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Nursing Pharmacology > C8- Central Nervous System Medications Antidepressants > Flashcards

C8- Central Nervous System Medications Antidepressants Flashcards

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1
Q

Depression is a deficit of one or more of the biogenic amines:

A

Serotonin (5HT)
Norepinephrine (NE)
Dopamine (DA)

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2
Q

Diagnosis of depression needs 5 or more symptoms for 2 weeks or more, what are some of the symptoms?

A

-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

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3
Q

Relief of depression may take how long?

A

4-6 weeks

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4
Q

When dosing of inpatients with antidepressants what should the nurse look for

A

cheeking
(preventing patient from accumulating multiple dose that might be taken with suicidal intent)

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5
Q

Prescriptions should be written how for antidepressants?

A

written for the smallest number of doses consistent with good patient management.

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6
Q

Who is most at risk for suicidal thoughts/tendencies while in early treatment?

A

children, adolescents and adults under 25

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7
Q

What is the prototype drug for tricyclic antidepressants?

A

Amitryptaline

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8
Q

Tricyclic antidepressant amitrptaline action

A

block neuronal reuptake of norepinephrine and serotonin
block acetylcholine and histamine receptors

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9
Q

therapeutic uses for tricyclic antidepressant amitryptaline

A

depression
bipolar disorder
neuropathic pain
fibromyalgia
chronic insomnia
adhd
panic disorder
OCD

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10
Q

Side effects of tricyclic antidepressant amitryptaline

A

sedation
orthostatic hypotension
anticholinergic effects (1-2 weeks)
cardio toxicity
photosensitivity
weight gain
diaphoresis
seizures (lowers seizure threshold)
hypomania
suicide risk

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11
Q

therapeutic effects of tricyclic antidepressants come into effect after?

A

4-6 weeks

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12
Q

Because TCA block receptors of histamine and acetylcholine, patients may experience side effects similar to

A

antihistamines
anticholinergics

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13
Q

Drug interactions of tricyclic antidepressants?

A

MAOIs (hypertensive crisis)
Anticholinergic agents (intensifies anticholinergic effects)
Sympathomimetics
CNS Depressants (alcohol)

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14
Q

Nursing administration of tricyclic antidepressants, when should you administer?

A

bedtime (h.s)

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15
Q

What should a nurse monitor for in regards to TCA administration?

A

suicidal precautions
warn of orthostatic hypotension
monitor cardiac function
monitor depression symptoms

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16
Q

Amitriptyline onset

A

physical 1-2 weeks
psychological 2-4 weeks

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17
Q

What is the T1/2 of amitriptyline?

A

10-26 hours

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18
Q

Avoid amitriptyline if pregnant due to what pregnancy category?

A

D- DO NOT USE

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19
Q

SSRIs stand for?

A

Selective serotonin reuptake inhibitors

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20
Q

There are two prototypes for SSRIs, what are they?

A

Fluoxetine
Citalopram

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21
Q

T or F, SSRIs are just as effective as TCAs

A

True

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22
Q

SSRIs do not cause:

A

hypotension
sedation
anticholinergic effects
cardiotoxicity
photosensitivity

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23
Q

SSRI action:

A

Inhibits serotonin reuptake
increases serotonin available at the synapse

24
Q

SSRI interactions

A

MAOIs- hypertensive crisis
Antiplatelet/anticoagulant - increased risk of bleeding

25
Q

SSRI side effects include?

A

Insomnia
agitation
weight gain
nausea/decreased apetite
sexual dysfunction
headaches (CNS stimulation)
serotonin syndrome

26
Q

SSRI Pregnancy category

A

C

27
Q

When should a patient take an SSRI?

A

in the morning to help insomnia or nervouness

28
Q

Relief from symptoms occurs around what time when taking SSRIs?

A

2-4 Weeks

29
Q

In regards to food, how should the patient be directed to take an SSRI?

A

No regard to food, can take on an empty stomach

30
Q

SSRI teaching is important, what should you advise the patient to report? What important information should the patient know about stopping the drug?

A

Patient should report any adverse effects
patient should not stop taking SSRI without consulting doctor

31
Q

What is serotonin syndrome?

A

a life threatening drug reaction that causes the body to have too much serotonin. Symptoms occur within minutes to hours

32
Q

Symptoms/Manifestations of serotonin syndrome?

A

Restlessness
hallucinations
loss of coordination
fast heartbeat
rapid changes is BP
increased body temp
nausea/vomitting/diarrhea

33
Q

When does serotonin syndrome occur?

A

when two drugs that affect the body’s level of serotonin are taken together
(SSRI, NSRI, Migrane medications)

34
Q

When is serotonin syndrome most likely to occur?

A

when you first start or increase the med (2-72 hours onset)

35
Q

There are drugs of abuse also associated with serotonin syndrome, what are they?

A

MDMA
LSD
Sumatriptan

36
Q

Serotonin/Norepinephrine reuptake inhibitors are also called what?

A

SNRIs

37
Q

SNRI prototype drug name:

A

Venlafaxine

38
Q

SNRI Action?

A

Block reuptake of serotonin and norepinephrine
minimal effect of other NT or receptors
pharmacologic effects are similar to SSRI

39
Q

SNRI adverse effects include:

A

Nausea
headache
dizziness
insomnia
serotonin syndrom

40
Q

Interactions with SNRIs?

A

MAOIs
Alcohol- liver damage
Withdrawal- abrupt discontinuation.

41
Q

Atypical antidepressant prototype drug name?

A

Buproprion

42
Q

atypical antidepressant buproprion effects which neurotransmitters?

A

Norepinephrine and dopamine

43
Q

Buproprion uses:

A

Nicotine withdrawl
depression

44
Q

Positives of using buproprion as an antidepressant?

A

Appetite suppressant
no sexual side effects
no weight gain

45
Q

Side effects of buproprion include?

A

Tachycardia
CNS stimulation/insomnia
seizures
nausea
dry mouth
constipation

46
Q

Mono-Amine Oxidase Inhibitors are otherwise referred to as?

A

MAOIs

47
Q

MAOI action

A

block the action of monoamine oxidase which normally metabolizes:
-norepinephrine
-dopamine
-epinephrine
-serotonin

48
Q

MAOI prototype drug name?

A

Tranylcypromine

49
Q

MAOI interacts with which drugs/agents?

A

Amphetamines
Antidepressants (TCA & SSRI)
Sympathomimetic (cold meds)
Barbiturates
CNS depressants
** foods with tyramine** (cheese, wine, pickled food)

50
Q

Side effects of MAOIs?

A

Hypertensive crisis
orthostatic hypotension
sedation
weight gain
pregnancy category C

51
Q

When should MAOIs be administered?

A

bedtime to reduce danger of sedation

52
Q

Monitor what with patients taking MAOIs

A

MAOIs can cause severe and unpredictable adverse effects
monitor liver function and blood tests

53
Q

What should the nurse include in the teaching of MAOIs to a patient?

A

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

54
Q

Tyramine-containing Foods

A

Aged cheeses
Aged/fermented meats
Liver
Fava beans
Red wines -Chianti
Smoked or pickled meats

55
Q

AGinkgo Biloba and St. John’s wort are coplementary and alternative therapy for depression what should be known about these?

A

May help mild depression but should not be taken with other antidepresants
discontinue use 1-2 weeks before surgery

Nursing Pharmacology (11 decks)

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