Antidepressants

Question 1

What are the Tricyclic Antidepressants

Answer 1

“-triptyline”
Amitriptyline
Nortriptyline

"-pramine"
Clomipramine
Desipramine
Imipramine
Trimipramine

Doxepin

Question 2

Tricyclic Antidepressants

Action

Answer 2

reduce reuptake of 5HT and NE

ALL TCA’s work the same

Question 3

Tricyclic Antidepressants

Indications

Answer 3

relief of symptoms of depression
sleep disorders
treatment of enuresis
chronic pain

Question 4

Tricyclic Antidepressants

Contra/cautions

Answer 4

allergy
recent MI or CV disease
anticholinergic conditions
manic-depression/bipolar disorder

Question 5

Tricyclic Antidepressants

Adverse Effects

Answer 5

CNS: sedation, sleep disturbances, fatigue, hallucinations, ataxia

GI: dry mouth, constipation, N/V

Question 6

Tricyclic Antidepressants

Drug-Drug

Answer 6

All these increase TCA levels: MAOIs, cimetidine, fluoxetine, ranitidine

This can cause death

Question 7

Tricyclic Antidepressants

Nursing process: Assessment

Answer 7

HX of cardiac dysfunction with ECG

Question 8

What are the Monoamine Oxidase Inhibitors (MAOIs)

Answer 8

Isocarboxazid
Phenelzine
Tranylcypromine

Question 9

MAOIs

Indications

Answer 9

Depression for those whom other treatments didn’t work on

Question 10

MAOIs

Action

Answer 10

irreversibly inhibits MAO allowing norepinephrine, serotonin and dopamine to accumulate

Question 11

MAOIs

Contra/Caution

Answer 11

allergy
pheochromocytoma 
CV disease
headaches 
renal/hepatic impairment

Question 12

MAOIs

Adverse effects

Answer 12

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

Question 13

MAOIs

Drug-drug

Answer 13

other antidepressants: hypertensive crisis, coma, convulsions, serotonin syndrome

methyldopa: sympathomimetic effects increase

insulin or PO anti diabetics: additive hypoglycemia

Question 14

MAOIs

Food-drug

Answer 14

tyramine: increase BP

aged cheeses/meats, soy sauce, red wine

Question 15

MAOIs

Nursing process: Assessment

Answer 15

HX: cardia dysfunction, seizure
Labs: ECG

Question 16

MAOIs

Nursing process: diagnosis

Answer 16

risk for acute pain r/t CNS and sympathomimetic

decreased CO r/t CV effects

Question 17

MAOIs

Nursing process: Implementation

Answer 17

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

Question 18

Tricyclic Antidepressants

Nursing process: diagnosis

Answer 18

risk for decreased CO

Question 19

Tricyclic Antidepressants

Nursing process: implementation

Answer 19

limit quantity of drug administered
oral is preferred
mostly taken before bed

Question 20

What are the Selective Serotonin Reuptake Inhibitors (SSRIs)

Answer 20

“-italopram” Citalopram, Escitalopram
“-oxetine” Fluoxetine, Paroxetine
Sertaline

Question 21

SSRIs

Action

Answer 21

block the reuptake of 5HT with no known effect on NE

Question 22

SSRIs

Indications

Answer 22

depression
OCDs
panic attacks
bulimia
PMDD
PTSD
social problems / social anxiety disorders

Question 23

SSRIs

Contraindications

Answer 23

known allergy
impaired renal/hepatic function
pregnancy and lact (assoc with congenital abnormal)

Question 24

SSRIs

Adverse effects

Answer 24

HA
drowsiness 
agitation
diziness
insomnia
tremor
anxiety

Question 25

SSRIs | Drug-drug

Answer 25

MAOIs: increased risk of serotonin syndrome TCAs: increase in therapeutic and adverse effects

Question 26

What are the Serotonin Norepinephrine Inhibitors (SNRIs)

Answer 26

Desvenlafaxine Duloxeine Venafaxine

Question 27

SNRIs | Action

Answer 27

decrease reuptake of both serotonin and norepinephrine | weakly inhibits dopamine

Question 28

SNRIs | Contra/caution

Answer 28

``` allergy taking MAOIs or TCAs severe depression / suicidality bipolar disorder risk of seizures ```

Question 29

SNRIs | Adverse effects

Answer 29

hyperhidrosis ED CV: tachycardia, palpitations, hypertension abnormal bleeding anticholinergic: angle closure glaucoma, urinary retention serotonin syndrome

Question 30

SNRIs | Drug-drug

Answer 30

MAOIs: hypertensive crisis SSRIs, TCAs, serotonergic drugs: increase serotonin aspirin, NSAIDs, antiplatelet drugs: risk of bleeds

Question 31

SNRIs | Nursing process: implementation

Answer 31

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

Question 32

Bupropion | "other antidepressant"

Answer 32

aka. wellbutrin low doses for smoking cessation available in extended and sustained release formulas black box warning: children increased suicidality

Question 33

Mirtazapine | "other antidepressant"

Answer 33

atypical depressant many anticholinergic effects black box warning: children increased suicidality

Question 34

Trazadone | "other antidepressant"

Answer 34

many CNS effects black box warning: suicidality, hypotension, priapism black box warning: children increased suicidality

Question 35

Nursing assessment (Hx) for all antidepressants

Answer 35

HX: severe depression/suicidality, bipolar disorder, conditions worsened by anticholinergic effects, impaired liver or kidney function, diabetes, pregnancy or lactation

Question 36

Physical exam/labs for all antidepressants

Answer 36

``` weight, vitals Labs: renal and hepatic function CNS: vision issues abdomen for adverse effects respiratory ```

Question 37

Nursing diagnosis for all antidepressants

Answer 37

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