C8- Central Nervous System Medications Antidepressants Flashcards
Depression is a deficit of one or more of the biogenic amines:
Serotonin (5HT)
Norepinephrine (NE)
Dopamine (DA)
Diagnosis of depression needs 5 or more symptoms for 2 weeks or more, what are some of the symptoms?
-depressed mood most of the day
-loss of interest or pleasure in all or almost all activities
-significant weight loss/gain
-insomnia/hypersomnia
-fatigue
-worthlessness or guilt
-inability to thin or concentrate
-recurrent thoughts of death/suicide
-psychomotor agitation or retardation
Relief of depression may take how long?
4-6 weeks
When dosing of inpatients with antidepressants what should the nurse look for
cheeking
(preventing patient from accumulating multiple dose that might be taken with suicidal intent)
Prescriptions should be written how for antidepressants?
written for the smallest number of doses consistent with good patient management.
Who is most at risk for suicidal thoughts/tendencies while in early treatment?
children, adolescents and adults under 25
What is the prototype drug for tricyclic antidepressants?
Amitryptaline
Tricyclic antidepressant amitrptaline action
block neuronal reuptake of norepinephrine and serotonin
block acetylcholine and histamine receptors
therapeutic uses for tricyclic antidepressant amitryptaline
depression
bipolar disorder
neuropathic pain
fibromyalgia
chronic insomnia
adhd
panic disorder
OCD
Side effects of tricyclic antidepressant amitryptaline
sedation
orthostatic hypotension
anticholinergic effects (1-2 weeks)
cardio toxicity
photosensitivity
weight gain
diaphoresis
seizures (lowers seizure threshold)
hypomania
suicide risk
therapeutic effects of tricyclic antidepressants come into effect after?
4-6 weeks
Because TCA block receptors of histamine and acetylcholine, patients may experience side effects similar to
antihistamines
anticholinergics
Drug interactions of tricyclic antidepressants?
MAOIs (hypertensive crisis)
Anticholinergic agents (intensifies anticholinergic effects)
Sympathomimetics
CNS Depressants (alcohol)
Nursing administration of tricyclic antidepressants, when should you administer?
bedtime (h.s)
What should a nurse monitor for in regards to TCA administration?
suicidal precautions
warn of orthostatic hypotension
monitor cardiac function
monitor depression symptoms
Amitriptyline onset
physical 1-2 weeks
psychological 2-4 weeks
What is the T1/2 of amitriptyline?
10-26 hours
Avoid amitriptyline if pregnant due to what pregnancy category?
D- DO NOT USE
SSRIs stand for?
Selective serotonin reuptake inhibitors
There are two prototypes for SSRIs, what are they?
Fluoxetine
Citalopram
T or F, SSRIs are just as effective as TCAs
True
SSRIs do not cause:
hypotension
sedation
anticholinergic effects
cardiotoxicity
photosensitivity
SSRI action:
Inhibits serotonin reuptake
increases serotonin available at the synapse
SSRI interactions
MAOIs- hypertensive crisis
Antiplatelet/anticoagulant - increased risk of bleeding
SSRI side effects include?
Insomnia
agitation
weight gain
nausea/decreased apetite
sexual dysfunction
headaches (CNS stimulation)
serotonin syndrome
SSRI Pregnancy category
C
When should a patient take an SSRI?
in the morning to help insomnia or nervouness
Relief from symptoms occurs around what time when taking SSRIs?
2-4 Weeks
In regards to food, how should the patient be directed to take an SSRI?
No regard to food, can take on an empty stomach
SSRI teaching is important, what should you advise the patient to report? What important information should the patient know about stopping the drug?
Patient should report any adverse effects
patient should not stop taking SSRI without consulting doctor
What is serotonin syndrome?
a life threatening drug reaction that causes the body to have too much serotonin. Symptoms occur within minutes to hours
Symptoms/Manifestations of serotonin syndrome?
Restlessness
hallucinations
loss of coordination
fast heartbeat
rapid changes is BP
increased body temp
nausea/vomitting/diarrhea
When does serotonin syndrome occur?
when two drugs that affect the body’s level of serotonin are taken together
(SSRI, NSRI, Migrane medications)
When is serotonin syndrome most likely to occur?
when you first start or increase the med (2-72 hours onset)
There are drugs of abuse also associated with serotonin syndrome, what are they?
MDMA
LSD
Sumatriptan
Serotonin/Norepinephrine reuptake inhibitors are also called what?
SNRIs
SNRI prototype drug name:
Venlafaxine
SNRI Action?
Block reuptake of serotonin and norepinephrine
minimal effect of other NT or receptors
pharmacologic effects are similar to SSRI
SNRI adverse effects include:
Nausea
headache
dizziness
insomnia
serotonin syndrom
Interactions with SNRIs?
MAOIs
Alcohol- liver damage
Withdrawal- abrupt discontinuation.
Atypical antidepressant prototype drug name?
Buproprion
atypical antidepressant buproprion effects which neurotransmitters?
Norepinephrine and dopamine
Buproprion uses:
Nicotine withdrawl
depression
Positives of using buproprion as an antidepressant?
Appetite suppressant
no sexual side effects
no weight gain
Side effects of buproprion include?
Tachycardia
CNS stimulation/insomnia
seizures
nausea
dry mouth
constipation
Mono-Amine Oxidase Inhibitors are otherwise referred to as?
MAOIs
MAOI action
block the action of monoamine oxidase which normally metabolizes:
-norepinephrine
-dopamine
-epinephrine
-serotonin
MAOI prototype drug name?
Tranylcypromine
MAOI interacts with which drugs/agents?
Amphetamines
Antidepressants (TCA & SSRI)
Sympathomimetic (cold meds)
Barbiturates
CNS depressants
** foods with tyramine** (cheese, wine, pickled food)
Side effects of MAOIs?
Hypertensive crisis
orthostatic hypotension
sedation
weight gain
pregnancy category C
When should MAOIs be administered?
bedtime to reduce danger of sedation
Monitor what with patients taking MAOIs
MAOIs can cause severe and unpredictable adverse effects
monitor liver function and blood tests
What should the nurse include in the teaching of MAOIs to a patient?
D/c 2 weeks before starting new antidepressant
sit up for one minute before getting out of bed
talk to prescriber about changes with OTC meds or herbals
Tyramine-containing Foods
Aged cheeses
Aged/fermented meats
Liver
Fava beans
Red wines -Chianti
Smoked or pickled meats
AGinkgo Biloba and St. John’s wort are coplementary and alternative therapy for depression what should be known about these?
May help mild depression but should not be taken with other antidepresants
discontinue use 1-2 weeks before surgery
