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pharm exam 1 > antidepressants and mood stabilizers > Flashcards

antidepressants and mood stabilizers Flashcards

1
Q

what herbs increase serotonin levels

A

ginkgo bilboa and St.Johns wart, Feverfew

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2
Q

what is the MOA for SSRIs

A

block the uptake of neurotransmitter serotonin which increase level of usable serotonin

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3
Q

when should you use SSRIs

A

major depression
anxiety disorders
prevention of migraine HA
decrease premenstural tension syndrome
eating disorders
substance use disorder

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4
Q

what drug is an SSRI

A

FLuoxetine

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5
Q

What are some advantages to taking fluoxetine

A

less sedation
less hypotension
less anticholinergic efffects
less cardiotoxiciity

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6
Q

what are some side effects of SSRI

A

HA ,nervousness
blurred vision, insomnia
dry mouth, GI upset
sexual dysfunction
the side effects decrease over 1-4 weeks

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7
Q

what are some adverse reactions to SSRI

A

SI
Seizures
hypoglycemia
osteoporosis

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8
Q

when should you not admin fluoxetine

A

if allergic
if using MAOI
hypotension

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9
Q

use caution when giving SSRI to….

A

breastfeeding
current SI
liver/kidney disease
glaucoma

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10
Q

what does SSRI interact with

A

alcohol
other CNS depressants
Grapefruit juice

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11
Q

what is the MOA of SNRI

A

inhibit the reuptake of serotonin and norepinephrine

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12
Q

what drug is an SNRI

A

duloxetine

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13
Q

when should SNRI be used

A

major depression
general anxiety disorder
social anxiety

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14
Q

what are some side effects of duloxetine

A

drowsy, dizzy, insomnia, HA
photosensitivity
ejaculation dysfunction

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15
Q

what are some adverse reactions of SNRI

A

nephrotoxic
tachycardia, HTN
ortho hypotension
SI, seizures
Steven johnson syndrome

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16
Q

what does SNRI interact with

A

St. johns wart
other CNS depressants
alcohol
MAOI

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16
Q

what are the contraindications for duloxetine

A

pregnancy, breastfeeding
anticoagulant therapy- increase risk for bleeding
current SI
using MAOIs

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17
Q

what is the MOA of tricyclic antidepressants

A

blocks the uptake of neurotransmitters norepinephrine and serotonin in brain
blocks the histamine receptors causing sedation

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18
Q

when does the onset of tricyclic antidepression occur

A

1-3 weeks

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19
Q

what are some side effects of tricyclic antidepressants

A

CNS disturbances- dizzy, sedation
dry mouth and eyes
urinary retention, sexual dysfunction
weight gain

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20
Q

what drug is an tricyclic antidepressant

A

amitriptyline

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21
Q

what is amitriptyline used for

A

major depression

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22
Q

what are some adverse reactions for amitriptyline

A

SI
cardiotoxicity
EPS, NMS, ortho hypotension

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23
Q

what does tricyclic antidepressant interact with

A

alcohol and other CNS depressants

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24
Q

what are contraindications for amitriptyline

A

CV disease
HTN
usiing MAOIs

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25
Q

what drug is a misc. antidepressant

A

trazodone

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26
Q

what is the classification of trazodone

A

serotonin modulator

27
Q

what is the MOA of misc. antidepressant and what is the protien binding

A

inhibits reuptake of serotonin
highly protein bound

28
Q

what is the peak action of the misc. antidepressant

A

2-4 weeks

29
Q

what is trazodone used for

A

major depression

30
Q

what are some side effects of trazodone

A

dizzy
dry mouth
erectile dysfunction
N and V
blurry vision

31
Q

what are some adverse reactions to trazodone

A

SI
hypotension
arrythmias
QT prolongation
serotinin syndrome

32
Q

what does misc. antidepressants interact with

A

CNS depressants
SSRI and SNRI
digoxin
phenytoin
antifungal/antivirals
NSAIDS
antihypertensives
St john wart, kava kava, valerian

33
Q

what should you asses when giving antidepressants

A

check baseline VS and weight for compairson
get hx of depression episodes
check mental status and for SI
check meds for antidepressants and other phychotropics
liver and renal function
allergies

