CH 8 DEPRESSIVE DISORDERS

Question 0

What does SSRI mean?

Answer 0

Selective serotonin reuptake inhibitors

Question 1

What 4 groups are antidepressants classified into?

Answer 1

Selective serotonin inhibitors ( SSRI)
Atypical antidepressants
Tricyclic antidepressants (TCA)
Monoamine oxidase inhibitors ( MAOI’s)

Question 2

What is the prototype drug of SSRI’s?

Answer 2

fluoxetine

Question 3

What are other medications in the SSRI class of drugs?

Answer 3

citalopram (celexa)
escitalopram ( Lexapro)
paroxetine (Paxil)
sertraline ( Zoloft)
vilazodone ( viibryd)

Question 4

What is the pharmalogical action of SSRI’s?

Answer 4

SSRI’s selectively block reuptake of the monoamine neurotransmitter serotonin in the synaptic space, thereby intensifying the effects of serotonin.

Question 5

What are the therapeutic uses of SSRI’s?

Answer 5

Major depression, OCD
bulimia nervosa 
Premenstrual dysphoric disorders
Panic disorders
PTSD

Question 6

What are the adverse effects of SSRI’s?

Answer 6

Sexual dysfunction
CNS stimulation….inability to sleep, agitation, anxiety
Weight loss early in therapy followed by wt gain with long term tx.
Rash sleepiness

Question 7

What are manifestations of serotonin syndrome?

Answer 7

May begin 2-72 hr after treatment.
Mental confusion, difficulty concentrating, fever, agitation
Anxiety, hallucinations, in coordination, hyperreflexia,
Diaphoresis, tremors

Question 8

What are some facts about SSRI’s?

Answer 8

Pregnancy category C
fluoxetine & paroxetine increase the risk of birth defects
It is contraindicated in clients taking MAOI’s?
Use cautiously in clients who have liver or kidney failure, cardiac disease, seizure disorders, diabetes, ulcers and a hx of GI bleeding.

Question 9

What increases the risk of serotonin syndrome?

Answer 9

MAOI’s,
TCA’s
St. John’s wart

Question 10

What med can displace warfarin?

Answer 10

fluoxetine can displace warfarin from bound protein and result in increased warfarin levels.

Question 11

What can fluoxetine increase?

Answer 11

Fluoxetine can increase the levels of Tricyclic antidepressants and lithium.

Question 12

What flouxetine suppress?

Answer 12

fluoxetine suppresses platelet aggregation and this increases the risk of bleeding when used concurrently with NSAID’s and anticoagulants.

Question 13

What is the protype drug for ATYPICAL ANTIDEPRESSANTS?

Answer 13

bupropion HCL ( Wellbutrin)

Question 14

What is the pharmacological action of ATYPICAL ANTIDEPRESSANTS?

Answer 14

The action is not fully understood. However, it likely acts by inhibiting dopamine uptake.

Question 15

What are the therapeutic uses of ATYPICAL ANTIDEPRESSANTS?

Answer 15

Treatment of depression
Alternative to SSRI clients unable tolerate sexual dysfunction side effects of SSRI’s.
Aid to quit smoking
Prevention of seasonal pattern depression.

Question 16

What are adverse effects of ATYPICAL ANTIDEPRESSANTS?

Answer 16

Headache, dry mouth, GI distress, constipation, increased heart rate
Nausea, restlessness, insomnia
Suppresses appetite and often causes wt. loss
Seizures

Question 17

What is true of bupropion?

Answer 17

Pregnancy category B
contraindicated in clients taking MAOI’s
Contraindicated in clients with seizure disorders

Question 18

what is the prototype drug of TRYCYCLIC ANTIDEPRESSANTS (TCA)?

Answer 18

amitriptyline (Elavil)

Question 19

Name some TCA medications.

Answer 19

imipramine ( Tofranil)
doxepin ( Sinequan)
nortiptyline ( Aventyl)
amoxapine ( Asendin)
trimipramine ( Surmontil)

Question 20

What are the pharmalogical actions of TCA’s?

