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Pharm Final > Antidepressants > Flashcards

Antidepressants Flashcards

1
Q

What are the Tricyclic Antidepressants

A

“-triptyline”
Amitriptyline
Nortriptyline

"-pramine"
Clomipramine
Desipramine
Imipramine
Trimipramine

Doxepin

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2
Q

Tricyclic Antidepressants

Action

A

reduce reuptake of 5HT and NE

ALL TCA’s work the same

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3
Q

Tricyclic Antidepressants

Indications

A

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

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4
Q

Tricyclic Antidepressants

Contra/cautions

A

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

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5
Q

Tricyclic Antidepressants

Adverse Effects

A

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

GI: dry mouth, constipation, N/V

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6
Q

Tricyclic Antidepressants

Drug-Drug

A

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

This can cause death

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7
Q

Tricyclic Antidepressants

Nursing process: Assessment

A

HX of cardiac dysfunction with ECG

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8
Q

What are the Monoamine Oxidase Inhibitors (MAOIs)

A

Isocarboxazid
Phenelzine
Tranylcypromine

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9
Q

MAOIs

Indications

A

Depression for those whom other treatments didn’t work on

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10
Q

MAOIs

Action

A

irreversibly inhibits MAO allowing norepinephrine, serotonin and dopamine to accumulate

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11
Q

MAOIs

Contra/Caution

A 
allergy
pheochromocytoma 
CV disease
headaches 
renal/hepatic impairment
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12
Q

MAOIs

Adverse effects

A

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

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13
Q

MAOIs

Drug-drug

A

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

methyldopa: sympathomimetic effects increase

insulin or PO anti diabetics: additive hypoglycemia

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14
Q

MAOIs

Food-drug

A

tyramine: increase BP

aged cheeses/meats, soy sauce, red wine

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15
Q

MAOIs

Nursing process: Assessment

A

HX: cardia dysfunction, seizure
Labs: ECG

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16
Q

MAOIs

Nursing process: diagnosis

A

risk for acute pain r/t CNS and sympathomimetic

decreased CO r/t CV effects

17
Q

MAOIs

Nursing process: Implementation

A

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

18
Q

Tricyclic Antidepressants

Nursing process: diagnosis

A

risk for decreased CO

19
Q

Tricyclic Antidepressants

Nursing process: implementation

A

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

20
Q

What are the Selective Serotonin Reuptake Inhibitors (SSRIs)

A

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

21
Q

SSRIs

Action

A

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

22
Q

SSRIs

Indications

A 
depression
OCDs
panic attacks
bulimia
PMDD
PTSD
social problems / social anxiety disorders
23
Q

SSRIs

Contraindications

A

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

24
Q

SSRIs

Adverse effects

A 
HA
drowsiness 
agitation
diziness
insomnia
tremor
anxiety
25
Q

SSRIs

Drug-drug

A

MAOIs: increased risk of serotonin syndrome

TCAs: increase in therapeutic and adverse effects

26
Q

What are the Serotonin Norepinephrine Inhibitors (SNRIs)

A

Desvenlafaxine
Duloxeine
Venafaxine

27
Q

SNRIs

Action

A

decrease reuptake of both serotonin and norepinephrine

weakly inhibits dopamine

28
Q

SNRIs

Contra/caution

A 
allergy
taking MAOIs or TCAs
severe depression / suicidality
bipolar disorder
risk of seizures
29
Q

SNRIs

Adverse effects

A

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

30
Q

SNRIs

Drug-drug

A

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

31
Q

SNRIs

Nursing process: implementation

A

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

32
Q

Bupropion

“other antidepressant”

A

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

33
Q

Mirtazapine

“other antidepressant”

A

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

34
Q

Trazadone

“other antidepressant”

A

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

35
Q

Nursing assessment (Hx) for all antidepressants

A

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

36
Q

Physical exam/labs for all antidepressants

A 
weight, vitals
Labs: renal and hepatic function
CNS: vision issues
abdomen for adverse effects
respiratory
37
Q

Nursing diagnosis for all antidepressants

A

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

Pharm Final (15 decks)

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