Mental Hlth - Antidepressants

Question 1

Depression: Drug Therapy

Answer 1

• Inhibit effects of monoamine oxidase
  > enzyme breaks down neurotransmitters
• Blocks reuptake of neurotransmitters
• Regulate receptor sites and/or breakdown
• Goal: more neurotransmitter in synaptic cleft

Question 2

Serotonin Syndrome CMs

Answer 2

• Common
  > delirium
  > agitation
  > HTN/tachy
  > sweating
  > clonus (muscle spasms)
  > hyperreflexia
  > tremors
  > shivering
• Severe
  > hyperthermia
  > seizures
  > rhabdomyolysis
  > renal failure
  > cardiac dysrhythmias

Question 2

Antidepressants - General

indication
BB
contra
caution
d-d

Answer 2

• Indication: depression
  > allows 4wks for therapeutic effect
• Black Box: incrd risk for suicidal ideation
  > esp. children & young adults
• Contraindications: seizure disorders
• Caution: older adult more susceptible to AE; pregnancy/lactation
• Drug-Drug:
  > more than 1 antidepressant incrs risk for AE & serotonin syndrome
  > Serotonergic drugs: fentanyl, St. John’s Wort

Question 3

1st Generation Antidepressants

Answer 3

• Tricyclic
• MAOIs
• more significant AEs
• toxicity lethal
• pregnancy cat D/X

Question 4

2nd Generation Antidepressants

Answer 4

• SSRI
• SNRI
• more tolerable AEs, still bothersome
• Pregnancy cat C

Question 5

Amitriptyline - Class & MOA

Answer 5

• Class: Tricyclic Antidepressant (TCA)
  > 1st gen
• MOA: reduce reuptake of serotonin & NE into nerves
  > blocks cholinergic, histaminergic, adrenergic, dopaminergic receptors

Question 6

Amitriptyline - Use & Caution

Answer 6

• Use: refractory to other treatment
• Caution: cardiovascular disease, seizure disorder

Question 7

Amitriptyline - Drug/Drug & AEs

Answer 7

• Drug-Drug: MAOIs (Phenelzine)
• AEs:
  > sedation
  > anticholinergic effects
  > weight gain
  > overdose: cardiac dysrhythmias & seizures (usually lethal)

Question 8

Amitriptyline - Nursing Considerations

Answer 8

Admin at HS
general slide

Question 9

Phenelzine - Class & MOA

Answer 9

• Class: Monoamine Oxidase Inhibitor (MAOI)
• MOA: irreversible inhibits MAO allowing neurotransmitters to accumulate in synaptic cleft (including dopamine)

Question 10

Phenelzine - Use & Caution

Answer 10

• Use:
  > depression refactory to other treatment
  > Parkinson’s disease
• Caution: cardiovascular disease

Question 11

Phenelzine - Drug/Drug/Food

Answer 11

• Drug-Drug:
  > sympathomimetic (Epinephrine, Norepinephrine)
  > serotonergic drugs (SSRI-Citalopram)
• Drug-Food:
  > tyramine incrs BP & risk for HTN crisis

Question 12

Phenelzine - AEs & Nursing

Answer 12

• AEs:
  > orthostatic hypoten
  > sexual dysfunc
  > severe: HTN crisis
• Nursing: avoid tyramine foods; wait 2-6wks MAOI to SSRI (incr risk serotonin syn)

Question 13

Food Containing Tyramine

Answer 13

• High
  > aged cheeses: cheddar, blue, swiss
  > smoked/pickled/cured meats: sausage, pepperoni
  > yeast extracts
  > red wines
• Moderate-Low
  > avocado
  > pasteurized light & pale beer
  > distilled spirits: vodka, giv
  > non-aged cheeses
  > chocolate & caffeinated beverages
  > fruit: bananas, grapes, pineapple

Question 14

Citalopram (Celexa) - Class & MOA

Answer 14

• Class: Selective Serotonin Reuptake Inhibitors (SSRI)
  > 2nd gen
• MOA: blocks reuptake of serotonin incring lvls in synaptic cleft

Question 15

Citalopram (Celexa) - Uses & AEs

Answer 15

• Use:
  > 1st line treatment of depression
  > OCD
  > panic attacks
  > PTSD
• AEs
  > dry mouth
  > sexual dysfunc
  > prolonged QTc
  > modest weight gain
  > insomnia more likely; take in AM

Question 16

Citalopram (Celexa) - Nursing Consideration

Answer 16

Slowly taper due to withdrawal syndrome

Question 17

Antidepressants Lifespan - Children

Answer 17

• Long term effects not clearly understood
• Some studies; efficacy poor, incrd risk for suicidal ideation

Question 18

Antidepressants Lifespan - Pregnancy

Answer 18

• Caution, benefit vs risk
• Neurological, cardiac, resp effects of fetus

Question 19

Antidepressants Lifespan - Older Adults

Answer 19

• More susceptible to AEs
• Reduce dose

Question 20

Duloxetine (Cymbalta) - Use, AEs, & Nursing

Answer 20

• Use:
  > depression
  > anxiety
  > off-label: neurpathic pain, fibromyalgia
• AEs
  > GI effects: nausea, anorexia, weight loss
• Nursing: general

Question 21

Antidepressant Care Plan

assessment
intervention
evaluate

Answer 21

• Assessment
  > indication for drug: depression, suicidal ideation
• Intervention
  > admin in AM if causes insomnia or HS if causes drowsiness
• Teach
  > report suicidal ideation
  > therapeutic effects up to 4 wks
  > do not discontinue abruptly
• Evaluate
  > therapeutic response, AE, teaching, compliance