antidepressants and mood stabilizers Flashcards
what herbs increase serotonin levels
ginkgo bilboa and St.Johns wart, Feverfew
what is the MOA for SSRIs
block the uptake of neurotransmitter serotonin which increase level of usable serotonin
when should you use SSRIs
major depression
anxiety disorders
prevention of migraine HA
decrease premenstural tension syndrome
eating disorders
substance use disorder
what drug is an SSRI
FLuoxetine
What are some advantages to taking fluoxetine
less sedation
less hypotension
less anticholinergic efffects
less cardiotoxiciity
what are some side effects of SSRI
HA ,nervousness
blurred vision, insomnia
dry mouth, GI upset
sexual dysfunction
the side effects decrease over 1-4 weeks
what are some adverse reactions to SSRI
SI
Seizures
hypoglycemia
osteoporosis
when should you not admin fluoxetine
if allergic
if using MAOI
hypotension
use caution when giving SSRI to….
breastfeeding
current SI
liver/kidney disease
glaucoma
what does SSRI interact with
alcohol
other CNS depressants
Grapefruit juice
what is the MOA of SNRI
inhibit the reuptake of serotonin and norepinephrine
what drug is an SNRI
duloxetine
when should SNRI be used
major depression
general anxiety disorder
social anxiety
what are some side effects of duloxetine
drowsy, dizzy, insomnia, HA
photosensitivity
ejaculation dysfunction
what are some adverse reactions of SNRI
nephrotoxic
tachycardia, HTN
ortho hypotension
SI, seizures
Steven johnson syndrome
what does SNRI interact with
St. johns wart
other CNS depressants
alcohol
MAOI
what are the contraindications for duloxetine
pregnancy, breastfeeding
anticoagulant therapy- increase risk for bleeding
current SI
using MAOIs
what is the MOA of tricyclic antidepressants
blocks the uptake of neurotransmitters norepinephrine and serotonin in brain
blocks the histamine receptors causing sedation
when does the onset of tricyclic antidepression occur
1-3 weeks
what are some side effects of tricyclic antidepressants
CNS disturbances- dizzy, sedation
dry mouth and eyes
urinary retention, sexual dysfunction
weight gain
what drug is an tricyclic antidepressant
amitriptyline
what is amitriptyline used for
major depression
what are some adverse reactions for amitriptyline
SI
cardiotoxicity
EPS, NMS, ortho hypotension
what does tricyclic antidepressant interact with
alcohol and other CNS depressants
what are contraindications for amitriptyline
CV disease
HTN
usiing MAOIs
what drug is a misc. antidepressant
trazodone
what is the classification of trazodone
serotonin modulator
what is the MOA of misc. antidepressant and what is the protien binding
inhibits reuptake of serotonin
highly protein bound
what is the peak action of the misc. antidepressant
2-4 weeks
what is trazodone used for
major depression
what are some side effects of trazodone
dizzy
dry mouth
erectile dysfunction
N and V
blurry vision
what are some adverse reactions to trazodone
SI
hypotension
arrythmias
QT prolongation
serotinin syndrome
what does misc. antidepressants interact with
CNS depressants
SSRI and SNRI
digoxin
phenytoin
antifungal/antivirals
NSAIDS
antihypertensives
St john wart, kava kava, valerian
what should you asses when giving antidepressants
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
what are some nursing interventions for antidepressatns
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
what should you teach the pt when taking antidepressants
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
what drug is a mood stabilizer
lithium
what is the MOA of lithium
alteration of ion transport in muscle and nerve cells
increases receptor sensitivity to serotonin
what kind of protein binding is lithium
weak protein binding
what is the half life of lithium
18-36 hr
what is lithium used for
bipolar disorder-manic episodes.
what is the theraputic range of lithium
1-1.5
anything >1.5 may cause toxicitiy
what does lithium deplete
sodium
what are some side effects of lithium
drowsy, dizzy, memory impairment, HA
dry mouth, metallic taste, GI upset
edema of hands and ankles, dehydration
increased urination
what are the adverse reactions to lithium
hyponatremia
hypotension
dysrhythmias
nephrotoxicity
leukocytosis
what does lithium interact with
increase levels
-NSAIDS
-haloperidol
increase r/f serotonin synd
-SSRI
-SNRI
can cause neurotoxicity
-St, johns wart
-ephedra
-Ginseng
-Kava Kava
-valerian
what are the contraidications of lithium
liver and renal disease
pregnancy
hyponatremia
dehydration
cardiac disease
what should we asses when giving mood stabilizers
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
how should a pt take lithium
with meals to avoid GI upset
how is fluoxetine given
PO
what is the half life of fluoxetine
when is the onset
when is the peak
4-6 days
3-4 wk initially
6-8hr
what labs should uou asses and what when giving antidepressants
kidney and liver function
UO
BUN
creat
hepatic enzyme levels (ALT, AST)
what are some S/S of Neuroleptic malignant syndrome(NMS)`
hyperpyrexia
muscle rigidity
tachycardia
cardiac dysrhythmias
what conditions should TCAs be avoid
cardiovascular disease
hypertension
what is the therapeutic effect of antidepressants
pt depression is controlled or gone
what is the therapeutic range for lithium
0.5-1.2
what food contain tyramine
cheese
red wine
beer
liver
bananas
yougurt
sausage
what should people taking MAOIs avoid and why
tyramine food because it causes hypertensive crisis
what is the half life of amitriptyline
10-50hr
what is the theraputic range for amitriptyline
120-150ng/mL
what should be assessed and what labs when giving lithium
hepatic and renal function
UO
BUN
Creat
liver enzymes
what should you teach a pt who is taking lithium
matain good fluid intake
take with meal to avoid gi upset
avoid caffeine- can decrease lithium levels
matian adequate sodium levels
what are some early and late signs of lithium toxicity
early
-NVD
-drowsy
-loss of app.
-slurred speech
-trembling
late
-blurry vision
-confusion
-increased urination
-convulsions
what is the therapeutic response to lithium
patient decreased or free from bipolar behavior
what is the half life of trazodone
10hr
