ANTIDEPRESSANTS Flashcards
Signs and symptoms of depression
-Low energy level
-Sleep disturbances
-Altered appetite
-Altered libido
-Inability to perform activities of daily living
-Overwhelming feelings of sadness, despair, hopelessness, and disorganization
Biogenic theory of depression
Depression results from a deficiency of norepinephrine, dopamine, or serotonin
-MAO (monoamine oxidase) may break them down to be recycled or restored in the neuron
-Rapidfire of the neurons may lead to their depletion
-the number or sensitivity of postsynaptic receptors may increase, depleting neurotransmitter levels
Actions of antidepressant therapy
-Inhibit the effects of MAO, leading to increased NE (dopamine)or 5HT(serotonin) in the synaptic cleft
-Block reuptake by the releasing nerve, leading to increased neurotransmitter levels in the synaptic cleft
-Regulate receptor sites and breakdown of neurotransmitters, leading to an accumulation of neurotransmitters in the synaptic cleft
Use of anti-depressant agents across the lifespan: children
-possible long-term effects
-Studies have not proven efficacy
-Many blackbox warnings due to increase suicidal ideation and behavior
-MAOIs should be avoided due to severity of drug food Interactions.
-the drug classes that are tried first are SSRI and SNRI
-Some TCAs have established pediatric doses
Fun fact about TCAS with older adults
They can worsen BPH (enlarged prostate)
-decreases bladder contractions
Tricyclic anti-depressants TCAs (Actions)
-Reduce the reuptake of serotonin and dopamine into nerves
Tricyclic anti-depressants TCAs ( indications/why would we give it?)
- Depression
-Sleep disorders
-Enuresis (involuntary urination)
-Anxiety
-Chronic pain
Tricyclic anti-depressants TCAs (cautions, and interactions)
Caution
-CV disease
-anticholinergic conditions
-manic depressions/bipolar disorder
-seizure disorders
-drug interactions include MAOIs, cimetidine, and fluoxetine
Tricyclic anti-depressants TCAs (adverse effects)
CNS
-sedation, sleep, disturbances, fatigue, hallucinations, ataxia
GI
-Dry mouse, constipation, nausea, vomiting, anorexia, decreased salivation
Cardiac
-tachycardia, hypertension, arrhythmias
Tricyclic anti-depressants TCAs (assessment and implementation)
Assessment
History: cardiac dysfunction/disease
Labs: ECG
Implementation
-limit drug access of the patient is suicidal
-Reduce dose of minor effects occur
-Administer dose at bedtime
-Parenteral form only if oral not feasible
Monoamine oxidase inhibitors MAOIs (action)
-irreversibly inhibits MAO, allowing norepinephrine, serotonin, and dopamine to accumulate in the synaptic cleft
Monoamine oxidase inhibitors MAOIs (indications)
Depression
Monoamine oxidase inhibitors MAOIs (contraindications)
Absolute
-pheochromocytoma (life-threatening tumor in the adrenal gland)
relative
-CV disease
-Headaches
-renal or hepatic impairment
Monoamine oxidase inhibitors MAOIs (cautions and interactions)
Cautions
-bipolar disorder
-Seizure disorder
-Hyper thyroidism
Interactions
-Other antidepressants- causes hypertensive crisis, coma, convulsions, serotonin syndrome
- sympathomimetics- causes increased CV effects
-antidiabetic agents-increased risk of hypoglycemia
-avoid eating anything that contains tyramine because this can increase blood pressure and create a possible hypertensive crisis
Monoamine oxidase inhibitors MAOIs (assessment and implementation)
Assessment
-History: cardiac dysfunction, seizure disorders, headaches, hyperthyroidism, pheochromocytoma
- labs: ECG
Implementation
-Monitor blood pressure and orthostatic blood pressure
-discontinue drug and monitor patient carefully at any complaint of severe headache
-Have phentolamine or another adrenergic blocker on standby
Selective serotonin reuptake inhibitors SSRIs (actions)
- specifically block the reuptake of serotonin was a little to no known effect on dopamine
-does not have many adverse effects associated with TCA’s and MAOIs
Action
-inhibits central nervous system neuronal reuptake of serotonin with little effect on norepinephrine and little affinity for cholinergic, histaminic, or Alpha adrenergic sites
Selective serotonin reuptake inhibitors SSRIs (indications)
-depression, OCD, panic attacks, bulimia, PMDD, post traumatic stress disorders, social phobias, social anxiety disorders
Selective serotonin reuptake inhibitors SSRIs (cautions and interactions)
Cautions
-Impaired renal or hepatic function
-pregnancy: congenital abnormalities in animal studies
Interactions
-MAOIs
-TCAs
-SNRIs
-St. John’s wort st. John.
Serotonin norepinephrine inhibitors SNRIs (actions)
-decrease neuronal, reuptake of both serotonin and Norepinephrine and more weakly inhibit dopamine re-uptake
Serotonin norepinephrine inhibitors SNRIs ( indications)
- Depression
-neuropathic pain
-Fibromyalgia
-anxiety
Serotonin norepinephrine inhibitors SNRIs (absolute contraindications)
MAOI use
Serotonin norepinephrine inhibitors SNRIs (caution and interactions)
Caution
-Severe depression, suicide
-bipolar disorder
-Seizure disorder
Interactions
-MAOIs
-SSRI, TCAs, St. John’s wort
SSRIs/SNRIs implementation
- establish suicide precautions for severely depressed patients, and limit the quantity of the drug dispensed
-administer the drug once a day in the morning to achieve optimal therapeutic effects, unless the patient benefits from a sedative effect by taking at night
-if dose is increased or if the patient is having severe G.I. effects, the dose can be divided
Serotonin norepinephrine inhibitors SNRIs ( common adverse effects)
- hyperhidrosis
-erectile dysfunction
-Cardiac: tachycardia, palpitations, hypertension
-abnormal bleeding
-anticholinergic: glaucoma, urinary retention
-serotonin syndrome
Antidepressant agents, nursing diagnosis/conclusion
-altered thought processes and sensory perception
-malnutrition risk
Tricyclic anti-depressants (drug names)
-TRIPTYLINE
amitriptyline
Nortriptyline
-PRAMINE
clomipramine
Desipramine
Imipramine
Trimipramine
Randomly, doxepin
MAOIs (drug names)
Isocarboxazid
Phenelzine
Tranylcypromine
Selegiline (transdermal)
SSRIs (drug names)
-ITALOPRAM
citalopram
Escitalopram
-OXETINE
fluoxetine
Paroxetine
Randomly, sertraline
SNRIs (drug names)
Desvenlafaxine
Duloxetine
Venlafaxine
Other anti-depressants
Bupropion:
-low dose: smoking cessation
-Available in extended and sustained release formulas
Mirtazapine:
-atypical antidepressant
-Many anticholinergic effects
Trazodone :
-Many CNS effects
-blackbox warning for suicide, hypotension, priapism
EsKetamine:
-Nasal spray is approved for depression
-CNS effects and increase blood pressure
