Depression meds Flashcards by Tyece Henry

Blocks the serotonin reuptake sites, allowing serotonin to remain active in the synapse longer
Can be used for OCD, bulimia (increase dosages), GAD, social phobia, PTSD

Selective Serotonin Reuptake Inhibitors

How well did you know this?

Not at all

Perfectly

examples of SSRIs

 Fluoxetine (Prozac)-longest ½ life
 Paroxetine (Paxil)-more sedating and weight gain
 Sertraline (Zoloft)
 Fluvoxamine (Luvox)-liver toxicity
 Citalopram (Celexa)-over 40 mg, cardiac issues
 Escitalopram (Lexapro)

How well did you know this?

Not at all

Perfectly

SSRI - only approved for OCD

Fluvoxamine (Luvox)

How well did you know this?

Not at all

Perfectly

SSRI - more sedating, more weight gain, higher risk of
sexual dysfunction, risk of discontinuation syndrome, akathisia,
Category D
-not recommended for adolescents

Paroxetine (paxil)

How well did you know this?

Not at all

Perfectly

adverse effects of SSRIs

 GI—N/V/D - very common!
 Hyponatremia (CMP, BNP)
 Sexual dysfunction (over 30%) - decreased libido, impotence , ejaculatory disturbances, anorgasmia
 Anxiety/agitation (wanes)
 Insomnia/sedation
 Weight loss/gain
 Discontinuation events
 Diaphoresis
-hypomania, psychosis

Suicide risk!!!

How well did you know this?

Not at all

Perfectly

Sudden discontinuation of SSRIs associated with withdrawal
symptoms (flu like symptoms, nightmares, vivid dreams, tremor,
anxiety, N, poor concentration

SSRI Discontinuation Syndrome:

How well did you know this?

Not at all

Perfectly

precipitous increase in CNS concentration of serotonin

serotonin syndrome - medical emergency

How well did you know this?

Not at all

Perfectly

serotonin syndrome adverse effects

 Confusion, restlessness, agitation, incoordination, myoclonus, fever, diaphoresis, shivering, tremor, diarrhea
 Progression—hypoxia, rhabdomyolysis, metabolic acidosis, DIC, renal failure, coma, death

Shivering
Sweating
Hyperthermia
Hypertension
Tachycardia
Myoclonus (sudden muscle contractions)
Nausea, tremor
Hyperreflexia/clonus (overactive reflexes)
Diarrhea
Mydriasis (pupil dilation)

How well did you know this?

Not at all

Perfectly

Block norepinephrine and serotonin reuptake

SNRIs—Serotonin and Norepinepherine Reuptake Inhibitors

How well did you know this?

Not at all

Perfectly

SNRIs—Serotonin and Norepinepherine Reuptake Inhibitors

 Duloxetine (Cymbalta)-may impair glycemic control in DM (neuropathy)
 Venlafaxine (Effexor) - monitor BP
 Desvenlafazine (Pristiq)
 Fetzima (Levomilnacipran)-newest one, more blocking
of NE than serotonin, also used for fibromyalgia

How well did you know this?

Not at all

Perfectly

SNRI - may impair glycemic control in DM, can be used
for peripheral neuropathy or nerve type pain, cases of fatal liver
toxicity

duloxetine (cymbalta)

How well did you know this?

Not at all

Perfectly

SNRI - lethal cardiac arrhythmias, may cause HTN at
higher doses (>300 mg)

venlafaxine (effexar)

How well did you know this?

Not at all

Perfectly

SNRI - newer form of venlafaxine, less side effects,
expensive

desvenlafaxine (pristiq)

How well did you know this?

Not at all

Perfectly

adverse effects of SNRIs - serotonin and Norepinepherine Reuptake Inhibitors

 GI—N/V/D, constipation, anorexia/weight loss or gain
 Hyponatremia
 Anxiety/agitation
 Insomnia/somnolence
 Discontinuation events
 Diaphoresis
 Neuroleptic malignant syndrome
 Caution with cardiac patients
 Dry mouth, sweating
 Sexual dysfunction

How well did you know this?

Not at all

Perfectly

Tricyclic antidepressants (TCAs)

 Amitriptyline (Elavil)
 Nortriptyline (Pamelor)
 Imipramine (Tofranil)
 Desipramine (Norpramin)
 Clomipramine (Anafranil)
 Doxepin (Sinequan)
 Protriptyline (Vivactil)
 Amoxepine (Asendin)
 Maprotiline (Ludiomil)

How well did you know this?

Not at all

Perfectly

adverse effects of tricyclic antidepressants (more severe)

 Anticholinergic
 Orthostatic hypotension
 Carbohydrate cravings, hyperglycemia
 Dry mouth
 Constipation
 Dizziness
 Nausea
 Anxiety
 Sexual dysfunction
 Weight gain
 Diaphoresis
 Seizures
 Excitement, nightmares, agitation, restlessness, insomnia,
confusion, disturbed concentration, disorientation
 Hypomania, psychosis

How well did you know this?

