Mental Health / Withdrawal

Question 1

Medication classes of Antidepressants

Answer 1

Selective serotonin reuptake inhibitors (SSRI)

Serotonin and Norepinephrine reuptake inhibitors (SNRI)

Tricyclic antidepressants

MAO inhibitors

Benzodiazepines

Question 2

Nursing considerations of antidepressants

Answer 2

SSRI & SNRI are first line- safety risk
Asses suicide risk
After starting drug- monitor 4-8 weeks for efficacy

Question 3

MOA for SSRI

fluoxetine (Prozac)

Answer 3

inhibitors of serotonin at nerve endings

More serotonin is available at the nerve endings

Question 4

Adverse effects of SSRI

Answer 4

weight gain
GI- N/V/D, constipation, dry mouth
CNS- headache, nervousness, insomnia
Sexual dysfunction
serotonin syndrome
withdrawal syndrome
Suicidal risk
Neonatal effects if pregnant

Question 5

Serotonin syndrome

Answer 5

2-72 hours after treatment, altered mental status, increased occurrence with MAOIs and other serotonergic drugs

Question 6

withdrawal syndrome of SSRI

Answer 6

dizziness, H/A, sensory disturbances, tremor, anxiety, dysphoria

Question 7

fluoxetine (Prozac)

Answer 7

Less sever/fewer s/e
less drug/drug interactions

Avoid use with MAO inhibitors

Question 8

MAO of venlafazine (Effexor)

Answer 8

Blocks neuronal activity of serotonin and norepinephrine

Question 9

Adverse effects of venlafazine

Answer 9

nausea, headache, anorexia, insomnia, somnolence, sexual dysfunction, withdrawal syndrome, sweating, blurred vision, increased LFTs (duloxetine)

Question 10

Tricyclic Antidepressants

Answer 10

amitryptaline (Elavil)

Question 11

MAO of amitryptaline (Elavil)

Answer 11

Block reuptake of 2 monoamine transmitters, norepinephrine & serotonin (intensify the effect), making more available in the synapse

Question 12

Adverse effects of amitryptaline (Elavil)

Answer 12

sedation
orthostatic hypotension
anticholinergic effects
sexual dysfunction
cardiac toxicity

Question 13

Monoamine Oxidase Inhibitors (MAOI)

Answer 13

phenelzine (Nardil)

Question 14

MAO of phenelzine (Nardil)

Answer 14

Inhibits MAO- enzyme found in the liver, intestinal wall and terminals of neurons
MAO converts norepi, 5-HT, and dopamine to inactive product

decreased MAO increases availability of neurotransmitters at the nerve endings

Question 15

adverse effects of phenelzine (Nardil)

Answer 15

food/drug interactions
CNS stimulation
orthostatic hypotension
rapid increase in BP, stroke, coma

drug interactions!

Question 16

Atypical Antidepressants

Answer 16

buproprioin (Wellbutrin)

Question 17

MAO of buproprion (Wellbutrin)

Answer 17

is unclear

Question 18

side effects of buproprion

Answer 18

seizure, agitation, headache, dry mouth, constipation, weight loss, GI upset, dizziness, tremor

Question 19

ketamine

Answer 19

low/dose intranasal administration that can be used to treat extreme pain

can rapidly help with suicidality and other serious symptoms of depression

Question 20

Adverse effects of ketamine

Answer 20

perceptual disturbances dissociation

Question 21

MOA of trzadone (Oleptro)

Answer 21

second-line agent

blockade of 5-HT reuptake

Question 22

Benzodiazepines

Answer 22

alprazolam (Xanax)
diazepam (valium)
lorazepam (Ativan)

Question 23

MOA of
alprazolam (Xanax)
diazepam (valium)
lorazepam (Ativan)

Answer 23

Enhance inhibitory effects of GABA in the CNS

Question 24

Adverse effects of
alprazolam (Xanax)
diazepam (valium)
lorazepam (Ativan)

Answer 24

CNS depression (decreased LOC)
w/d effects
memory loss
respiratory depression

Question 25

benzo nursing considerations

Answer 25

Teratogenic- avoid while pregnant do not mix w other medications avoid grapefruit or fatty foods Antidote: flumazenil (Romazicon)

Question 26

MAO of tramadol (Ultram)

Answer 26

Binds weakly to mu opioid receptors | inhibit reuptake of both norepi and serotonin

Question 27

Adverse effects of tramadol

Answer 27

drowsy, dizzy, headache, nausea, constipation, respiratory depression rare- seizures

Question 28

MAO of gabapentin (Neurontin) & pregablin (Lyrica)

Answer 28

thought to spontaneously suppress neuronal firing

Question 29

Adverse effects of gabapentin & pregablin

Answer 29

drowsy, dizzy, visual problems

Question 30

NSAIDS

Answer 30

``` aspirin (ASA) ibuprofen (Advil) naproxen (Aleve) ketorolac (Toradol) celecoxib (Celebrex) ```

Question 31

NSAIDS MOA

Answer 31

blocks a key enzyme: COX- that is crucial to the production of prostaglandins

Question 32

Side effects of NSAIDS

Answer 32

GI upset, stomach ulcers, GI bleeding, rash, edema, kidney failure, increases in BP, inhibits platelet aggregation, SOA in asthma patients

Question 33

Side effects of Aspirin

Answer 33

toxicity- n/v | Reye's Syndrome