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Psych Exam 1 > Depression meds > Flashcards

Depression meds Flashcards

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1
Q

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

A

Selective Serotonin Reuptake Inhibitors

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2
Q

examples of SSRIs

A

 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)

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3
Q

SSRI - only approved for OCD

A

Fluvoxamine (Luvox)

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4
Q

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

A

Paroxetine (paxil)

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5
Q

adverse effects of SSRIs

A

 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!!!

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6
Q

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

A

SSRI Discontinuation Syndrome:

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7
Q

precipitous increase in CNS concentration of serotonin

A

serotonin syndrome - medical emergency

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8
Q

serotonin syndrome adverse effects

A

 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)

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9
Q

Block norepinephrine and serotonin reuptake

A

SNRIs—Serotonin and Norepinepherine Reuptake Inhibitors

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10
Q

SNRIs—Serotonin and Norepinepherine Reuptake Inhibitors

A

 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

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11
Q

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

A

duloxetine (cymbalta)

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12
Q

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

A

venlafaxine (effexar)

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13
Q

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

A

desvenlafaxine (pristiq)

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14
Q

adverse effects of SNRIs - serotonin and Norepinepherine Reuptake Inhibitors

A

 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

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15
Q

Tricyclic antidepressants (TCAs)

A

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

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16
Q

adverse effects of tricyclic antidepressants (more severe)

A

 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

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17
Q

nursing priorities for tricyclic antidepressants

A

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

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18
Q

Monoamine oxidase inhibitors (MAOIs)

A

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

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19
Q

adverse effects of monoamine oxidase inhibitors

A

 “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.)

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20
Q

Mirtazepine (Remeron) adverse effects

A

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

21
Q

Trazodone (Desyrel) adverse effects

A

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

22
Q

Mirtazepine (Remeron) use

A

weight gain
insomnia

23
Q

trazodone (desyrel) use

A

priapism
insomnia

24
Q

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

A

Bupropion (Wellbutrin)

25
Q

adverse effects of bupropion (wellbutrin)

A

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

26
Q

contraindications of bupropion (wellbutrin)

A

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

27
Q

Aripiprazole (Abilify) use

A

Atypical antipsychotic—approved for MDD, bipolar

28
Q

adverse effects of Aripiprazole (Abilify)

A

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

29
Q

Newer antidepressant, good for comorbidity of anxiety

A

Brintellix (Vortioxetine)

30
Q

adverse effects of brintellix (vortioxetine)

A

nausea, diarrhea, dizziness, and sexual dysfunction

31
Q

laboratory monitoring for antidepressants

A

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

32
Q

antidepressant precautions

A

 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

33
Q

category C SSRIs

A

Zoloft, Celexa, Lexapro, Prozac

34
Q

category D SSRIs

A

paxil

35
Q

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

A

St. John’s Wort

36
Q

nursing priorities in herbals for depression

A

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

37
Q

Hamilton Rating Scale for Depression (HAM-D)

A

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

38
Q

Patient Health Questionnaire (PHQ-2)

A

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

39
Q

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

A

Patient Health Questionnaire (PHQ-9)

40
Q

Assess severity of depression symptoms versus screening tool

A

Quick Inventory of Depression Symptoms (QIDS)

41
Q

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

A

Beck Depression Inventory (BDI-2)

42
Q

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

A

Zung Self-rating Depression Scale (SDS)

43
Q

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

A

Geriatric Depression Scale (GDS)

44
Q

MAOI client education

A

Avoid foods and medications high in tyramine when taking MAOIs

45
Q

foods high in tyramine

A

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

46
Q

atypical antidepressants

A

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

47
Q

abrupt withdrawl from SSRIs causes:

A

flu-like symptoms

48
Q

therapeutic effects/goals for antidepressants

A

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

Psych Exam 1 (7 decks)

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