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depression and mood stabilization Flashcards

1
Q

what is depression

A
  • mood disorder
  • interferes with everyday life for several weeks or longer
  • affects people of all ages
  • women more than men
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2
Q

what feelings are associated with depression

A
  • sadness
  • loss
  • anger
  • frustration
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3
Q

describe the pathophysiology of depression

A

immune factors: increased CRF and activation of HPA axis

monoamine neurotransmitter dysfunction: deficiency of norepi and serotinin

neuroendocrine factors: downregulation (decreased sensitivity of cortisol receptors)

other factors: genetic and environmental factors

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4
Q

describe newer antidepressants

A
  • SSRIs and SNRIs
  • first line tx
  • effective and safer
  • 4-6weeks for full effect
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5
Q

describe older antidepressants

A
  • TCA and MAOIs
  • more adverse effects
  • require more monitoring
  • more cost effective
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6
Q

give and example of a tricyclic antidepressant

A

imipramine

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7
Q

describe the action of tricyclic antidepressants (imipramine)

A

blocks the reuptake of norepi and serotonin at the presynaptic nerve endings

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8
Q

what are tricyclic antidepressants (imipramine) used for

A

treatment of depression

also for bedwetting in adolescents

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9
Q

whats the PO onset for tricyclic antidepressants (imipramine)

A

2-6hrs

use caution in older adults and children

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10
Q

what are some adverse effects of tricyclic antidepressants (imipramine)

A
  • sedation
  • orthostatic hypotension
  • cardiac dysrhythmias

black box warning: TCAs are more toxic in overdose then other antidepressants and suicide is the leading cause of death in adolescents - increased risk of suicide in children, adolescents and young adults ages 18-24

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11
Q

whats a contraindication of tricyclic antidepressants (imipramine)

A

cardiac abnormalities and MI

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12
Q

describe administration of tricyclic antidepressants (imipramine)

A
  • PO given at bedtime to reduce bedtime sedation
  • start with small dose and increase slowly
  • pre-post mood assessment
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13
Q

what are some nursing implications of tricyclic antidepressants (imipramine)

A
  • do NOT give with MAOIs
  • or with antidepressants, herbs, grapefruit juice, or alcohol
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14
Q

describe patient education for tricyclic antidepressants (imipramine)

A
  • take only as prescribed
  • take with a glass of water and food if GI upset occurs
  • do not stop abruptly
  • do not crush or chew pills
  • avoid alcohol
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15
Q

give an example of an SSRI

A

fluoxetine

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16
Q

describe the action of SSRIs (fluoxetine)

A

blocks the reabsorption of serotonin in the brain

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17
Q

what are SSRIs (fluoxetine) used for

A
  • treatment of depression
  • anxiety, OCD
  • bulimia
  • PMDD
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18
Q

whats the PO onset of SSRIs (fluoxetine)

A

6-8hrs

use caution in older adults and children

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19
Q

what are some adverse effects of SSRIs (fluoxetine)

A
  • GI symptoms
  • CNS stimulation
  • serotonin syndrome (symptoms vary from mild to severe and can cause death)

black box warning: suicide is the leading cause of death in adolescents - increased risk of suicide in children, adolescents, and young adults ages 18-24 taking an antidepressant

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20
Q

whats a contraindication of SSRIs (fluoxetine)

A

known sensitivity

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21
Q

describe administration of SSRIs (fluoxetine)

A
  • PO daily with food
  • sugar free gum or candy to counteract dry mouth
  • pre/post mood assessment
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22
Q

what are some nursing implications for SSRIs (fluoxetine)

A
  • do NOT give with MAOIs
  • also dont give with antidepressants, herbs, grapefruit juice, and alcohol
23
Q

describe patient education for SSRIs (fluoxetine)

