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Pharmacology NCLEX > Depressive Disorder > Flashcards

Depressive Disorder Flashcards

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1
Q

Antidepressant Medicaiton

A
  • SSRI
  • SNRI
  • atypical antidepressants
  • TCS
  • MAOI
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2
Q

SSRI (Selective Serotonin Reuptake Inhibitor)

A 
Fluoxetine*
Citalopram
Escitalopram
Paroxetine
Sertraline
Fluvoxamine
Vortioxetine
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3
Q

Action: SSRI

A
  • 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
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4
Q

Therapeutic Uses: SSRI

A 
major depression
OCD
Bulimia nervosa
Premenstrual dysphoric disorder
panic disorders
PTSD
social anxiety disorder
GAD
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5
Q

Complication: SSRI

A 
Sexual Dysfunction
CNS Stimulation
Weight loss early in therapy
Serotonin Syndrome
Withdrawal syndrome
hyponatremia
rash
Sleepiness, faintness, lightheadedness
GI bleeding
bruxism
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6
Q

Complications: SSRI: Sexual Dysfunction

A

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
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7
Q

Complications: SSRI: CNS Stimulation

A

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
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8
Q

Complications: SSRI: Early weigh loss

A

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
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9
Q

Complications: SSRI: Serotonin Syndrome

A 
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)
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10
Q

Complications: SSRI: Withdrawal syndrome

A

Resulting in headache, nausea, visual disturbances, anxiety, dizziness, and tremors
- instruct clients to tape dose gradually

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11
Q

Complications: SSRI: Hyponatremia

A

Most likely in older adult clients taking diuretics

- obtain baseline sodium, monitor level periodically throughout treatment

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12
Q

Complications: SSRI: Rash

A

advise clients that a rash is treatable with an antihistamine or withdrawal of medication

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13
Q

Complications: SSRI: sleepiness, faintness, lightheadedness

A
  • advise clients that these adverse effects are not common, but can occur
  • advise clients to avoid driving if theses side effects occur
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14
Q

Complications: SSRI: GI bleeding

A

use caution in clients who have a history of GI bleed and ulcers, and those taking other medications that affect blood coagulation

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15
Q

Complications: SSRI: Bruxism

A
  • 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.
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16
Q

Contraindication: SSRI

A
  • 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
17
Q

Cautions: SSRI

A

liver and kidney dysfunction, cardiac disease, seizure disorders, diabetes, ulcers, and a history of GI bleeding

18
Q

Interactions: SSRI

A

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.

19
Q

SNRI (Serotonin-Norepinephrine Reuptake Inhibitors)

A

Venlafaxine*
Desvenlafaxine
Duloxetine

20
Q

Action: SNRI

A

blocks reuptake of norepinephrine as well as serotonin with effects similar to the SSRIs

21
Q

Therapeutic Uses: SNRI

A
  • Major depression
  • GAD
  • Social Anxiety disorder
  • panic disorder
  • pain due to fibromyalgia, osteoarthritis, lock-back pain, diabetic neuropathy (duloxetine; unlabeled use venlafaxine)
22
Q

Complications: SNRI

A
  • 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
23
Q

Complications: SNRI: nausea, anorexia, weight loss

A

monitor weight and food intake

24
Q

Complications: SNRI: headache, insomnia, anxiety

A

monitor for these findings

25
Q

Complications: SNRI: HTN, tachycardia

A

monitor vital signs and report changes

26
Q

Complications: SNRI: dizziness, burred vision

A

avoid driving, use of machinery until effects are known

27
Q

Complications: SNRI: withdrawal syndrome

A

resulting in HA, nausea, visual disturbances, anxiety, dizziness, tremors
- instruct the client to withdraw from medication gradually

28
Q

Complications: SNRI: Risk for Suicide

A

assess children/adolescents carefully for suicide ideation, though disorders

29
Q

Complications: SNRI: Sexual Dysfunction

A

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
30
Q

Complications: SNRI: Bronchitis, dyspnea

A

instruct client to report respiratory findings to provider

Pharmacology NCLEX (4 decks)

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