C8- Central Nervous System Medications Antidepressants Flashcards by Amelia Heusuk

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

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

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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

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Relief of depression may take how long?

4-6 weeks

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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)

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Prescriptions should be written how for antidepressants?

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

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

children, adolescents and adults under 25

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What is the prototype drug for tricyclic antidepressants?

Amitryptaline

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Tricyclic antidepressant amitrptaline action

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

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therapeutic uses for tricyclic antidepressant amitryptaline

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

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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

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therapeutic effects of tricyclic antidepressants come into effect after?

4-6 weeks

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

antihistamines
anticholinergics

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Drug interactions of tricyclic antidepressants?

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

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Nursing administration of tricyclic antidepressants, when should you administer?

bedtime (h.s)

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

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

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Amitriptyline onset

physical 1-2 weeks
psychological 2-4 weeks

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What is the T1/2 of amitriptyline?

10-26 hours

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Avoid amitriptyline if pregnant due to what pregnancy category?

D- DO NOT USE

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SSRIs stand for?

Selective serotonin reuptake inhibitors

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There are two prototypes for SSRIs, what are they?

Fluoxetine
Citalopram

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T or F, SSRIs are just as effective as TCAs

True

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SSRIs do not cause:

hypotension
sedation
anticholinergic effects
cardiotoxicity
photosensitivity

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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

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