Antidepressive Flashcards
Feverfew herb interfere with
SSRI antidepressant like fluoxetine Prozac
St. John’s wort herb interfere with (x), causing s/s
SSRI antidepressant, causing serotonin syndrome (HA, dizziness, sweating, agitation)
what herbs leads to palpitation, heart attack, and HTN crisis when taken with which type antidepressants?
Ginseng, ephedra, ma-huang, and St. John’s wort when taken with Monoamine Oxidase Inhibitors (MAOIs)
why do pts use herbal remedies
pt want to self-treat
is there a need for collaboration when taking herbal remedies?
yes, colloborate between herbalist, MD, accupuncturist to treat the anxiety (not the actual mood d/o)
list 4 types of antidepressants?
monoamine oxidase inhibitors (MAOIs), tricyclic antidepressant (TCA), selective serotonin reuptake inhibitors (SSRI), non-selective serotonin reuptake inhibitor (NSRI)
Action of monoaminie oxidase inhibitor (MAOI)
monoamine oxidase usually inactivate norepinephrine, dopamine, epinephrine, and serotonin. So you MAOIs block that, so neurotransmitters increase in level.
Monoamine oxidase enzymes are found
in liver and brain
what are types of monoamine oxidase enzymes?
MAO-A and MAO-B enzymes
what is the difference between MAO-A and MAO-B enzymes?
MAO-A enzyme typically inactivate dopamine in brain. MAO-B enzyme typically inactivate norepinephrine and serotonin.
are MAOI agents selective or nonselective to MAO-A or MAO-B
nope. The agent works on both enzymes
when do you prescribe MAOI agents?
for Atypical Depression not responding to other treatment
List 3 types of MAOIs
phenelzine sulfate Nardil, isocarboxazid Marplan, tranylcypromine sulfate Parnate
what foods cause HTN crisis with MAOIs
Cheese (cheddar, swiss, bleu), bananas, raisins, pickled foods, red wine, beer, cream, yogurt, chocolate, coffee, italian green beans, liver, yeast, soy sauce, pickled herring, sausage, pepperoni
what effect do contraindicated food have with MAOIs?
sweating, tremors, bounding HR, high BP, high temp.
what sort of drugs caust HTN crisis with MAOIs?
CNS stimulants or sympathomimetics (vasoconstrictors and cold medication containing phenylephrine and pseudoephedrine); diet pills, meth, DEXTROMETHOPRHAN, other antidepressants, Meperidine demorol d/t dopamine
What chemical in foods cause HTN crisis with MAOIs?
tyramine
why do you avoid tyramine containing foods with MAOIs?
it has sympathomimetic-like effects that can cause HTN crisis
S/E of MAOIs
CNS stimulation: agitation, restlessness, insomnia, orthostatic hypotension, and anticholinergic effects
St. John’s wort herb does what?
decrease reuptake of neurotransmitters serotonin, norepinephrine, dopamine
When do you stop taking herbal supplements?
1-2 weeks before surgery.
how to eat tyramine containing foods with MAOIs?
if high, avoid. If moderate, eat occasionally. If low, eat in limited quantities.
What do you do in a HTN crisis?
VS, cooling measure, ice pack/bath, bear hug
What are collaborative invervention for HTN crisis?
IV fluids, benzodiazipine for muscle rigidity, short acting antiHTN meds
TCA or Lithium should be decreased in what type of pt
Asian pt, and all antidepressant should be decreased for Hispanic pt.
if taking herbal remedies with antidepressant,
antidepressive dose may need to be modified or herb needs to be d/c’d
herbal remedies interact with antidepressants, especially
MAOIs and SSRI
tricyclic antidepressants (TCA) action
block reuptake of norepinephrine and serotonin; also block histamine receptors
S/E of TCA
anticholinergic effect, orthostatic hypotension (rise slowly), sedation, cardiac toxicity, seizures
See effect of TCA in
2-4 weeks
if TCA does not work
slowly w/d and prescribe another antidepressant
TCA treats
major depression, neuralgia, pruritic, bulemic, cataplectic, narcoleptic adjunct, enuretic, panic, ulcer, OCD
TCA should do this
elevate mood, increase interest in ADLs, decrease insomnia
TCA has a (x) action
sedative action
W/D s/s of TCA with stopped abruptly
n/v, anxiety, akathisia (inability to be still)
half life of TCA
up to 10-50 hrs; look for cumulative drug effect
A/E of TCA
cardiac toxicity/dysrhythmia. blood dyscrasias: leukopenia, thrombocytopenia, and agranulocytosis
anticholinergic effect s/s
tachycardia, urinary retention, constipation, dry mouth, and blurred vision.
allergic reaction to TCA s/s
skin rash, pruritus, petechiae, sexual dysfunction, impotence, amenorrhea
which TCA cause Extrapyramidal S/s
Amitriptyline Elavil
which TCA cause neuroleptic malignant syndrome
Clomipramine Anafranil
TCA (x) seizure threshold, so do what?
decrease seizure threshold. Adjust TCA dose.
