CH 8 DEPRESSIVE DISORDERS Flashcards
What does SSRI mean?
Selective serotonin reuptake inhibitors
What is the prototype drug of SSRI’s?
fluoxetine
What are other medications in the SSRI class of drugs?
citalopram (celexa) escitalopram ( Lexapro) paroxetine (Paxil) sertraline ( Zoloft) vilazodone ( viibryd)
What is the pharmalogical action of SSRI’s?
SSRI’s selectively block reuptake of the monoamine neurotransmitter serotonin in the synaptic space, thereby intensifying the effects of serotonin.
What are the therapeutic uses of SSRI’s?
Major depression, OCD bulimia nervosa Premenstrual dysphoric disorders Panic disorders PTSD
What are the adverse effects of SSRI’s?
Sexual dysfunction
CNS stimulation….inability to sleep, agitation, anxiety
Weight loss early in therapy followed by wt gain with long term tx.
Rash sleepiness
What are manifestations of serotonin syndrome?
May begin 2-72 hr after treatment.
Mental confusion, difficulty concentrating, fever, agitation
Anxiety, hallucinations, in coordination, hyperreflexia,
Diaphoresis, tremors
What are some facts about SSRI’s?
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.
What increases the risk of serotonin syndrome?
MAOI’s,
TCA’s
St. John’s wart
What med can displace warfarin?
fluoxetine can displace warfarin from bound protein and result in increased warfarin levels.
What can fluoxetine increase?
Fluoxetine can increase the levels of Tricyclic antidepressants and lithium.
What flouxetine suppress?
fluoxetine suppresses platelet aggregation and this increases the risk of bleeding when used concurrently with NSAID’s and anticoagulants.
What is the protype drug for ATYPICAL ANTIDEPRESSANTS?
bupropion HCL ( Wellbutrin)
What is the pharmacological action of ATYPICAL ANTIDEPRESSANTS?
The action is not fully understood. However, it likely acts by inhibiting dopamine uptake.
What are the therapeutic uses of ATYPICAL ANTIDEPRESSANTS?
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.
What are adverse effects of ATYPICAL ANTIDEPRESSANTS?
Headache, dry mouth, GI distress, constipation, increased heart rate
Nausea, restlessness, insomnia
Suppresses appetite and often causes wt. loss
Seizures
What is true of bupropion?
Pregnancy category B
contraindicated in clients taking MAOI’s
Contraindicated in clients with seizure disorders
what is the prototype drug of TRYCYCLIC ANTIDEPRESSANTS (TCA)?
amitriptyline (Elavil)
Name some TCA medications.
imipramine ( Tofranil) doxepin ( Sinequan) nortiptyline ( Aventyl) amoxapine ( Asendin) trimipramine ( Surmontil)
What are the pharmalogical actions of TCA’s?
These meds block reuptake of norepinephrine & serotonin in the synaptic space, thereby intensifying the effects of these neurotransmitters.
What are the therapeutic uses of TCA’s?
Depression Depressive episodes of bipolar disorders Neuropathic pain, fibromyalgia Anxiety disorders Insomnia
What are complications of TCA medications?
Orthostatic hypotension
Anticholinergic effects….dry mouth, blurred vision, photophobia,constipation, tachycardia, urinary hesitancy
Sedation, diaphoresis, decreased seizure threshold.
What are some facts about TCA.
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
What do TCA’s decrease?
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.
What drug- drug interactions are their with TCA’s?
Concurrent use with MAOI’s or St. John’s wart may lead to serotonin syndrome.
What is the prototype drug of MONOAMINE OXIDASE INHIBITORS?
phenelzine ( Nardil)
Name some MAOI medications.
isocarboxazid (Marplan)
tranylcypromine (Parnate)
selegiline (emsam)- transdermal MAOI
What is the purpose of MAOI medications?
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.
What are some adverse reactions of MAIO’s
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.
What are some food/ drug interactions of MAOI’s?
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.
What are recommended teaching for SSRI’s?
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
What are recommended teachings for ATYPICALLY ANTIDEPRESSANTS?
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.
What are recommended teachings for TCA’s
Monitor for toxicity manifested by cardiac dysrhythmias
Administer @ bedtime due to sedation and risk for orthostatic hypotension.
What is the recommended teachings for MAOI’s?
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.
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?
Orthostatic hypotension is an adverse effect of MAIO’s, including phenelzine
What food contain tyramine?
Bananas and yeast products
What is an appropriate nursing teaching for a pt. taking fluoxetine ( Prozac)
The pt. may have a decreased desire for intimacy.
What 4 groups are antidepressants classified into?
Selective serotonin inhibitors ( SSRI)
Atypical antidepressants
Tricyclic antidepressants (TCA)
Monoamine oxidase inhibitors ( MAOI’s)
