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PHARM > ANTIDEPRESSANTS > Flashcards

ANTIDEPRESSANTS Flashcards

1
Q

Signs and symptoms of depression

A

-Low energy level
-Sleep disturbances
-Altered appetite
-Altered libido
-Inability to perform activities of daily living
-Overwhelming feelings of sadness, despair, hopelessness, and disorganization

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2
Q

Biogenic theory of depression

A

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

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3
Q

Actions of antidepressant therapy

A

-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

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4
Q

Use of anti-depressant agents across the lifespan: children

A

-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

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5
Q

Fun fact about TCAS with older adults

A

They can worsen BPH (enlarged prostate)
-decreases bladder contractions

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6
Q

Tricyclic anti-depressants TCAs (Actions)

A

-Reduce the reuptake of serotonin and dopamine into nerves

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7
Q

Tricyclic anti-depressants TCAs ( indications/why would we give it?)

A
  • Depression
    -Sleep disorders
    -Enuresis (involuntary urination)
    -Anxiety
    -Chronic pain
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8
Q

Tricyclic anti-depressants TCAs (cautions, and interactions)

A

Caution
-CV disease
-anticholinergic conditions
-manic depressions/bipolar disorder
-seizure disorders

-drug interactions include MAOIs, cimetidine, and fluoxetine

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9
Q

Tricyclic anti-depressants TCAs (adverse effects)

A

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

GI
-Dry mouse, constipation, nausea, vomiting, anorexia, decreased salivation

Cardiac
-tachycardia, hypertension, arrhythmias

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10
Q

Tricyclic anti-depressants TCAs (assessment and implementation)

A

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

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11
Q

Monoamine oxidase inhibitors MAOIs (action)

A

-irreversibly inhibits MAO, allowing norepinephrine, serotonin, and dopamine to accumulate in the synaptic cleft

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12
Q

Monoamine oxidase inhibitors MAOIs (indications)

A

Depression

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13
Q

Monoamine oxidase inhibitors MAOIs (contraindications)

A

Absolute
-pheochromocytoma (life-threatening tumor in the adrenal gland)

relative
-CV disease
-Headaches
-renal or hepatic impairment

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14
Q

Monoamine oxidase inhibitors MAOIs (cautions and interactions)

A

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

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15
Q

Monoamine oxidase inhibitors MAOIs (assessment and implementation)

A

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

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16
Q

Selective serotonin reuptake inhibitors SSRIs (actions)

A
  • 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

17
Q

Selective serotonin reuptake inhibitors SSRIs (indications)

A

-depression, OCD, panic attacks, bulimia, PMDD, post traumatic stress disorders, social phobias, social anxiety disorders

18
Q

Selective serotonin reuptake inhibitors SSRIs (cautions and interactions)

A

Cautions
-Impaired renal or hepatic function
-pregnancy: congenital abnormalities in animal studies

Interactions
-MAOIs
-TCAs
-SNRIs
-St. John’s wort st. John.

19
Q

Serotonin norepinephrine inhibitors SNRIs (actions)

A

-decrease neuronal, reuptake of both serotonin and Norepinephrine and more weakly inhibit dopamine re-uptake

20
Q

Serotonin norepinephrine inhibitors SNRIs ( indications)

A
  • Depression
    -neuropathic pain
    -Fibromyalgia
    -anxiety
21
Q

Serotonin norepinephrine inhibitors SNRIs (absolute contraindications)

A

MAOI use

22
Q

Serotonin norepinephrine inhibitors SNRIs (caution and interactions)

A

Caution
-Severe depression, suicide
-bipolar disorder
-Seizure disorder

Interactions
-MAOIs
-SSRI, TCAs, St. John’s wort

23
Q

SSRIs/SNRIs implementation

A
  • 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
24
Q

Serotonin norepinephrine inhibitors SNRIs ( common adverse effects)

A
  • hyperhidrosis
    -erectile dysfunction
    -Cardiac: tachycardia, palpitations, hypertension
    -abnormal bleeding
    -anticholinergic: glaucoma, urinary retention
    -serotonin syndrome
25
Q

Antidepressant agents, nursing diagnosis/conclusion

A

-altered thought processes and sensory perception
-malnutrition risk

26
Q

Tricyclic anti-depressants (drug names)

A

-TRIPTYLINE
amitriptyline
Nortriptyline

-PRAMINE
clomipramine
Desipramine
Imipramine
Trimipramine

Randomly, doxepin

27
Q

MAOIs (drug names)

A

Isocarboxazid

Phenelzine

Tranylcypromine

Selegiline (transdermal)

28
Q

SSRIs (drug names)

A

-ITALOPRAM
citalopram
Escitalopram

-OXETINE
fluoxetine
Paroxetine

Randomly, sertraline

29
Q

SNRIs (drug names)

A

Desvenlafaxine

Duloxetine

Venlafaxine

30
Q

Other anti-depressants

A

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

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