TCA serum range should be
100-200 ng/mL
TCA interact with what drugs
ETOH, hypnotics, sedatives, barbituates potentiate CNS depression,
What happens when you take TCA amitriptyline with MAOIs?
cardiovascular instability and toxic psychosis.
TCA amitriptyline with antithyroid meds does what?
increase risk of dysrhythmia
What to do if pt has TCA toxicity
ABC (airway), GI decontamination (can’t lavage), ECG abn tx with sodium bicarbonate drip (increase blood alk which slow Na influx when acidic to decrease dysrhythmia); control agitation/fever; controvertial admin of physostigmine (blocks acetylcholine)
what is polydrug therapy? Should you do this?
giving several antidepressants or antipsychotics together. Avoid doing this.
Mrs Teal said to learn which TCA
imipramine Tofranil
Imipramil tofranil treats
major depression
what kind of antidepressant is imipramil tofranil
TCA
Nursing Consideration with imipramil tofranil
take at HS to decrease danger from sedative effect. Take with food to decrease GI irritation. Avoid taking with ETOH or other CNS depressants.
Common s/e of imiprmine tofranil
drowsiness, dry mouth, hypotension, delayed micturition (delayed peeing when you want to pee).
therapeatuic range of imipramil tofranil
150-250 ng/mL
Imipramil tofranil max for elderly
150 mg/d
Imipramil tofranil max for adults
300 mg/d
anticholinergic mnemonic
dry as a bone (poor skin turgor; dry mucous membrane), blind as a bat (dilated), hot as a hare (high temp), red as a beet (flushed), mad as a hatter (confused/psychotic)
anticholinergic syndrome
inhibition of muscarinic cholinergic neurotransmission (acetocholine receptors blocked)
s/s of anticholingergic syndrome
sinus tachycardia, ileus, urinary retention, HTN, tremulousness, myoclonic jerking
what cause anticholinergic syndrome
anti: cholinergics, histamines, psychotics, spasmotics; cyclic antidepressants, mydraitics to dilate pupils, plants like datura
what kinds of plants cause anticholinergic syndrome?
datura, morning glory seeds, jimson weed, loco week , georgia o’keeffe
Selective serotonin reuptake inhibitor action
block reuptake of serotonin into the nerve terminal of CNS; so enhancing its transmission at serotonergic synapse
SSRI treats
major depressive d/o and anxiety d/o such as OCD, panic, phobias, PTSD; eating d/o, drug abuse, decrease premenstrual tension syndrome, preventing migraine HA, decrease aggressive behavior in boderline personality d/o.
SSRI are used more than (x) to treat depression
TCA
SSRI are (x) expensive than TCA
SSRI are less expensive than TCA
SSRI does not block
dopamine, norepinephrine, cholinergic and alpha1-adrenergic receptors.
List 3 SSRIs
Fluoxetine Prozac, fluvoxamine Luvox, sertraline zoloft
SSRI s/e to teach
sexual dysfunction (men will stop taking this d/t decrease sexual arousal; or women will become anorgasmic); these s/e cease over 2-4 weeks; there’s also weight gain in some pts
ssri s/e
dry mouth, blurred vision, insomnia, HA, nervousness, anorexia, nausea, diarrhea, suicidal ideation, GI distress, restlessness.
who should not take SSRI
pt with suicidal ideation
which SSRI shoud OCD take
fluvoxamine luvox,
most prescribed SSRI
sertraline zoloft
FDA approved (x) dose of fluoxetine prozac
90 mg/wk
SSRI interact with which food? What happens?
grapefruit leads to toxicity
List an Atypical (heterocyclic) antidepressant?
bupropion Wellbutrin
You should not take MAOIs with (or p 14 days of)
atypicial (heterocyclic) antidepressants like bupropion Wellbutrin
Do not take atypical heterocyclic antidepressant bupropion Wellbutrin with (or p 14 days of)
MAOI
another name for atypical antidepressant?
heterocyclic antidepressant
cost of SSRI
Expensive!
SSRI has (x) of safety
wide margin; get GI pain, not die
SSRI does what in children
increase suicide rate in children
SSRI fluoxetine prozac therapeautic range
90-300 ng/mL
SSRI a/e
seizures, hyponatremia, palpitations, chest pain
SSRI fluoxetine prozac + ETOH does this
more CNS/respiratory depression, hypotension
SSRI starts to work in
1-2 weeks; at 2 weeks, pt may commit suicide.
