Depressive Disorders Flashcards
List some common Si/Sx of MDD
- Anhedonia
- insomnia,
- anergia
- feeling hopleless, helpless, or worthless
- flat affect
- negative though process
- Decrease in sexual libido
What are the key Sx of depression?
depressed mood and anhedonia
Which gender is most at risk, be specific w/ age group?
ratio is equal until adolescents where females are at a higher risk
What is a common reason older adults experience depression?
risk of depression increases as health deteriorate
T/F There is a single cause for depression
False, it is a multifaceted
What is the concordance rate for depression for identiacal twins?
50%
What are the 2 main neurotransmitters that affect depression?
- serotonin
2. NE
What is important to assess when you pt is depressed?
suicial ideation
Which factors increase the risk of suicide?
- hopelessness
- Substance Use
- Recent loss or separation
- History of suicide attempts
- Acute suicidal ideation
What are some ways the elderly experience depression differently?
- irritability
- cognitive changes
- longer recovery time
List some nursing Dx for depression
- Risk for suicide- highest priority
- Ineffective coping
- Hopeless
- Social Isolation
- Spiritual distress
- Self-care deficit
What is the MOA of SSRIs?
block the reuptake of serotonin in the synaptic cleft making serotonin more available
List some side effects of SSRIs
- seizures
- abnormal bleeding
- weight gain
- N/V
- tension headache
- Serotonin Syndrome
- Akathisia
Serotonin Syndrome
drug rxn that causes the body to have too much Serotonin that occurs when 2 drugs affect are taken simultaneously
List some Sx/Si of SE Syndrome
- Tachycardia
- Hypertensive
- Delirious
- Muscle Spasms
- diaphoresis
- pyrexia
- diarrhea
What are some contraindications for SSRIs?
Do not mix with
- Tramadol
- Triptans
- other SSRIs and SNRIs
List the SSRIs
- Celexa (citalopram)
- Lexapro (escitalopram)
- Prozac (fluoxetine)
- Luvox (Fluvoxamine)
- Paxil (paroxetine)
- Zoloft (sentraline)
What is the worst SSRIs? Explain why it is the worse
Paxil, the worse because it has horrible DC process
What is the MOA of SNRIs?
They block the reuptake of SE and NE
List the SNRIs
- Effexor (venlafaxine)
- Pristiq (Desvenlafaxine Succinate)
- Cymbalta (Duloxetine)
- Fetzim (levomilnacipran)
What are some side effects of SNRIs?
- N/V
- insomnia
- weight gain
- diaphoresis
- sexual dyfxn
What is the MOA of tricyclics?
inhibit the reuptake the NE and SE in the presynaptic cleft
List some side effects of TCAs
- anticholinergic effects ( urinary retention, blurred vision, dry mouth, tachycardia, constipation, esophageal reflux)
- orthostatic hypotension
- weight gain
- arrhythmias
When is the best time to administer a TCA? Why?
bed time because it has sedating effects
TCAs are contraindicated in what type of pts?
- cardio pts (MI, arrhythmias, heart block, tachycardia)
- CVA pts
- Pregnant women
- Seizures
- Narrow-angle glaucoma
List the TCAs
- Elavil (amitripyline)
- Anafranil (clomipramine)
- Nopramin (desipramine)
- Sinequan (Doxepine)
- Tofranil (Imipramine)
- Pamelor (nortriptyline)
What is the MOA for MAOIs?
monamine oxidase is responsible for inactivating or breaking down monoamine neurotransmitters in the brain (dopamine, SE,NE, and Tyr)
What are side effects of MAOIs?
- orthostatic hypotension
- weight gain
- edema
- vertigo
- muscle twitching
- weakness and fatigue
If Lee is on Nardil and he tells you that he eats avocados and raisins, are you concerned or is this okay? Explain
I am concerned b/c these foods contain tyramine which is contraindicated for those who are taking MAOIs
Why can’t someone taking Marplan or Parnate eat tyr- riched foods?
MAOIs block the breaking down of tyr in the liver and intestines which result in an increase of try and lg amts of NE to be released
List some tyr- riched foods
- aged cheese (blue, gouda, romano, parmesan, swiss, etc..)
- wine
- beer
- avocado
- beef or chicken liver
- caffeine
- olives
What is Lee at risk for he is taking Nardil and eats avocados and raisins?
he is at risk for hypertensive crisis which is a medical ER
What type of pts are MAOIs contraindicated?
- Cerebrovascular disease
- HTN and CHF
- Liver disease
- Recurrent or severe headaches
What type of antidepressant is contraindicated for pts with suicidal ideation?
TCAs
Is it okay for a pt to just stop taking their Lexapro?
No, all antidepressants should be taperd slowly
What is the one thing any pt should avoid while taking antidepressants?
ETHOL
Do therapeutic effects occur w/in 30-45 mins of administration?
No, the full therapeutic effect may take several weeks w
What is some pt. teachings while taking Prozac or Celexa?
- Obs for signs of serotonin syndrome
- Avoid the concurrent use of St. Johns Wort
- Follow a healthy diet and exercise regimen
What are some pt. teachings for someone taking Elvail or Norpamin?
- Change positions slowly
- Chew sugarless gum
- Eat high fiber foods
- Increase fluid intake to 2-3 L/day
What are some pt. teachings for a pt taking Nardil or MARPLAN?
- Avoid ty-riched foods
2. Avoid OTC meds
What is the MOA if St. John’s Wort?
increases the amt of SE, NE, and dopamine in the brain
Who most benefits from light therapy?
pts. w/ seasonal affective disorder
What is the MOA of light therapy?
influences light on melatonin so exposure to light suppresses the nocturnal secretion of melatonin
If a client plans to take control of one life situation by discharge, which nursing Dx is the pt addressing?
Powerlessness
