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