Depression Flashcards
Diagnosing MDD SIGECAPS
sleep disturbances
interest reduced
guilt and self blame
energy loss and fatigue
concentration problems
appetite changes
psychomotor changes
suicidal thoughts
Med management
First line: SSRI
Serious side effects are rare
Much safer than TCAS
What critical information should be given to a patient when starting meds for MDD
4-6 week therapeutic effect
Continue medication for a minimum 6-12 months
when do you consider medication management indefinitely
More than 2 prior episodes of MDD consider
Rebound is when
stopping abruptly especially with short half lives
Prozac has a longer half-life
which medication has a particularly short half life
Sertraline
What medication is most likely to have the least amount of sexual dysfunction
mirtazapine
Wellbutrin is contraindicated for
for seizure hx or eating disorder (increases seizure risks) electrolyte imbalances cause seizure increase
When client is depressed, low energy, fatigue what is a good medication option
NDRI Wellbutrin
S/E of SSRI (3) (SSS)
stomach upset
sexual dysfunction
serotonin syndrome
SSRIs can also be used for (4)
panic
OCD
anxiety
PTSD
common drug for panic disorder
paroxetine
common drug for compulsion
citalopram
EFFECTIVE FOR SADNESS PANIC COMPULSIONS
Effective- escitalopram
For-Fluoxetine Fluvoxamine
Sadness-Sertraline
Panic-Paroxetine
Compulsions-Citalopram
Duloxetine is a ()
SNRI
SNRI’s can help with
neuropathic pain
Second line for depression is
TCAs
TCA potential risks 156 (4)
electrocardiogram changes
cardiac dysrhythmias possible
monitor EKG before tx and annually for older adults
TCA should not be d/c abruptly because of
risk of discontinuation syndrome
avoid TCA prescription for clients at high risk of
SI
Black box warning for antidepressants
all antidepressants carry a black box warning for increased SI, agitation, aggression
ECT is indicated for (2)
MDD with psychotic features and treatment-resistant depression
Contraindications of ECT (4)
Cardiac disease
compromised pulmonary status
Hx of brain injury or tumor
anesthesia medical compliations
Safety plan includes and is not a
not a contract
includes crisis number
support system
provider to call
coping skills
case manager
CHART SAFETY PLAN
Prozac can effect sleep by? What should you do if client reports sleep distrubances?
Can cause insomnia, advise them to take it in the morning
How does depression manifest for adolescents? (2)
anger, irritability
What neurotransmitters are involved in depression?
Dopamine, NE, Serotonin
Parts involved in depression (3)
Amygdala (enlarged), hippocampus, thalamus (reduced)
If a client with depression is on chemo-medication what depression medications should you choose? (3)
Citalopram, escitalopram, sertraline (SSRIs less chance of reactions)
What type of drugs should you use for a client with chronic neuropathic pain (Fibromyalgia) (2)
SNRIs and TCA
For chronic neuropathic pain what drugs can you give a client with depression (2)
Gabapentin and pregabalin (PGR) (alpha delta ligands)
Rare side effect of serotonin- norepinephrine inhibitors
Interstitial lung disease
What do you need to monitor for clients taking SNRIs like Duloxetine or venlafaxine
BP
SSRIs like citalopram and SNRIs duloxetine can cause
hyponatremia
symptoms of duloxetine-induced hyponatremia (8)
onset is days after starting or up to months
fatigue
weakness
lethargy
headache
nausea
dizziness
aloc
seizure
What type of drugs can cause sexual problems (4)
SSRIS, SNRIs, TCAs, MAOIs
what drugs are less likely to cause sexual dysfunction (2)
wellbutrin and remeron
If client is depressed, has low energy, fatigue (anergia) what type of medication may be best for them
Wellbutrin because it increases energy levels
Wellbutrin contraindications (3)
seizure d/o
contraindications that can increased seizure risk such as anorexia or bulimia
Why does wellbutrin increase seizure risk
by decreasing seizure threshold
antidepressants used for insomnia include (4)
trazodone, mirtazapine, amitriptyline, doxepin
5-HT2C receptor is a subtype of _____
serotonin receptor
5-HT2C receptors play a role in regulating (3)
mood, anxiety, and can influence response to antidepressants
if a client has a genetic dysfunction regarding the 5HT2C receptor it can
impact the serotonin signaling pathways- making tx less effective
What medications to consider if client has 5HT2C genetic dysfunction and SSRIs are not effective (3)
SNRIS- venlafaxine, duloxetine
atypical antidepressants Remeron (mirtazapine) or bupropion (Wellbutrin)
TCAs such as amitriptyline and nortriptyline
What medications can cause depression?
Steroids*** can also cause psychosis (flonase/prednisone)
liothyronine
beta-blockers
interferon
isotretinoin (accutane)
some retroviral drugs
antineoplastic drugs
benzodiazepines
progesterone
SSRIS can cause what in older adults
increase anxiety