Answer 20

These meds block reuptake of norepinephrine & serotonin in the synaptic space, thereby intensifying the effects of these neurotransmitters.

Question 21

What are the therapeutic uses of TCA’s?

Answer 21

Depression
Depressive episodes of bipolar disorders
Neuropathic pain, fibromyalgia 
Anxiety disorders
Insomnia

Question 22

What are complications of TCA medications?

Answer 22

Orthostatic hypotension
Anticholinergic effects….dry mouth, blurred vision, photophobia,constipation, tachycardia, urinary hesitancy
Sedation, diaphoresis, decreased seizure threshold.

Question 23

What are some facts about TCA.

Answer 23

Pregnancy category C
contraindicated in clients with seizure disorders
Use cautiously in clients with CAD, diabetes, liver & kidney, and respiratory disorders, urinary retention and obstruction,
Angle- closure glaucoma, benign prostatic hyperplasia, and hypothyroidism

Question 24

What do TCA’s decrease?

Answer 24

TCA’s decrease the effects of ephedrine, amphetamine because uptake into the nerve terminals is blocked, and they are unable to reach their site of action.

Question 25

What drug- drug interactions are their with TCA’s?

Answer 25

Concurrent use with MAOI’s or St. John’s wart may lead to serotonin syndrome.

Question 26

What is the prototype drug of MONOAMINE OXIDASE INHIBITORS?

Answer 26

phenelzine ( Nardil)

Question 27

Name some MAOI medications.

Answer 27

isocarboxazid (Marplan)
tranylcypromine (Parnate)
selegiline (emsam)- transdermal MAOI

Question 28

What is the purpose of MAOI medications?

Answer 28

These medications block MAO in the brain, thereby increasing the amt of norepinephrine, dopamine, and serotonin available for transmission of impulses.man increased amt of these neurotransmitters at nerve endings intensifies responses and relieves depression.

Question 29

What are some adverse reactions of MAIO’s

Answer 29

CNS stimulation, orthostatic hypotension
Hypertensive crisis resulting from intake of dietary tyramine
Severe hypertension occurs as a result of intensive vasoconstriction & stimulation of the heart.

Question 30

What are some food/ drug interactions of MAOI’s?

Answer 30

combined use of TCA’s can lead to hypertensive crisis
Combined use if SSRI’s can have an additive hypotension effect
Use of meperidine ( Demerol) can lead to hyperpyrexia
Tyramine rich foods…hypertensive crisis
Concurrent use of vasopressors may result in hypertension.

Question 31

What are recommended teaching for SSRI’s?

Answer 31

Advise clients to take meds in the AM to minimize sleep disturbances
Advise clients to take with food to minimize GI disturbances
Obtain baseline sodium levels for older adults taking diuretics, and monitor periodically

Question 32

What are recommended teachings for ATYPICALLY ANTIDEPRESSANTS?

Answer 32

for all atypical antidepressants, avoid MAOI’s.
Advise clients taking bupropion for prevention of seasonal pattern depression to take meds beginning in autumn each yr and taper dose by spring.

Question 33

What are recommended teachings for TCA’s

Answer 33

Monitor for toxicity manifested by cardiac dysrhythmias

Administer @ bedtime due to sedation and risk for orthostatic hypotension.

Question 34

What is the recommended teachings for MAOI’s?

Answer 34

Give clients a list of tyramine rich food so hypertensive crisis can be avoided.
Advise clients to avoid taking any other prescription or non prescription medications unless approved by the provider.

Question 35

A nurse is caring for a client who has a new prescription for phenelzine ( Nardil) for the treatment of depression. What indicates that the client has developed an adverse effect of this med?

Answer 35

Orthostatic hypotension is an adverse effect of MAIO’s, including phenelzine

Question 36

What food contain tyramine?

Answer 36

Bananas and yeast products

Question 37

What is an appropriate nursing teaching for a pt. taking fluoxetine ( Prozac)

Answer 37

The pt. may have a decreased desire for intimacy.