A
  • take only as prescribed
  • take with a glass of wtaer and food if GI upset occurs
  • do not stop abruptly
  • do not crush or chew pills
  • avoid alcohol
24
Q

give an example of an SNRI

A

venlafaxine

25
describe the action of SNRIs (venlafaxine)
inhibits the neuronal uptake of serotonin as well as inhibits the uptake of norepi in the brain
26
what are SNRIs (venlafaxine) used for
treatment of depression - GAD - social phobia - panic disorder
27
whats the onset of PO SNRIs (venlafaxine)
6-8hrs use caution in older adults and children
28
what are some adverse effects of SNRIs (venlafaxine)
- GI symptoms - CNS - cardiovascular - GU **black box warning: suicide is the leading cause of death in adolescents - increased risk of suicide in children, adolescents, and young adults ages 18-24 taking an antidepressant**
29
whats a contrindication of SNRIs (venlafaxine)
known sensitivity
30
describe administration of SNRIs (venlafaxine)
- PO daily with food - extended release should be taken in the morning and evening at approximately the same time - if patients have difficulty swallowing extended release capsules can be opened and given in applesauce - pre/post mood assessment
31
what are some nursing implications of SNRIs (venlafaxine)
- do NOT give with MAOIs - alos dont give with antidepressants, hebrs, grapefruit juice, and alcohol
32
describe patient education for SNRIs (venlafaxine)
- take only as prescribed - take with a glass of water and food if GI upset occurs - do not stop abruptly - avoid alcohol
33
give an example of an MAOI
phenelzine
34
describe the action of MAOIs (phenelzine)
increases epinephrine, norepinephrine, serotonin, and dopamine in the CNS
35
what are MAOIs (phenelzine) used for
treatment of depression as third line
36
whats the onset of PO MAOIs (phenelzine)
2-4hrs more likely to cause hypertensive crisis
37
what are some adverse effects of MAOIs (phenelzine)
- hypertensive crisis - avoid tyramine containing food (aged meats, cheese, and beer) **black box warning: suicide is the leading cause of death in adolescents - increased risk of suicide in children, adolescents, and young adults ages 18-24 taking an antidepressant**
38
whats a contraindication of MAOIs (phenelzine)
known sensitivity
39
describe administration of MAOIs (phenelzine)
- PO three times daily - may need reminder system - can be crushed - pre/post mood assessment
40
what are some nursing implications for MAOIs (phenelzine)
- do NOT give with SSRIs - also do not give with antidepressants, herbs, tyramine foods, and alcohol
41
describe patient education for MAOIs (phenelzine)
- take only as prescribed - take with a glass of water and food if GI upset occurs - do not stop abruptly - avoid alcohol
42
why does antidepressant discontinuation syndrom occur
occurs due to sudden termination of most antidepressants
43
what are some symptoms of antidepressant discontinuation syndrom
flu like sx - insomnia - nausea - balance - sensory disurbances - hyperarousal
44
the nurse is teaching the importance of proper diet to a aptient taking an MAOI for depression. which of the following food selections by the patient indicates further teaching is required? 1. tossed salad 2. salami and swiss cheese sammie 3. hamburger and fries 4. chicken salad and grapes
2. salami and swiss cheese sammie *aged meats and cheese contain tyramine which should be avoided when taking a MAOI*
45
give an example of an atypical antidepressant and describe it
**bupropion** action: inhibits reuptake of norepi, serotonin, an dopamine adverse effects: CNS and others **black box warning for serious neuropsyciatric reactions when administered for smoking cessation**
46
name and describe a mood stabilizing agent
lithium - effective in controlling mania in 65-80% of pts by treating and preventing manic episodes - decreases frequency and intensity of manic cycles - stimulates neuronal growth, reducing brain atrophy in people with long standing mood disorders
47
whats used to treat bipolar disorder
lithium carbonate
48
describe the action of lithium carbonate
affects synthesis, release, and reuptake of several neurotransmitters in the brain including, acetylcholin, dopamine, GABA, and norepi
49
what is lithium carbonate used for
drug of choice in tx of bipolar disorder
50
what are some adverse effects of lithium carbonate
- metallic taste - hand tremors - GI side effects
51
what are some contraindications/cautions for lithium carbonate
- known sensitivity - pregnancy
52
whats a nursing implication for lithium carbonate
do NOT give with diuretics
53
describe patient education for lithium carbonate
- take only as prescribed - **keep scheduled visits for blood tests** - maintain a normal diet - use effective birth control - monitor for signs of toxicity

Pharm 2 (34 decks)

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