Antidepressants Flashcards
What are the three main subclasses inside the antidepressant class?
What are their prototype medications?
Psychotherapeutic drug - antidepressants
- SSRIs: sertraline (Zoloft) - 2nd generation
- Tricyclic antidepressants (TCAs) : Amitriptyline —first gen
- MAOIs : Phenelzine sulfate —first gen
What is the difference between the 1st and 2nd generation of antidepressants?
2nd generation: SSRIs Sertraline (Zoloft):
- causes less AE that TCAs and MAOIs
- fewer drug drug and food-drug interactions
- still takes 4-6 weeks to reach maximum clinical effectiveness
What are some AE with sertraline (Zoloft)?
SSRI antidepressant
- insomnia
- sexual dysfunction
- stomach issues
- weight gain/loss
- serotonin syndrome (life threatening)
- dry mouth
- urinary retention
- constipation
- headache
How and when should sertraline (Zoloft) be taken?
- Should be taken in the morning with at least 120-180mls of water and food
- take at same time everyday
What are some considerations with sertraline (Zoloft)?
- take 4-6 weeks to take effet
- monitor for suicidal ideas or thoughts
- avoid St. John wort!!!
- assist elderly with ADLs and annulation due to drowsiness and postural hypotension
- ## don’t use medication within 14 days of MAOI therapy (can cause serotonin syndrome)
How does sertraline (zoloft) work?
Works by stopping the reputable of serotonin in the brain, so it stays there
Causes an increased in level of serotonin in the brain
What is serotonin syndrome related to sertraline (Zoloft) therapy? And how does it manifest?
Serotonin syndrome: when there is too much serotonin in the brain
S&S:
- high BP
- high HR
- muscle rigidity
- mental status changes
- delirium
- agitation
- tachycardia
- sweating
- hyper flex is
- tremors
- confusion
- twitching
- muscle spasms
What are some teaching points with sertraline (Zoloft) the SSRIs 2nd generation antidepressant?
- teach pt to eat fiber
- encourage talking about AE
- provide a list of drugs and their interactions (no St. John wort)
- take as prescribed
- tapper down period if stop is needed don’t stop abruptly
- assess for suicidal thoughts or ideas
- avoid St. John wort
- monitor and advise about AE of serotonin syndrome
- can cause insomnia and sexual dysfunction
- change position slowly for elderly s due to possible orthostatic hypotension
What are some drug interactions with sertraline (Zoloft)?
- increase serotonin activity: MAOIs (to avoid within 2-5weeks of each other)
- increase drug effect with: highly protein bound like phenytoin, warfarin
What is the prototype medication for Tricyclic antidepressants (TCAs)?
Is it a first or second generation?
Amitriptyline (Elavil)
First generation
How does the TCA Amitriptyline work?
- block reputable of serotonin and norepinephrine in the brain
Corrects the imbalance between the two
What are some possible AE with Amitriptyline (Elavil)?
- orthostatic hypotension
- drowsiness
- ataxia
- insomnia
- urinary retention
- constipation
- dry mouth
- blurred vision
- agitation
- sexual dysfunction
& more
When and how should TCA Amitriptyline (Elavil) should be taken?
- should be taken with food and at least 120-180 mls of water to decrease GI upset
- take in the morning
- take at same time everyday
- avoid St. John wort!!!
What are some contraindications to the use of Amitriptyline (Elavil)?
- use of SSRIs, MAOIs, anticholinergics, St. John wort, CNS depressants and other meds that are highly protein bound
- seizure disorder
- acute/chronic 🤍 problems
- recent MI
- KDA
- pregnancy
What are some drug interactions with Amitriptyline (Elavil)?
- increase anticholinergic effects with: anticholinergics and phenothiazine
- increase risk for toxicity: MAOIs
- increase risk of carbamazepine toxicity with carbamazepine
What are some nursing considerations/important points about Amitriptyline (Elavil)?
