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.
