Antidepressants, Anxiety and Insomnia Flashcards
S&S antidepressant discontinuation syndrome
Flu-like symptoms, insomnia, nausea, imbalance, sensory disturbances, and hyperarousal
Side effects/adverse reactions of tricyclic antidepressants
Anticholinergic
Drowsiness and dizziness
Weight gain
Suicidal ideation
orthostatic hypotension
Histamine effects: sleepiness
Interactions of Tricyclic antidepressants, SSRIs
Alcohol and other CNS depressants
MAOIs: > serotonin and norepinephrine
Grapefruit
MOAI
Prototype
Action
use
Phenelzine
Prevents destroying epinephrine, dopamine, epinephrine and serotonin
Depression not controlled
Phenelzine interactions
CNS stimulants
Vasoconstrictors and cold medications
Other antidepressants
Tyramine-hypertension
Antidepressant general characteristics
2-4 weeks before depressive symptoms improve
Metabolized in liver
Taper antidepressants
Tricyclic antidepressants
Prototype
Action
Use
Imipramine
Blocks histamine receptors. Blocks cholinergic receptors. Inhibit reuptake of norepinephrine and serotonin
Use: major depression
Why must you avoid grapefruits when taking antidepressants
Inhibits specific enzymes in the liver which causes the body to not be able to metabolize the drug–>drug toxicity
SSRIs
Prototype
Action
Use
Fluoxetine (prozac),
Action: block reuptake of serotonin
Uses: major depression, anxiety disorders, prevention of migraine headaches
Venlafaxine
Action: inhibit reuptake of serotonin and norepinephrine
Use: major depression, GAD
Side effects/Adverse reactions of Fluoxetine
GI distress (N/V/D)
Urinary retention, sexual dysfunction
Suicidal ideation
Serotonin syndrome
Symptoms of serotonin syndrome
Hypertensive crisis, fever, agitation, rigidity
Side effects of venlafaxine
Drowsiness, dizziness, GI distress, urinary retention, sexual dysfunction, suicidal ideation
Phenelzine side effects
Agitation, restlessness, insomnia
Orthostatic hypotension
Atypical antidepressants
Prototype
Action
use
Bupropion
Action: Affect 1, 2, or all neurotransmitters: serotonin, norepinephrine, and dopamine
Use: MDD, Reactive depression, anxiety
Atypical antidepressants
Interaction
Do not take with MAOIs/ do not use within 14 days of discontinuing MAOIs
Nursing interventions atypical antidpressants
Monitor vital signs
Monitor for drug-drug and food-drug interactions
Provide pt with a list of foods to avoid
Signs of depression
Mood changes, insomnia, apathy, lack of interest in activities
Mood stabilizer
Prototype
Action
Use
Lithium carbonate
Action: Stabilizes receptor activity
Use: Bipolar disorder manic episodes. Keeps mood balanced
Side effects/Adverse reactions of mood stabilizer
Metallic taste
Hand tremors, weakness
Polyuria, polydipsia (excess thirst)
edema, weight gain
Lithium is a salt so you urinate more to try to balance electrolytes
Mood stabilizer interactions
Increased lithium levels with thiazides
Decrease: caffeine, loop diuretics
What do you do if a medication has a narrow therapeutic range
Come in often to check for labs and maybe edit the dose
Benzodiazepines
Prototype
Action
Use vs major use
Diazepam
Action: Enhances GABA to reduce neuron excitability (> GABA=drowsiness & daytime sleepiness)
Use: reduce anxiety, treat insomnia
Major use: Anticonvulsant
Preoperative sedation, prevention of agitation and DTs (delirium tremens) in acute alcohol withdrawal
Nursing interventions and education of benzos
Nursing interventions: Nonpharmacologic methods
Tapered: if not experience withdrawal symptoms
Nonbenzodiazepines
Prototype
Uses
Zolpidem (Ambien)
Used as a sleep aid, same effect as benzodiazepines, but structurally different
Can benzos/nonbenzos be used as a sleep aid?
Still be groggy, not totally metabolized yet
Cause weird dreams
drug therapy side effects for benzos
CNS depressant: dizziness, drowsiness, uncoordinated, confusion, poor concentration