(Teaching tips included)
- may take 2-3weeks to take effect
- wait 14 days after being off MAOIs to start TCAs
- avoid St. John wort
- eat more fiber to help with constipation
- for dry mouth: mouth hygiene often, suck hard candy and/or sugarless gum
- advise pt to change position slowly due to risk of orthostatic hypotension
- don’t stop medication abruptly
- report if AE are too excessive
- assess for suicidal thoughts
What is the biggest risk with Amitriptyline (Elavil) overdose? And what is it’s usual treatment?
Biggest risk:
Can cause serious cardiac toxicities in overdose
- dysrhythmias
- seizures
(Often lethal)
Treatment:
- no antidote
- decrease drug absorption with activated charcoal
- speed elimination by alkalinizing urine with sodium bicarb IV
- manage seizures and dysrhythmias
- basic life support
How does phenelzine sulfate, the MAOI antidepressant works?
Works by blocking monoamine oxidase which causes:
- increase in epinephrine
- increase in norepinephrine
- increase in dopamine
- increase in serotonin
= stimulation of the CNS
What are some AE with phenelzine sulfate?
- orthostatic hypotension
- hypertensive crisis (with thyramine containing foods)
- dry mouth
- constipation
- blurred vision
- dizziness
- dry mouth
- n& v
What are signs and symptoms of the hypertension crisis related to phenelzine therapy?
And why does it occur?
S&S:
- headache
- stiff neck
- fever
- n/v
- dilated pupils
Occurs due to consumption of thyramine containing foods
What are some of the thyramine containing foods or drinks?
- aged cheese
- cured meats
- soy sauce
- tofu
- chocolate
- Orange
- grapefruit
- smoked meats
- soy beans
- red wine
- beers
How should phenelzine sulfate be taken?
The MAOI antidepressant
- take with food and at least 120-180mls of water
- take in the morning
- take at same time everyday
What are some things you xannot take or eat with phenelzine sulfate?
- no St. John wort
- no thyramine containing foods
- no SSRIs
- no OTC meds for cough or cold formulas (causes cardiac AE)
What are some nursing implications and teaching needed with phenelzine sulfate ?
- take as prescribed
- take same time every day
- change position slowly due to risk of orthostatic hypotension
- don’t take OTC cough or cold formulas
- assess for suicidal thoughts
- don’t stop medication abruptly (need to tapper down)
- avoid thyramine containing foods
- avoid St. John wort
- take with food and glass of water
- not to be taken with SSRIs
- ## take up to 4 weeks to take effect compliance is important
What are some drug interactions with phenelzine sulfate?
- increase risk of serotonin syndrome : SSRIs
- increase CNS depression: dimenhydramine, cetirizine
- increase CVA AE : cold or cough formulas
What are some S&S of a MAOI overdose (phenelzine sulfate) and what is it’s usual treatment?
Why does it usually occur?
S&S:
- tachycardia
- circulatory collapse
- seizure
- coma
Symptoms usually occur 12hrs posh ingestion
Treatment:
- protect brain and heart
eliminate toxin by:
- gastric lavage
- urine acidification
- hemodialysis
Usually occurs due to thyramine containing foods or hypotensive drugs
What are the four words that complete the MAOI letters?
M: massive hypertension
A: avoid thyramine containing foods
O: OTC drug interactions (cough/cold)
I: increased suicidal risk
The nurse is reviewing meds used for depression. Which of these statements is a reason that selective serotonin reuptake inhibitors (SSRIs) are more widely prescribed today than TCAs?
A) SSRIs have free sexual side effects
B) unlike TCAs, SSRIs do not have food drug interactions
C) TCAs cause serious cardiac dysrhythmias if an overdose occurs
D) SSRIs cause a therapeutic response faster than TCAs
C
The nurse is reviewing the food choices of a pt who is taking a MAOI. Which food choice would indicate the need for additional teaching?
A) orange juice
B) fried eggs over easy
C) salami and Swiss cheese sandwich
D) biscuits and honey
C
A pt who has been taking an SSRI is complaining of feeling «so badly» when he started taking an OTC st john wort herbal product at home. The nurse suspects that he is experiencing serotonin syndrome. Which of these are symptoms of serotonin syndrome? Select all that apply
A) agitation
B) drowsiness
C) tremors
D) bradycardia
E) sweating
F) constipation
A, C, E
