Depression 8 Flashcards
Anti-cholinergic effects
Dry mouth, blurred vision, photophobia, urinary hesitancy or retention, constipation, tachycardia.
Treat with chewing on sugarless gum, sipping water, wearing sunglasses, eating high-fiber foods, regular exercise, increasing liquids, avoiding before taking medication.
Tricyclic antidepressants/TCA
Amitriptyline/Elavil
Blocked the reuptake of norepinephrine and serotonin thereby increasing their effect. Used for depression, depressive episodes of bipolar, chronic pain, and enuresis
Side effects include orthostatic hypotension. Anticholinergic effects. Sedation. Client should take at bedtime. Toxicity resulting in cholinergic blockade and cardiac toxicity. Decreased seizure threshold. Excessive sweating.
Contra indicated with seizure disorders. Caution with coronary artery disease, diabetes, liver and kidney disorders, respiratory disorders, urinary retention, angle closure glaucoma, BPH, hyperthyroidism.
MAOI and St. John’s wort can lead to serotonin syndrome. Don’t take with antihistamines. Alcohol, benzodiazepines, opioids, antihistamines increased CNS depression.
Selective serotonin reuptake inhibitors/SSRIs
Fluoxetine/Prozac
Other meds include Celexa, Lexapro, Paxil, and Zoloft. They intensify the effects of serotonin. They are used for major depression, OCD, bulimia, premenstrual dysphoric disorder, panic disorders, PTSD.
Side effects include sexual dysfunction, CNS stimulation such as the inability to sleep and anxiety. Weight-loss early in therapy followed by weight gain with long-term therapy. Serotonin syndrome. Withdrawal syndrome such as headache, nausea, visual disturbances, anxiety, dizzy, tremors. Hyponatremia, rash treated with antihistamine. Sleepiness, faintness, lightheadedness. G.I. bleed. Bruxism.
Contraindicated with MAOIs or TCAs. Use with caution with liver and renal dysfunction, cardiac disease, seizure disorders, diabetes, ulcers, and GI bleed.
MAOIs, TCAs, St. John’s wort increase the risk for serotonin syndrome. They can increase warfarin levels. They can increase lithium levels. They increase the risk of bleeding when used with NSAIDs.
Take medication in morning to decrease sleep disturbances. Take with food to decrease G.I. disturbances. Obtain baseline sodium level for older adults on diuretics.
MAOIs/monoamine oxidase inhibitors
Phenelzine(Nardil)
Other medications include Parnate, Marplan, and Emsam
They increase the amount of norepinephrine, dopamine, and serotonin. Used for atypical depression, bulimia, OCD.
Side effects include CNS stimulation such as anxiety, mania. Orthostatic hypotension. Hypertensive crisis resulting from intake of tyramine. Rash with transdermal treated with topical steroid.
Do not take with SSRIs or with pheochromocytomas, heart failure, cardiovascular and cerebrovascular disease, and severe renal insufficiency. Use with caution with diabetes and seizures.
Avoid over-the-counter decongestion. Antihypertensive increase the risk for hypertension. Demerol can lead to hyperpyrexia. Do not eat tyramine rich foods. Avoid caffeine.
Avoid any other medication unless approved.
Atypical antidepressants
Bupropion/Wellbutrin
Inhibits dopamine uptake.
Used for depression, an alternative to SSRIs when sexual’s dysfunction is not tolerated, quit smoking aid, prevention of SAD
Side effects include headache, dry mouth, G.I. distress, constipation, increased heart rate, nausea, restlessness, insomnia. It suppresses appetite and causes weight loss. Seizures: avoid if head injury and monitor. Contraindicated with MAOIs.
If SAD take medication beginning in autumn of each year and taper off by spring.
Suicide prevention
With antidepressants, only prescribed a weeks worth of medication for acutely ill, and then a month at a time. This is especially for TCAs.