34
Q

what are some nursing interventions for antidepressatns

A

check pt mood for drug effectiveness and decreased depression
SI
VS- for ortho hypo
monitor for drug-drug and food interactions
tell client not to use alcohol or other CNS depressant when taking drug
monitor for side effects/adverse reaction

35
Q

what should you teach the pt when taking antidepressants

A

take as perscribed
do not stop abruptly
change positions slowly
take at bedtime
therapeutic effect can take 1-2 weeks
tell pt what herbs it interacts with
the S/S of serotonin syndrome
do not drive
fluoxetine can be used weekly for maintenance
avoid alcohol and CNS depressants bc they add to the effect

36
Q

what drug is a mood stabilizer

A

lithium

37
Q

what is the MOA of lithium

A

alteration of ion transport in muscle and nerve cells
increases receptor sensitivity to serotonin

38
Q

what kind of protein binding is lithium

A

weak protein binding

39
Q

what is the half life of lithium

A

18-36 hr

40
Q

what is lithium used for

A

bipolar disorder-manic episodes.

41
Q

what is the theraputic range of lithium

A

1-1.5
anything >1.5 may cause toxicitiy

42
Q

what does lithium deplete

A

sodium

43
Q

what are some side effects of lithium

A

drowsy, dizzy, memory impairment, HA
dry mouth, metallic taste, GI upset
edema of hands and ankles, dehydration
increased urination

44
Q

what are the adverse reactions to lithium

A

hyponatremia
hypotension
dysrhythmias
nephrotoxicity
leukocytosis

45
Q

what does lithium interact with

A

increase levels
-NSAIDS
-haloperidol
increase r/f serotonin synd
-SSRI
-SNRI
can cause neurotoxicity
-St, johns wart
-ephedra
-Ginseng
-Kava Kava
-valerian

46
Q

what are the contraidications of lithium

A

liver and renal disease
pregnancy
hyponatremia
dehydration
cardiac disease

47
Q

what should we asses when giving mood stabilizers

A

check for SI
get baseline VS
get health and drug HX
-diuretics, tetracyclines. NSAIDS decrease renal Clarence and cause accumulation
check neuro and cardiac status
check the lithium levels and sodium levels
medical and meds hx

48
Q

how should a pt take lithium

A

with meals to avoid GI upset

49
Q

how is fluoxetine given

A

PO

50
Q

what is the half life of fluoxetine
when is the onset
when is the peak

A

4-6 days
3-4 wk initially
6-8hr

50
Q

what labs should uou asses and what when giving antidepressants

A

kidney and liver function
UO
BUN
creat
hepatic enzyme levels (ALT, AST)

51
Q

what are some S/S of Neuroleptic malignant syndrome(NMS)`

A

hyperpyrexia
muscle rigidity
tachycardia
cardiac dysrhythmias

52
Q

what conditions should TCAs be avoid

A

cardiovascular disease
hypertension

53
Q

what is the therapeutic effect of antidepressants

A

pt depression is controlled or gone

54
Q

what is the therapeutic range for lithium

A

0.5-1.2

55
Q

what food contain tyramine

A

cheese
red wine
beer
liver
bananas
yougurt
sausage

56
Q

what should people taking MAOIs avoid and why

A

tyramine food because it causes hypertensive crisis

57
Q

what is the half life of amitriptyline

A

10-50hr

58
Q

what is the theraputic range for amitriptyline

A

120-150ng/mL

59
Q

what should be assessed and what labs when giving lithium

A

hepatic and renal function
UO
BUN
Creat
liver enzymes

60
Q

what should you teach a pt who is taking lithium

A

matain good fluid intake
take with meal to avoid gi upset
avoid caffeine- can decrease lithium levels
matian adequate sodium levels

61
Q

what are some early and late signs of lithium toxicity

A

early
-NVD
-drowsy
-loss of app.
-slurred speech
-trembling
late
-blurry vision
-confusion
-increased urination
-convulsions

62
Q

what is the therapeutic response to lithium

A

patient decreased or free from bipolar behavior

63
Q

what is the half life of trazodone

A

10hr

pharm exam 1 (4 decks)

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