Module 15 Antidepressant agents Ch21 Flashcards
Signs and Symptoms of
Depression
Low energy level Sleep disturbances Lack of appetite Limited libido Inability to perform activities of daily living Overwhelming feelings of sadness, despair, hopelessness, and disorganization
Biogenic Amine Theory of
Depression
• Monoamine oxidase (MAO) may break them
down to be recycled or restored in the neuron
• Rapid fire of the neurons may lead to their
depletion
• The number or sensitivity of postsynaptic
receptors may increase, depleting
neurotransmitter levels
Depression results from adeficiency of
norepinephrine (NE), dopamine, or serotonin
(5HT)
Actions of Antidepressant
Therapy
Inhibit the effects of MAO, leading to increased NE or 5HT in the synaptic cleft Block reuptake by the releasing nerve, leading to increased neurotransmitter levels in the synaptic cleft Regulate receptor sites and breakdown of neurotransmitters, leading to an accumulation of neurotransmitters in the synaptic cleft
Classifications of
Antidepressants
Tricyclic antidepressants (TCAs) MAO inhibitors (MAOIs) Selective serotonin reuptake inhibitors (SSRIs) Serotonin norepinephrine inhibitors (SNRIs) “Others”
Tricyclic Antidepressants
Actions
Reduce the reuptake of 5HT and NE into
nerves
• All TCAs are similar
• Choice depends on individual response to
the drug and tolerance of adverse effects
Tricyclic Antidepressants Indication and drug class
Indications • Relief of symptoms of depression • Used in patients with sleep disorders • Treatment of enuresis • Chronic pain
drug name -triptyline • Amitriptyline • Nortriptyline -pramine • Clomipramine • Desipramine • Imipramine • Trimipramine Doxepin
Tricyclic Antidepressants
Contraindication
ADE
Drug drug interaction
Contraindication • Known allergy • Recent MI • CV disease • Anticholinergic conditions • Manic-depression/ bipolar disorder
s/ Cautions
Adverse Effects • CNS: Sedation, sleep disturbances, fatigue, hallucinations, ataxia • GI: Dry mouth, constipation, nausea, vomiting
Drug-Drug Interactions
• MAOIs, cimetidine, fluoxetine,
ranitidine
Tricyclic Antidepressants:
The Nursing Process
• History: cardiac dysfunction • Labs: ECG Assessment unique to TCAs • Decreased cardiac output Nursing Diagnosis unique to TCAs
Implementation
• Limit drug access if the patient is suicidal
• Parenteral form only if oral not feasible
• Reduce dose if minor adverse effects occur
• Discontinue slowly if major or life-threatening adverse effects occur
• Provide comfort and safety measures
• Drowsy/anticholinergic effects: administer dose at bedtime
• Provide thorough patient teaching
Monoamine Oxidase Inhibitors
(MAOIs)
Action
indication
Action • Irreversibly inhibits MAO, allowing norepinephrine, serotonin, and dopamine to accumulate in the synaptic cleft Indications • Depression
Monoamine Oxidase Inhibitors Drug list
Isocarboxazid
Phenelzine
Tranylcypromine
Monoamine Oxidase Inhibitors
Contraindications
drug-drug
Adverse effects
Contraindications
• Known allergy
• Pheochromocytoma
• CV disease
• Headaches
• Renal or hepatic impairment
Adverse Effects
• CNS: Dizziness, excitement, nervousness, mania,
hyperreflexia, tremors, confusion, insomnia, agitation
• Liver toxicity
• Black box warning for suicidal ideation and behavior
especially for children and young adults
Drug-Drug Interactions • Other antidepressants – Hypertensive crisis, coma, convulsions, serotonin syndrome • Methyldopa – Sympathomimetic effects increase • Insulin or oral antidiabetic agents – Additive hypoglycemia
Food Interactions
• Tyramine – Increase blood pressure
Monoamine Oxidase Inhibitors:
The Nursing Process
Assessment unique to MAOIs •History: cardiac dysfunction, seizure disorders •Labs: ECG Nursing Diagnoses unique to MAOIs • Acute pain • Decreased cardiac output related to CV effects
Implementation
• Limit drug access to a potentially suicidal patient
• Monitor blood pressure and orthostatic blood
pressure
• Monitor liver function before and periodically during
therapy
• Discontinue drug and monitor patient carefully at any
complaint of severe headache
• Have phentolamine or another adrenergic blocker on
standby
• Provide comfort measures
• Provide thorough patient teaching
• Drug-food interactions (tyramine)
Selective Serotonin Reuptake
Inhibitors (SSRIs)
Specifically block the reuptake of 5HT, with little to no known
effect on NE
Do not have many adverse effects associated with TCAs and
MAOIs
Actions
• Inhibits CNS neuronal reuptake of serotonin with little effect on norepinephrine and
little affinity for cholinergic, histaminic, or alpha-adrenergic sites
Indications
• Depression, OCDs, panic attacks, bulimia, PMDD, posttraumatic stress disorders,
social phobias, social anxiety disorders
Selective Serotonin Reuptake
Inhibitors (SSRIs) drug list
• Citalopram • Escitalopram -italopram • Fluoxetine • Paroxetine -oxetine Sertraline
Selective Serotonin Reuptake
Inhibitors (SSRIs)
Contraindication
s
drug - drug
ADE Adverse effect
Contraindication s Known allergy Impaired renal or hepatic function Pregnancy/lactation Associated with congenital abnormalities Adverse Effects Headache, drowsiness, dizziness, insomnia, anxiety, tremor, agitation Drug-Drug Interactions MAOIs TCAs
