Antidepressant Meds: Med Overview

Question 1

MAOIs

Drugs

Answer 1

Isocarboxazid
Tranylcypromine sulfate
Phenelzine sulfate

Question 2

MAOIs

Adverse Effects

Answer 2

Postural Hypotension
If foods with tyramine ingested, can have HYPERTENSIVE crisis: headache, sweating, palpitations, stiff neck, intracranial hemorrhage.
potentiates alcohol and other meds.

Question 3

MAOIs

Nursing Considerations

Answer 3

Inhibits monoamine oxidase enzyme, preventing destruction of norepinephrine, epinephrine, and serotonin. Avoid foods with tyramine- aged cheese, liver, yogurt, herring, yest, beer, wine, sour cream, pickled products. Avoid caffeine, antihistamines, amphetamines. Takes 3-4 weeks to work. Avoid tricyclics until 3 weeks after stopping MAO inhibitors. Monitor vital signs. Sunblock required.

Question 4

MAOIs

No Popular Meds…

Answer 4

Nardil (phenelzine), Parnate ( Tranylcypromine) , Marplan (Isocarboxazid).

NO Barbiturates, Meperidine ( demerol), Tricyclic and SSRI antidepressants, antihistamines, CNS depressants, Antihypertensives, OTC medications- cold remedies, asthma medications, nasal decongestants.

NO Avocados, cheese, wine, aged meats, smoked fish

Question 5

Tricyclics
( think tricycles)
Drugs

Answer 5

Amitriptyline hydrochloride, Imipramine, Desipramine hydrochloride, doxepin, Nortriptyline.

Question 6

Tricyclics

Adverse Effects

Answer 6

Sedation/ drowsiness, especially w Elavil ( amitriptyline ), blurred vision, dry mouth, diaphoresis, postural hypotension, palpitations, nauseous, vomiting, constipation, urinary retention, increased appetite.

Question 7

Tricyclics

Nursing Considerations

Answer 7

Increased brain amine levels, Suicide risk high after 10-14 days because of increased energy. Monitor vital signs, sunblock required, increased fluid intake, take dose at bedtime ( sedative effect), use sugarless candy or gum for dry mouth, delay of 2-6 weeks before noticeable effects.

Question 8

Tricyclics

Alert/ watch for signs

Answer 8

When depressed patients begin to feel better after starting meds, they are at increased risk of suicide.

Watch for signs of: sedation, orthostatic hypotension, dec sexual ability/desire, dry mouth, urinary retention, cardiac dysrhythmias.

Question 9

Selective serotonin reuptake inhibitors ( SSRIs)

SNRIs ( Serotonin-norepinephrine reuptake inhibitors)
Drugs

Answer 9

SSRIs- fluoxetine, paroxetine, sertraline hydrochloride, citalopram.

SNRIs- Venlafaxine, Duloxetine

Question 10

Selective serotonin reuptake inhibitors ( SSRIs)

SNRIs ( Serotonin-norepinephrine reuptake inhibitors)

Adverse Effects

Answer 10

Palpitations, bradycardia. Nausea, vomiting, diarrhea or constipation, increased or decreased appetite. Urinary retention. Nervousness, insomnia.

Question 11

Selective serotonin reuptake inhibitors ( SSRIs)

SNRIs ( Serotonin-norepinephrine reuptake inhibitors)

Nursing Considerations

Answer 11

Decreases neuronal uptake of serotonin. Take in AM to avoid insomnia. Takes at least 4 weeks to work. Can potentiate effect of digoxin, warfarin, and diazepam. Used for anorexia.

Question 12

Heterocyclics/ Atypical

Drugs

Answer 12

Bupropion

Trazodone

Question 13

Heterocyclics/ Atypical

Adverse Effects

Answer 13

Dry mouth

Nausea

Question 14

Heterocyclics/ Atypical

Nursing Considerations

Answer 14

May require gradual reduction before stopping. Avoid use with alcohol, other CNS depressants for up to 1 week after end of therapy.

Question 15

Herbals
Drugs
Adverse Effects

Answer 15

Drug: St John’s Wort

Dizziness, hypertension, allergic skin reaction, phototoxicity.

Question 16

Herbals

Nursing Considerations

Answer 16

Avoid use of St. john’s Wort and MAOI within 2 weeks of each other. Do not use alcohol. Contraindicated in pregnancy. Avoid exposure to sun and use sunscreen.
Discontinue 1 to 2 weeks before surgery.

Question 17

Herbal Interactions

Answer 17

St John’s wort- interacts with SSRIs; do not take within 2 weeks of MAOI.
Ginseng may potentiate MAOIs. Avoid Ma huang or ephedra with MAOIs.
Kava Kava should not be combined with benzodiazepines or opioids due to increased sedation.
Increase use of brewer’s yeast with MAOIs can increase blood pressure.