Depressive Disorder Flashcards
Antidepressant Medicaiton
- SSRI
- SNRI
- atypical antidepressants
- TCS
- MAOI
SSRI (Selective Serotonin Reuptake Inhibitor)
Fluoxetine* Citalopram Escitalopram Paroxetine Sertraline Fluvoxamine Vortioxetine
Action: SSRI
- selectively block reuptake of the monoamine neurotransmitter serotonin in the synaptic space, thereby intensifying the effects of serotonin
- SSRIs are considered first-line treatment for depression. Can take 1-3 weeks or longer before pharmacological benefits take effect
Therapeutic Uses: SSRI
major depression OCD Bulimia nervosa Premenstrual dysphoric disorder panic disorders PTSD social anxiety disorder GAD
Complication: SSRI
Sexual Dysfunction CNS Stimulation Weight loss early in therapy Serotonin Syndrome Withdrawal syndrome hyponatremia rash Sleepiness, faintness, lightheadedness GI bleeding bruxism
Complications: SSRI: Sexual Dysfunction
anorgasmia, impotence, decreased libido
- warn clients about possible adverse effects and to notify the provider if intolerable
- instruct client on ways to manage sexual dysfunction which can include lowering dosage, discontinuing medication temporarily, and using adjunctive medication to improve sexual function (sildenafil and buspirone)
- inform clients that an atypical antidepressant such as bupropion has fewer sexual dysfunction adverse effects
Complications: SSRI: CNS Stimulation
inability to sleep, agitation, anxiety
- advise clients to notify the provider. Dose can beed to be lowered
- advise clients to take the dose in the morning
- advise clients to avoid caffeinated beverages
- teach relaxation techniques to promote sleep
Complications: SSRI: Early weigh loss
can be followed by weight gain with long term treatment
- monitor the clients weight
- encourage clients to participate in regular exercise and to follow a healthy, well balanced diet
Complications: SSRI: Serotonin Syndrome
Can being 2-72 hours after starting treatment and can be lethal - mental confusions - fever - tachycardia - elevated blood pressure - abdominal pain, diarrhea - irritability, mood swings, agitation - anxiety, restlessness - incoordination, hyperreflexia - diaphoresis - tremors, muscle spasms - cardiovascular shock - seizures - death RN Considerations: - advise clients to observe manifestations. If any occur, instruct the client to notify the provider and withhold the medication - start symptomatic treatment (Medications to create serotonin- receptor blockade and muscle rigidity, cooling blankets, anticonvulsants, artificial ventilations)
Complications: SSRI: Withdrawal syndrome
Resulting in headache, nausea, visual disturbances, anxiety, dizziness, and tremors
- instruct clients to tape dose gradually
Complications: SSRI: Hyponatremia
Most likely in older adult clients taking diuretics
- obtain baseline sodium, monitor level periodically throughout treatment
Complications: SSRI: Rash
advise clients that a rash is treatable with an antihistamine or withdrawal of medication
Complications: SSRI: sleepiness, faintness, lightheadedness
- advise clients that these adverse effects are not common, but can occur
- advise clients to avoid driving if theses side effects occur
Complications: SSRI: GI bleeding
use caution in clients who have a history of GI bleed and ulcers, and those taking other medications that affect blood coagulation
Complications: SSRI: Bruxism
- advise clients to report to provider
- advise clients to use a mouth guard
- changing to a different classification of antidepressants or adding a low dose of buspirone can decrease this adverse effect.
Contraindication: SSRI
- Pregnancy Risk Category C, except for paroxetine which is D
- Paroxetine increases the risk of birth defects. Therefor other SSRIs are recommended. Late in pregnancy, use of SSRIs increases the risk of withdrawal symptoms or pulmonary hypertension in the newborn
- Contraindicated in clients taking MAOIs or TCAs. SSRIs need to be discontinued at least 2 weeks before starting MAOI
Cautions: SSRI
liver and kidney dysfunction, cardiac disease, seizure disorders, diabetes, ulcers, and a history of GI bleeding
Interactions: SSRI
MAOIs, TCAs, and St. John Wort:
Increase the risk of serotonin syndrome
- MAOIs should be discontinued for 14 days prior to starting an SSRI. If already taking fluoxetine, the client should wait 5 weeks before starting an MAOI
- avoid concurrent use of TCAs and St. Johns Wort
Warfarin:
Fluoxetine can displace warfarin from bound protein and result in increase warfarin levels
- monotor PT and INR levels
- assess for indications of bleeding and the need for dosage adjustment
TCA and Lithium
Fluoxetine can increase the levels of TCAs and lithium
- avoid concurrent use
NSAIDS and Anticoagulants
Fluoxetine suppresses platelet aggregation and thus increases the risk of bleeding when used concurrently with NSAIDS and anticoagulants.
-advise clients to monitor for indications of bleeding (bruising, hematuria) and to notify the provider if they occur.
SNRI (Serotonin-Norepinephrine Reuptake Inhibitors)
Venlafaxine*
Desvenlafaxine
Duloxetine
Action: SNRI
blocks reuptake of norepinephrine as well as serotonin with effects similar to the SSRIs
Therapeutic Uses: SNRI
- Major depression
- GAD
- Social Anxiety disorder
- panic disorder
- pain due to fibromyalgia, osteoarthritis, lock-back pain, diabetic neuropathy (duloxetine; unlabeled use venlafaxine)
Complications: SNRI
- nausea, anorexia, weight loss
- headache, insomnia, anxiety
- HTN, tachycardia
- dizziness, blurred vision
- withdrawal syndrome
- risk for suicide in children and adolescents
- sexual dysfunction
- serotonin syndrome
- bronchitis, dyspnea
Complications: SNRI: nausea, anorexia, weight loss
monitor weight and food intake
Complications: SNRI: headache, insomnia, anxiety
monitor for these findings
Complications: SNRI: HTN, tachycardia
monitor vital signs and report changes
Complications: SNRI: dizziness, burred vision
avoid driving, use of machinery until effects are known
Complications: SNRI: withdrawal syndrome
resulting in HA, nausea, visual disturbances, anxiety, dizziness, tremors
- instruct the client to withdraw from medication gradually
Complications: SNRI: Risk for Suicide
assess children/adolescents carefully for suicide ideation, though disorders
Complications: SNRI: Sexual Dysfunction
anorgasmia, decreased libido, impotence, menstrual changes
- instruct clients to report sexual dysfunction to provider
- instruct clients on wats to manage sexual dysfunction, which can include lowering dosage, discontinuing medication temporarily, and using adjunct medications to improve sexual function
- inform clients that an atypical antidepressant such as bupropion has fewer sexual dysfunction adverse effects
Complications: SNRI: Bronchitis, dyspnea
instruct client to report respiratory findings to provider