Not at all

Perfectly

nursing priorities for tricyclic antidepressants

Avoid in the elderly
Check EKGs
LETHAL IN OVERDOSE: lethal dose is 3 x therapeutic dose

How well did you know this?

Not at all

Perfectly

Monoamine oxidase inhibitors (MAOIs)

 Tranlycypromaine (Parnate)
 Phenelzine (Nardil)
Isocarboxazid (Marplan)

How well did you know this?

Not at all

Perfectly

adverse effects of monoamine oxidase inhibitors

 “Dirty drugs”—not frequently used, atypical depression
 Orthostatic hypotension
 Anticholinergic
 Hypertensive crisis—stroke or death, ingestions of tyramine-containing foods or stimulant drugs
(Tryamine foods: aged cheeses, smoked fish, chocolate, coffee, yogurt, red wine, beer fava beans, etc.)

How well did you know this?

Not at all

Perfectly

Mirtazepine (Remeron) adverse effects

 Sedation, fatigue, insomnia, agitation, restlessness, and nervousness
 Vivid dreams
 Dry mouth, constipation, blurred vision
 Edema
 Agranulocytosis/neutropenia

Trazodone (Desyrel) adverse effects

 Drowsiness
 Weakness, lethargy, fatigue
 Hypomania, psychosis, panic reactions
 Orthostatic hypotension
-SIADH
-erectile dysfunction

Mirtazepine (Remeron) use

weight gain
insomnia

trazodone (desyrel) use

priapism
insomnia

used for smoking cessation, increases anxiety (do NOT prescribe to someone with anxiety), increases energy, weight loss, may increase sex drive
Appetite suppressants

Bupropion (Wellbutrin)

adverse effects of bupropion (wellbutrin)

 Vivid nightmares  Headache  Nervousness, agitation, hypomania  Dry mouth, urinary retention, constipation  Diaphoresis  Increased blood pressure  Nausea  Seizures  Sexual side effects in over 30%

contraindications of bupropion (wellbutrin)

bulimia, anorexia, alcohol abuse, h/o seizures or doses > 450 mg

Aripiprazole (Abilify) use

Atypical antipsychotic—approved for MDD, bipolar

adverse effects of Aripiprazole (Abilify)

 Black box: Dementia, SI  Slow titration of doses  Somnolence  May smoke out DM

Newer antidepressant, good for comorbidity of anxiety

Brintellix (Vortioxetine)

adverse effects of brintellix (vortioxetine)

nausea, diarrhea, dizziness, and sexual dysfunction

laboratory monitoring for antidepressants

 Baseline-CBC, LFT, TFT, Electrolytes (especially SSRIs)  Ongoing-repeat every 6-12 months

antidepressant precautions

 Abrupt withdrawal  Lowering seizure threshold: Maprotiline, bupropion  Risk of suicide  Toxic in Overdose -TCAs -MAOIs  Diabetes: -Increase with medications that increase norepinephrine (TCAs, venlafaxine, buproprion, duloxetine) should not be used first because these may worsen diabetic control

category C SSRIs

Zoloft, Celexa, Lexapro, Prozac

category D SSRIs

paxil

herbal for depression: anxiety, bed-wetting, cancer, insomnia, etc

St. John's Wort

nursing priorities in herbals for depression

-Avoid in pregnancy or breast-feeding and birth control pills -Sun sensitivity

Hamilton Rating Scale for Depression (HAM-D)

The higher the number, increase in depression severity:  Over 23, very severe depression  19-22, severe  14-18, moderate  8-13, mild

Patient Health Questionnaire (PHQ-2)

Depressed mood or anhedonia over the past two weeks 1. Little interest or pleasure in doing things? 2. Feeling down, depressed, or helpless?

Severity of depression during the past two weeks (5 or higher)

Patient Health Questionnaire (PHQ-9)

Assess severity of depression symptoms versus screening tool

Quick Inventory of Depression Symptoms (QIDS)

Depressive symptoms over the past week, cost, not a free tool

Beck Depression Inventory (BDI-2)

Degree of depression in a previously diagnosed individual (50 or over)

Zung Self-rating Depression Scale (SDS)

65 and up Score of 10 or higher, depression Yes/no questions, cognitive impairment may affect score

Geriatric Depression Scale (GDS)

MAOI client education

Avoid foods and medications high in tyramine when taking MAOIs

foods high in tyramine

Aged cheese Wine; beer Chocolate; colas Coffee; tea Sour cream; yogurt Smoked and processed meats Beef or chicken liver Canned figs Caviar Raisins Pickled herring Yeast products Broad beans Soy sauce Cold remedies Diet pills

atypical antidepressants

Bupropion (Wellbutrin SR, Wellbutrin XL, others) Mirtazapine (Remeron) Trazodone

abrupt withdrawl from SSRIs causes:

flu-like symptoms

therapeutic effects/goals for antidepressants

Elevation of mood Improved appetite Improved sleep Increased physical activity Improved clarity of thinking Better memory Decreased feelings of guilt, worthlessness, helplessness, inadequacy, delusional preoccupation and ambivalence