Antidepressants Flashcards
TCAs (Tricyclic antidepressant)
Amitriptyline (Elavil)
Nortriptyline (Pamelor)
TCAs SE
- Lethal in overdose
- Lower seizures threshold
- Orthostatic Hypertension
- Anticholinergic side effects [blurred vision, constipation, urinary retention, orthostatic hptn, dry mouth]
SSRI (selective serotonin reuptake inhibitors)
Fluoxetine (Prozac)
Sertraline (Zoloft)
Citalopram (Celexa)
Escitalopram (Lexapro)
SSRI SE
- Serotonin syndrome
- Sexual side effects
- CNS stimulant
- nausea
-agitation - Do NOT take with MAOI/TCA or St. John’s wort
MAOIs (monoamine oxidase inhibitors)
Phenelzine (Nardil)
Tranylcypromine (Parnate)
Isocarboxazid (Marplan)
MAOIs SE
- Avoid tyramine — risk of hypertensive crisis — watch for headaches
- CNS stimulant
- Orthostatic hypotension
- weight gain
-daytime sedation
-sexual dysfunction
-insomnia
OTHERS
Bupropion (Wellbutrin) — can’t take with seizure disorder, eating disorder, or with MAOI.. appetite suppression
Trazadone (Desyrl) — risk of priapism a prolonged erection of the penis, usually without sexual arousal
SNRIs (Serotonin norepinephrine reuptake inhibitors)
Venlafaxine (Effexor)
Duloxetine (Cymbalta)
Herbal Medication (alternative)
St.John’s Wort avoid with other meds
Antidepressants are used for many disorders:
Major depressive disorder
Bipolar disorder
Generalized anxiety disorder
Post traumatic stress disorder
TCAs Patient Teaching
- Monitor for cardiac arrythmias (sign of toxicity) (HIGH RISK FOR OD Death!!)
- Administer at bedtime due to sedation and risk for orthostatic hypotension.
- may take up to two to four weeks
SSRIs Patient Teaching
- take in the morning to minimize sleep disturbances (CNS stimulant)
- take with food to reduce GI distress— do not take with GRAPEFRUIT juice
- do not take with MAOIs, TCAs, or St.John’s Wort
- may take up to four to six weeks
MOAIs Patient Teaching
- provide list of tyramine foods (avoid) — “Tyramine CAN Trigger Bad Side Reactions”
- C: Cold meds (OTC), TCAs, SSRIs
- A: Aged cheeses (cheddar, Swiss, Parmesan, blue cheese) & meats (pepperoni, salami)
- N: No bananas, avocados, figs
- T: Tofu & soy
- B: Beer & red wine
- S: Smoked fish
- R: Refrain from chocolate
- remind patient that any other medications taken must be approved by the provider
- teach about signs of hypertensive crisis (first sign is HEADACHE)
Antidepressants Basic Education
- Antidepressants may take a few weeks to experience relief of manifestations.
- SSRIs may take up to four to six weeks
- TCAs may take up to two to four weeks
- Suicide risk may INCREASE during the initial treatment period.
- Remind patients and families to be alert to any signs of suicidal ideation
- For clients who may have been too depressed to plan or implement a self harm attempt, the improved energy and focus during the initial treatment period may pose a risk for acting on thoughts of self harm
Anticholinergic Effects
-Blurry vision, constipation, urinary retention (may require catheterization for severe cases!), dry mouth, orthostatic hypotension & risk of falling.
-Clients typically develop a tolerance, and the severity of anticholinergic effects minimizes after a few weeks.
- The nurse should consider using hard candies, drinking water, and chewing sugarless gum to minimize discomfort related to dry mouth, encourage fiber and fluid intake to minimize constipation, and consider fall risk precautions for those who experience blurry vision or orthostatic hypotension
Serotonin Syndrome
- Symptoms: Restlessness, dilated pupils, tachycardia, high blood pressure, muscle rigidity, sweating, and loss of muscle coordination.
- Nursing care: Vital sign stabilization, sedation with benzodiazepines, and the administration of serotonin antagonist medications like cyproheptadine
