Norepinephrine
Reuptake Inhibitors (SSNRI’s) OR… Nonselective
Reuptake Inhibitors
• Heterocyclic Antidepressants (tricyclics –
TCA’s)
• Monamine Oxidase Inhibitors (MAOI’s)
• Miscellaneous Antidepressants

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6
Q

Facts common to most antidepressants

A 
• Take 1- 6 weeks to improve mood, although
serotonin levels rise sooner
• 30% clients need different drug
• “First break” treatment 6 – 12 months
• Some clients need longer treatment
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7
Q

Adverse effects common to most

antidepressants

A
  • Anticholinergic effects
  • Weight gain
  • Sexual side effects
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8
Q

Antidepressants main facts

A

• No addiction
• Withdrawal effects may occur
• Clients at greater risk for suicide when they
begin to have more energy!
• ***ALL now have black box warning: watch for
extreme personality changes leading to
suicide!!!!

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9
Q

SSRI Examples

A
  • Fluoxetine (Prozac, Sarafem)
  • Paroxetine (Paxil)
  • Sertraline (Zoloft)
  • Citalopram (Celexa)
  • Escitalopram (Lexapro)
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10
Q

SSRI Main Facts

A

First line therapy for depression
• Useful for anxiety, eating disorders, OCD
• Less side effects than older antidepressants
• Watch “washout” for Prozac
• *SSRI discontinuation syndrome – flu-like
symptoms, vivid dreams, agitation

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11
Q

SSRI s/e’s

A
  • Insomnia/ somnolence
  • Anxiety/ agitation/ restlessness
  • Nausea
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12
Q

Serotonin main facts

A 
• Potentially life-threatening
• Related to serotonin overdose
• Other medications contribute:
– MAOI’s
– St. John’s Wort
– Lithium
No lab test, just supportive treatment
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13
Q

Serotonin Syndrome Symptoms clinical

triad:

A 
• Cognitive: mental confusion,
hypomania, hallucinations, agitation,
headache, coma.
• Autonomic: shivering, sweating, fever,
hypertension, tachycardia, nausea,
diarrhea.
• Somatic : myoclonus/clonus (muscle
twitching), hyperreflexia, tremor.
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14
Q

SSNRI/NSRI Examples

A
  • Serotonin & Norepinephrine
  • Venlafaxine (Effexor)
  • Nefazodone (Serzone)
  • Duloxetine (Cymbalta)
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15
Q

SSNRI/NSRI Main facts

A 
• Less weight gain
• Less sexual dysfunction
• May be more anxiolytic (also may
produce anxiety)
• May increase BP
• Serzone: liver failure
• Cymbalta: treat fibromyalgia
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16
Q

Heterocyclics/TCAs main facts

A
  • Oldest class
  • Effective 70% of time
  • Also inhibit NE & 5-HT2 reuptake
  • Start low, go slow
  • 4 – 8 weeks before full effect
  • Also for chronic pain
17
Q

Heterocyclics/TCAs examples

A

– Amitriptyline (Elavil)
– Clomipramine (Anafranil)
– Imipramine (Tofranil)

18
Q

Heterocyclics/TCAs adverse effects

A 
• **Anticholinergic effects – review them!!!
• Other:
– Photosensitivity
– Decreased seizure threshold
• OVERDOSE DANGEROUS!
19
Q

Monamine Oxidase Inhibitors (MAOI’s) main facts

A

• Inhibit monamine oxidase, enzyme that
breaks down NE & 5-HT2
• Effective
• Not used often 2nd interactions

20
Q

MAOIs examples

A

– phenelzine (Nardil)
– Isocarboxazid (Marplan)
– tranylcyromine (Parnate)

21
Q

MAOI s/e’s

A
  • Orthostatic hypotension
  • Edema
  • Constipation
  • Hypomania
  • Insomnia
  • Usual s/e
22
Q

Tyramine

A

• Natural product of bacterial fermentation
• Displaces NE from storage vessels =
INCREASED BP
• Must be AVOIDED
• Long list of foods/ drugs to be avoided

23
Q

Foods containing tyramine

A 
• Anything aged: cheeses, meats, extracts, fish, some
wines
• Flavor cubes
• Bananas
• Sauerkraut
• Soy
• Draft beer
• Brewer’s yeast
24
Q

Interactions with MAOIs

A 
• Assume drugs not safe
with ANYTHING (RX or
OTC) else unless you have
other information!!
• Give adequate “washout”
time (10 days) prior to OR,
other meds
25
Q

Hypertensive crisis

A 
• It’s what happens when you mix tyramine with
MAOI’s
• S/S are same as those of severe HTN:
– Headache
– Nosebleeds
– Tachycardia
– N/V
– Diaphoresis
– Chest pain/ coma/ stroke
26
Q

Misc antidepressants

A

–Buproprion (Wellbutrin, Zyban) -
seizures
–Trazodone (Desyrel) - sleep
–Mirtazapine (Remeron)

27
Q

Antipsychotics as adjuncts

A

“atypical antipsychotic medications” such as Seroquel or Abilify are now being used to supplement antidepressant drugs in severely depressed people.

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