Ch. 28 - Antidepressants

Question 1

Depression:

Answer 1

Mood disorder:

1. ) Depressed mood, despair, insomnia
2. ) Loss of interest in normal activities
3. ) Fatigue
4. ) Decreased ability to think
5. ) Suicidal thoughts

Question 2

Major Antidepressants Agents:

Answer 2

1. ) Tricyclic antidepressants
2. ) Selective serotonin reuptake inhibitors (SSRIs)
3. ) Serotonin norepinephrine reuptake inhibitors
4. ) Atypical antidepressants
5. ) Monoamine oxidase inhibitors

Question 3

1.) Tricyclic Antidepressants (TCAs):

Answer 3

1. ) amitriptyline (Elavil)
2. ) imipramine (Tofranil)
3. ) trimipramine (Surmontil)
4. ) doxepin (Sinequan)
5. ) desipramine (Norpramin)
6. ) nortriptyline (Pamelor)
7. ) protriptyline (Vivactil)

Question 4

TCA - Action:

Answer 4

1. ) Blocks uptake of neurotransmitters:
   
   • Norepinephrine
   • Serotonin

Question 5

TCA - Action: cont….

Answer 5

2. ) Elevates mood
3. ) Increases interest in ADLs
4. ) Decreases insomnia
5. ) Clinical response —> 2-4 weeks

Question 6

TCA - Uses:

Answer 6

1. ) Major depression
2. ) Less expensive than SSRIs
3. ) D/c gradually

Question 7

TCA - many side effects:

Answer 7

1. ) Anticholinergic effects
2. ) Sedation
3. ) Orthostatic hypotension
4. ) Cardiac toxicity
5. ) Seizures
6. ) Sexual dysfunction
7. ) Blood dyscrasias

Question 8

2.) Selective serotonin reuptake inhibitors (SSRIs):

Answer 8

1. ) fluoxetine (Prozac)
2. ) sertraline (Zoloft)
3. ) paroxetine (Paxil)
4. ) citalopram (Celexa)
5. ) escitalopram (Lexapro)

Question 9

SSRI - Action:

Answer 9

1. ) Block reuptake of serotonin

2. ) Fewer SE than TCAs

Question 10

SSRI - Uses:

Answer 10

1. ) Major depression (primary)
2. ) Anxiety disorders
3. ) Obsessive compulsive

Question 11

SSRI - Interactions:

Answer 11

Increased CNS effects w/ alcohol & other CNS depressants

*Don’t consume w/ grapefruit juice

Question 12

fluoxetine (Prozac) - Prototype drug (SSRI):

Answer 12

• Dosage
  
  • Initial: 20mg/day in AM
  • Max: 80mg/day
• Therapeutic effect: 2-4 weeks

Question 13

fluoxetine (Prozac) - SE:

Answer 13

1. ) Decrease over 2-4 weeks
2. ) Dry mouth
3. ) HA, blurred vision
4. ) Nervousness, insomnia, tremors
5. ) GI distress
6. ) Sexual dysfunction

Question 14

fluoxetine (Prozac) - Adverse reactions:

Answer 14

1. ) Hyponatremia
2. )Seizures
3. ) Suicidal Ideation

Question 15

fluoxetine (Prozac) - CAUTION:

Answer 15

1. ) Severe depression w/ suicidal tendencies
2. ) Glaucoma
3. ) Seizure disorder
4. ) Underweight

Question 16

3.) Serotonin norepinephrine reuptake inhibitors (SNRI):

Answer 16

1. ) venlafaxine (Effexor)
2. ) duloxetine (Cymbalta)
3. ) desvenlafaxine (Pristiq)

Question 17

Serotonin norepinephrine reuptake inhibitors (SNRI) - Action:

Answer 17

Inhibit repute of serotonin & norepinephrine

—> increases these substances

Question 18

Serotonin norepinephrine reuptake inhibitors (SNRI) - Uses:

Answer 18

1. ) Major depression
2. ) Generalized anxiety
3. ) Social anxiety

Question 19

Monoamine Oxidase Inhibitors (MAOI):

Answer 19

1. ) tranylcypromine sulfate (Parnate)
2. ) isocarboxazid (Marplan)
3. ) selegiline (Emsam)
4. ) phenelzine sulfate (Nardil)

Question 20

Monoamine Oxidase Inhibitors (MAOI) - Action:

Answer 20

1. ) Monamine oxidase ENZYME inactivates neurotransmitters

2. ) By inhibiting MAO enzyme —> levels rise

Question 21

Monoamine Oxidase Inhibitors (MAOI) - Use:

Answer 21

Depression not controlled by TCAs & Second Generation Antidepressants

Question 22

MAOI - Drug Interactions:

Answer 22

Vasoconstrictors & Cold medications

-Hypertensive Crisis

Question 23

MAOI - Herbal Alert:

Answer 23

Ginseng, ephedra, St. John’s Wort —>

 * Palpitations
 * Heart Attack
 * Hypertensive Crisis

Question 24

MAOI - Food Interactions:

Answer 24

• Containing tyramine

- aged cheese, red wine, beer, yogurt, processed meats, bananas, raisins, yeast, soy sauce ===> Hypertensive Crisis

Question 25

MAOI - SE:

Answer 25

1. ) Agitation
2. ) Restlessness
3. ) Insomnia
4. ) Anticholinergic effects
5. ) Orthostatis hypotension

Question 26

Nursing Process - Antidepressants:

Answer 26

• Monitor:
  
  • Drug-drug & food-drug interactions (MAOIs)
  • Suicidal tendencies

Question 27

Health Teaching - Antidepressants:

Answer 27

1. ) Take as prescribed!
2. ) List of foods to avoid (MAOI)
3. ) Therapeutic response —-> 2-4 weeks
4. ) Possible teratogenic effects

Question 28

Health Teaching - Antidepressants (1):

Answer 28

5. ) Avoid:
   
   • Alcohol, CNS depressants, & cold medicines

6.) DO NOT STOP abruptly
>needs to be gradually decreased & monitored

Question 29

Health Teaching - Antidepressants (2):

Answer 29

7. ) Take drug at bedtime d/t sedative effects (TCA)

8. ) Herbs may interact w/ antidepressants