Medications for depressive disorders Flashcards
What is the black-box warning for all of the antidepressant drugs we discuss? What age groups are more effected by this? Due to this, what are some nursing considerations?
Higher risk for suicide
Especially in children/adolescents
Make sure to assess for suicide risk/isolation and educate parents and loved ones of this risk and teach signs of risk.
What is the therapeutic action/outcome for SSRIs?
selectively inhibits the reuptake of serotonin making more of it available; reduces depression/anxiety symptoms
What drugs are the most common used for depression (first line)? why?
SSRIs
much safer than other drug classes discussed
How long does it take for SSRIs to reach their full effect?
4-6 weeks (make sure that this is emphasized to patient, adherence is HUGE)
When would we prescribe other antidepressants other than SSRIs?
When we know that SSRIs are not effective.
What is a risk of having to much serotonin available?
serotonin syndrome!!
What are some adverse effects of SSRIs?
Sexual dysfunction (common)
CNS stimulation
n/v
weight gain/loss
Serotonin syndrom (fever, confusion, agitation/anxiety, hallucinations, hyperreflexia, diaphoresis, tremors)
Withdrawals (HA, nausea, anxiety, dizziness, tremor) - elevated serotonin levels suddenly fall and produce symptoms
Bruxism (teeth grinding)
hyponatremia
What are some nursing considerations for SSRIs?
sexual dysfunction is a big cause of compliance issues, educate patient and tell them to call physician if they think they are going to stop taking medication (other SSRIs may have less sexual dysfunction side effects and may be prescribed)
weight gain/loss can also lead to compliance issues, educate the patient! same as sexual dysfunction
n/v usually subsides with time (few weeks)
CNS stimulation - patient may have difficultly sleeping, may need to lower dose or have patient take in the morning
Serotonin syndrome - monitor for signs and notify physician if they present, educate patient on symptoms
For withdrawals - taper the dose gradually (usually over a week)
Bruxism - might need to wear a mouth guard
hyponatremia is especially a problem in elderly patients that are also taking diuretics
When can serotonin syndrome begin to manifest?
2-72 hours
What are some drug-drug interactions for SSRIs?
MAOIs - increase serotonin levels as well
TCAs - increase serotonin as well
St. Johns Wort - increase serotonin levels as well
ALL OF THESE INCREASE THE RISK FOR SEROTONIN SYNDROME
warfarin (coumadin) - SSRIs are highly protein bound, so is warfarin, this may result in an incresed serum drug level of warfarin which increases the risk for bleeding. THESE TWO MEDICATIONS COMPETE FOR PROTEIN BINDING
If taking an SSRI, how long should the patient wait after the last dose to start taking an MAOI?
5 weeks
If taking an MAOI, how long should the patient wait after the last dose to start taking an SSRI?
14 days
What are some patient teaching points for SSRIs?
Take as directed - taper off slowly (over a week… withdrawals)
report symptoms of serotonin syndrome (educate symptoms)
report side effects if intolerable
can take 4-6 weeks to reach full effect
Suicide watch (young adults, adolescents, children) tell providers and parents about risk!!!!
dont take with st. johns wort (OTC) - serotonin syndrome
Make sure they know possible interactions for MAOI (and time lapse between switces) and TCAS…… MAOIs ESPECIALLY
keep lab appointments for sodium levels if elderly on diuretics
What is the therapeutic action/outcome for Tricyclic antidepressants (TCAs)?
inhibit reabsorption and reuptake of serotonin and norepinephrine (NE) making both more readily available;
this will reduce symptoms of depression, anxiety, insomnia, and neuropathic pain
How long does it take for TCAs to take full effect?
2-6 weeks
What does the increase of available norepinephrine with TCAs increase the risk for?
Increases the risk for HTN crisis.
What are some adverse effects of TCAs?
Sedation
Orthostatic hypotension
excessive sweating
Anticholinergic effects: blurred vision constipation dry mouth tachycardia urinary retention photophobia toxicity - CARDIAC DYSRHYTHMIAS, confusion, seizures
What are some nursing considerations for TCAs?
Sedation: take at night, usually diminishes with time
constipation: drink 2-3L water daily
dry mouth: suck on hard candy, chew gum
tachycardia: monitor HR
urinary retention: void before taking medication
Toxicity: take vitals, monitor ECG and call physician with changes
orthostatic hypotension: monitor, fall risk
Avoid use of st. johns wort (serotonin syndrome), SSRI (serotonin syndrome), and MAOI (HTN crisis) in concurrecnce
excessive sweating - change linens frequently
What are some patient teaching points for TCAs?
sedation: avoid driving or operating heavy machinery, take at night, avoid other CNS depressants
blurred vision: avoid driving; report if severe
Constipation: drink 2-3L daily, high fiber foods
dry mouth: suck on hard candy, chew gum
Tachycardia: REPORT HEART PALPITATIONS
urinary retention: void before taking medication, report if unable to void
photophobia: wear sunglasses
toxicity: REPORT SYMPTOMS
orthostatic hypotension: change positions slowly, peripheral vascular relaxation
REPORT ANY ANTICHOLINERGIC SYMPTOMS
Suicide watch!!!
No st. johns wort - serotonin syndrome risk
2-6 weeks for full effect
antihistamines and TCAs togther increase anticholinergic symptoms
What is the therapeutic actions and outcome of MAOIs?
limits the breakdown of norepinephrine, dopamine, and serotonin making more of it available. this improves depressive symptoms as well as bulimia.
NOT USED OFTEN BECAUSE OF SAFETY AND DIET CONCERNS.
How long does it take for MAOIs to take full effect?
4-6 weeks
What are some adverse effects of MAOIs?
CNS stimulation: anxiety, agitation, mania, hypomania
orthostatic hypotension
hypertensive crisis
What are some nursing considerations for MAOIs?
monitor for adverse effects of CNS stimulation
Monitor orthostatic hypotension
No foods high in tyramine (HTN crisis), patient will spend a lot of time with dietician
cannot be taken within 2 weeks of SSRIs
avoid giving sympathomimetic medications (phenylephrine) or other vasopressors (alpha stimulants) and PO decongestants (sudafed) because of increased risk for HTN and tachycardia
LOOK AT TYRAMINE HANDOUT
DO IT NOW!!!
What are some signs of HTN crisis? What causes this?
HA, stiff neck, blurred vision, chest pain, stroke symptoms
Vasoconstriction from the drug-food interaction causes a very high BP and elevated HR
How do we treat HTN crisis?
phentolamine (regitine) - IV alpha adrenergic blocker
or
nifedipine (procardia) - selective calcium channel blocker
What drugs cannot be taken along with MAOIs?
TCAs - HTN crisis
SSRIs - serotonin syndrome
What are some patient teaching points for MAOIs?
avoid tyramine foods
avoid st. johns wort/ herbal remedies
avoid OTC medications unless approved by provider
allow time for full effect (4-6 weeks)
get up slowly
avid caffeine, chocolate, herbal remedies - increased risk for HTN
What is the patient teaching that is consistent with all of the antidepressants?
take every day to gain therapeutic levels
most take 1-2 to begin and 6-8 for full effects
dont stop suddenly; continue once symptoms improve
dont take MAOIs with SSRIs of TCAs
SUICIDE WATCH
avoid st. johns wort and other herbal remedies
