Depression + Bipolar Flashcards
what are some overall nursing considerations for antidepressants? (5)
- slow onset: 1-3 weeks; max 12
- wean off
- no PRN use
- suicide risk: mostly seen with <25 yrs old
- start low + go slow
what are the 3 monoamine neurotransmitters?
norepinephrine, serotonin + dopamine
what will you see with changes in both biochemistry + symptoms with antidepressants? (referring to time frame)
biochemistry: quick changes
symptoms: slow changes
what are the 5 classes of antidepressants?
- SSRIs
- SNRIs
- tricyclic antidepressants
- MAOIs
- atypical antidepressants
what antidepressant drug class tends to be our 1st line? (b/c of SE profile)
+ what would be our last choice drug class?
SSRIs
last = MAOIs
what is our SSRI prototype?
fluoxetine (Prozac)
what is the MOA of fluoxetine?
slow reuptake of serotonin into presynaptic nerve terminals = MORE serotonin in synaptic cleft
what antidepressant has the BEST safety profile? (w/same efficacy as the others) <3
SSRIs
fluoxetine
what is most prominent + significant SE of SSRIs?
sexual dysfunction
“SSRI = Sex Sucks”
aside from sexual dysfunction, what are some other SE of SSRIs? (5)
- nausea
- weight gain (when nausea resolves)
- nervousness
- insomnia
- anxiety
should SSRIs be used in pregnancy?
not late in pregnancy - can cause pulmonary HTN + withdrawal in infant
*can they be used earlier in pregnancy?? if you know will you send me an edit to this card
with SSRI use, patients are at an increased risk of what?
bleeding (esp. GI)
-older adults, hx of GI bleed, anticoag or NSAID use increases this risk
what is serotonin syndrome?
getting too much serotonin - from taking multiple meds that affect synthesis or reuptake of serotonin - LIFE THREATENING
LONG LIST OF MEDS!!
when can serotonin syndrome occur?
2-72 hours after treatment starts?
what are the s+s of serotonin syndrome? (5)
- mental status change
- tremors
- fever + sweating
- HTN
- ataxia
what is tx for serotonin syndrome?
STOP the SSRI + give supportive therapies (aimed at treating the symptoms - orientation, keep patient safe/fall precautions, antipyretic, keep linens dry, antihypertensives)
what are s+s serotonin withdrawal syndrome? (7) + why does it happen?
b/c of abrupt discontinuation….
- dizziness
- HA
- nausea
- sensory disturbances
- tremor
- anxiety
- dysphoria (“general unhappiness with life”)
when can serotonin withdrawal syndrome occur? + how long can it last? (time frame)
days to weeks after cessation of drug –> can last 1-3 WEEKS
how can we prevent serotonin withdrawal syndrome?
slowly taper drug + educate patient on this!
what is the prototype of SNRIs?
venlafaxine (Effexor)
what is the MOA of venlafaxine?
block reuptake of serotonin + norepinephrine
what are the SE of venlafaxine?
- nausea
- HA
- HTN
- nervousness
- insomnia
- somnolence
- sweating
what is the MOA of imipramine?
inhibit reuptake of serotonin + norepinephrine
also blocks ACh receptors and/or histamine
what is prototype of tricyclic antidepressants?
imipramine
“ines”
when are tricyclic antidepressants usually scheduled? why?
at bedtime - can cause sedation
what SE of tricyclic antidepressants is common during initial treatment?
sedation
what are SE of tricyclic antidepressants? (2 - one broad, one specific)
- anticholinergic: can’t pee, can’t see, can’t spit, can’t shit
- orthostatic hypotension
(you can’t do all of those things while you’re riding your bike)
what antidepressant is associated with a high risk of overdose - large doses are lethal and can cause cardiac toxicity (avoid with suicidal patient)?
tricyclic antidepressants
what drug-drug interactions occur with tricyclic antidepressants (broad, not specific)?
- MAOIs (duh they suck with everything)
- sympathomimetics
- anticholinergics
what effect would you see with someone on tricyclic antidepressants + other CNS drugs?
increased sedation
what is MAO?
enzyme that converts our MAO NTs into active products; is also in foods (which explains the drug-food interactions b/c liver needs MAOs to break down MAO foods)
what is MOA of MAOIs? (say that 5 times fast)
inhibit breakdown of NE + dopamine + serotonin
how long does the action of MAOIs last?
the “lifetime” of the neurotransmitter - 2 weeks
when can you see full effect of MAOI use?
4-8 weeks
what are the 4 prototypes for MAOIs?
KNOW THEM ALL
SPIT:
- Selegiline
- Phenelzine
- Isocarboxiazide
- Tranylcypromine
what AE comes from the drug-food interactions between MAOIs + tyramine foods?
hypertensive crisis
how long is the washout period between MAOIs and new drugs [that could interact with MAOIs]?
14 days
“MA, OI! NO NEW FRIENDS for 14 DAYS!!!”
name some tyramine foods that interact with MAOIs?
all the good things…
avos, caffeine, wine, aged cheeses, meats, bananas, chocolate, yogurt, fava beans
do we need to know what specific reaction we would see with MAOIs + specific drugs?
………
??? make an edit if you think so!
what is the prototype for atypical antidepressants?
bupropion (Wellbutrin)
bupropion is similar in structure to what?
amphetamine
what are the pros of bupropion? (2)
- no weight gain
2. no sexual dysfunction (can actually increase)
what are the SE of buproprion?
- seizures
- agitation
- HA
- psychotic symptoms
patients with which disorder should avoid use of bupropion?
seizure disorders (SE of bupropion is seizures)
what is DOC for bipolar (per Knowlton)?
lithium
what is lithium known as? (therapeutic class)?
mood stabilizer
what is the therapeutic range for lithium? what is optimal?
- 4-0.1 mEq/L
0. 4-0.8 is BEST <3
TOXIC levels are seen at what number for lithium?
1.5 mEq
lithium acts like ______; what scenarios r/t this would we see an increased risk of lithium toxicity?
salt - when Na is low in the body, it will hold onto lithium to compensate
- diarrhea
- dehydration
- poor oral intake
- diuretics
- acute renal failure
what are the s+s of lithium toxicity? (6)
- tremors
- N/V
- polyuria
- muscle weakness
- ataxia
- EKG changes
…can lead to convulsions, coma, death
how do we treat lithium toxicity?
we just manage symptoms; unless > 2.5, we can give dialysis
AE of lithium (a fuck ton - 7)
- GI: N/V/D
- HYPOthyroidism + goiter
- tremors
- renal damage
- polyuria
- edema
- birth defects
how can we mitigate the AE of GI disturbances with lithium?
give with food + split up doses
how could we mitigate hand tremors with lithium use? (2 options)
lower dose or give with BB
what nursing intervention would you implement for patient with polyuria on lithium therapy?
encourage good oral intake of fluids + monitor their levels
what drug-drug interactions exist with lithium? (2)
- NSAIDS - can impact kidneys + therefore toxicity
2. diuretics - can increase risk of toxicity
