Antidepressants Flashcards
What are the Tricyclic Antidepressants
“-triptyline”
Amitriptyline
Nortriptyline
"-pramine" Clomipramine Desipramine Imipramine Trimipramine
Doxepin
Tricyclic Antidepressants
Action
reduce reuptake of 5HT and NE
ALL TCA’s work the same
Tricyclic Antidepressants
Indications
relief of symptoms of depression
sleep disorders
treatment of enuresis
chronic pain
Tricyclic Antidepressants
Contra/cautions
allergy
recent MI or CV disease
anticholinergic conditions
manic-depression/bipolar disorder
Tricyclic Antidepressants
Adverse Effects
CNS: sedation, sleep disturbances, fatigue, hallucinations, ataxia
GI: dry mouth, constipation, N/V
Tricyclic Antidepressants
Drug-Drug
All these increase TCA levels: MAOIs, cimetidine, fluoxetine, ranitidine
This can cause death
Tricyclic Antidepressants
Nursing process: Assessment
HX of cardiac dysfunction with ECG
What are the Monoamine Oxidase Inhibitors (MAOIs)
Isocarboxazid
Phenelzine
Tranylcypromine
MAOIs
Indications
Depression for those whom other treatments didn’t work on
MAOIs
Action
irreversibly inhibits MAO allowing norepinephrine, serotonin and dopamine to accumulate
MAOIs
Contra/Caution
allergy pheochromocytoma CV disease headaches renal/hepatic impairment
MAOIs
Adverse effects
CNS: dizziness, excitement, nervousness, mania, hyperreflexia, tremors, confusion, insomnia, agitation
liver toxicity
black box warning: suicidal ideation and behavior especially for children and young adults
MAOIs
Drug-drug
other antidepressants: hypertensive crisis, coma, convulsions, serotonin syndrome
methyldopa: sympathomimetic effects increase
insulin or PO anti diabetics: additive hypoglycemia
MAOIs
Food-drug
tyramine: increase BP
aged cheeses/meats, soy sauce, red wine
MAOIs
Nursing process: Assessment
HX: cardia dysfunction, seizure
Labs: ECG
MAOIs
Nursing process: diagnosis
risk for acute pain r/t CNS and sympathomimetic
decreased CO r/t CV effects
MAOIs
Nursing process: Implementation
limit drug access to potential suicidal patient
monitor BP and orthostatic BP
discontinue if HA occurs
phentolamine on standby for hypertensive crisis
take with food to avoid GI effects
Tricyclic Antidepressants
Nursing process: diagnosis
risk for decreased CO
Tricyclic Antidepressants
Nursing process: implementation
limit quantity of drug administered
oral is preferred
mostly taken before bed
What are the Selective Serotonin Reuptake Inhibitors (SSRIs)
“-italopram” Citalopram, Escitalopram
“-oxetine” Fluoxetine, Paroxetine
Sertaline
SSRIs
Action
block the reuptake of 5HT with no known effect on NE
SSRIs
Indications
depression OCDs panic attacks bulimia PMDD PTSD social problems / social anxiety disorders
SSRIs
Contraindications
known allergy
impaired renal/hepatic function
pregnancy and lact (assoc with congenital abnormal)
SSRIs
Adverse effects
HA drowsiness agitation diziness insomnia tremor anxiety
SSRIs
Drug-drug
MAOIs: increased risk of serotonin syndrome
TCAs: increase in therapeutic and adverse effects
What are the Serotonin Norepinephrine Inhibitors (SNRIs)
Desvenlafaxine
Duloxeine
Venafaxine
SNRIs
Action
decrease reuptake of both serotonin and norepinephrine
weakly inhibits dopamine
SNRIs
Contra/caution
allergy taking MAOIs or TCAs severe depression / suicidality bipolar disorder risk of seizures
SNRIs
Adverse effects
hyperhidrosis
ED
CV: tachycardia, palpitations, hypertension
abnormal bleeding
anticholinergic: angle closure glaucoma, urinary retention
serotonin syndrome
SNRIs
Drug-drug
MAOIs: hypertensive crisis
SSRIs, TCAs, serotonergic drugs: increase serotonin
aspirin, NSAIDs, antiplatelet drugs: risk of bleeds
SNRIs
Nursing process: implementation
suicide precautions for black box warnings
limiting quantity of drug given at a time
take in AM to achieve optimal therapeutic effects
or PM to help with sedation
lower does in old people
childbearing age use barrier contraception
Bupropion
“other antidepressant”
aka. wellbutrin
low doses for smoking cessation
available in extended and sustained release formulas
black box warning: children increased suicidality
Mirtazapine
“other antidepressant”
atypical depressant
many anticholinergic effects
black box warning: children increased suicidality
Trazadone
“other antidepressant”
many CNS effects
black box warning: suicidality, hypotension, priapism
black box warning: children increased suicidality
Nursing assessment (Hx) for all antidepressants
HX: severe depression/suicidality, bipolar disorder, conditions worsened by anticholinergic effects, impaired liver or kidney function, diabetes, pregnancy or lactation
Physical exam/labs for all antidepressants
weight, vitals Labs: renal and hepatic function CNS: vision issues abdomen for adverse effects respiratory
Nursing diagnosis for all antidepressants
acute pain r/t to GI/GU/CNS effects
disturbed though process r/t CNS effects
disturbed sensory perception r/t CNS effects
imbalanced nutrition r/t GI effects
