Module 3 - Anxiolytic and Antidepressant Agents Flashcards
Anxiolytic Agents
reduce anxiety by reducing over activity in the CNS
what do benzodiazepines do?
Depress activity in the brainstem and limbic system
how do antihistamines work
- Depress CNS by sedation
- used for allergic conditions
Buspirone (BuSpar)
- Nonsedating and non–habit forming
- May have drug interaction with SSRIs (serotonin syndrome)
- Do not administer with MAOIs
antidepressnts reduce..
symptoms of depression, panic, and anxiety
what are the two older generation antidepressants?
Tricyclic antidepressants (TCAs) Monoamine oxidase inhibitors (MAOIs)
name the three newer generation antidepressants.
1)Selective serotonin reuptake inhibitors (SSRIs)
2)Serotonin-norepinephrine reuptake inhibitors (SNRIs)
3)Miscellaneous
(atypical; do not fall conveniently into the other categories)
older generation:
what are tricyclic antidepressants used for?
depression (if SSIR’s have failed), childhood enuresis (imipramine), OCD (clomipramine), adjunctive analgesics for chronic pain conditions (e.g., trigeminal neuralgia)
older generation:
when are tricyclic antidepressants used?
- used if newer generation drugs have failed.
- largely been replaced by SSRIs as first-line Tx
Tricyclic Antidepressants:
Side effects
Dry mouth, blurred vision, urine retention, and hypertension, sedation and anti-cholinergic effects, impotence, orthostatic hypotension
in elderly: Dizziness, postural hypotension, constipation, delayed micturation, edema, muscle tremors
when should Tricyclic Antidepressants be avoided?
- should never be taken with alcohol or other CNS depressants
- patients with heart attack, heart block, or arrhythmia
what happens with Tricyclic Antidepressants overdose?
- Lethal—70% to 80% die before reaching the hospital
- CNS and cardiovascular systems are mainly affected
- Death results from seizures or dysrhythmias
- No specific antidote
- Decrease drug absorption with activated charcoal
- Speed elimination by alkalinizing urine
- Manage seizures and dysrhythmias
- Basic life support
A 77-year-old female patient is diagnosed with depression and anxiety and is started on imipramine. Because of this patient’s age, which adverse effects would take priority when planning care?
a) Dry mouth and photosensitivity
b) Anxiety, headaches, insomnia
c) Drowsiness and sedation
d) Urinary frequency
C - drowsiness and sedation
Older Generation:
what are MAO Inhibitors (MAOI’s) used for?
- Considered second-line treatment for depression not responsive to cyclics
- highly effective
Older Generation:
MAO Inhibitors adverse effects.
orthostatic hypotension, headache, insomnia, and diarrhea
Older Generation:
MAO Inhibitor precautions
many food and drug interactions.
- Concurrent use of MAOIs and SSRIs may lead to serotonin syndrome
- when switching to SSRI’s from MAOI’s need 2-5 week washout period
- when taken with tyramine causes hypertensive crisis leading to cerebral hemorrhage, stroke, coma, or death
Why are foods containing Tyramine dangerous to consume with MAOI’s?
What are these foods?
-causes hypertensive crisis leading to cerebral hemorrhage, stroke, coma, or death
- Fruit: Avocados, Bananas, raisins, paypaya, figs
- veggies: bean pods
- dairy products: cheese, sour cream, yoghurt
- alcohol: beer, wine (red)
meat: beed/chicken liver, pate, meat extracts, pickled herring, pepperoni, salami, sausage, bologna, hotdogs - chocolate
- yeast products
- soy sauce
signs and symptom and treatment of severe hypotension
signs/ symptoms - headache, nausea, high BP
treatment - IV regitine (rapid acting) or nifedipine
MAOI Overdose
- Tachycardia, circulatory collapse, seizures, coma (appear 12 hours after ingestion)
- Treatment: protect brain and heart, eliminate toxin
- Gastric lavage
- Urine acidification
- Hemodialysis
what are the benefits of newer generation antidepressants?
- Fewer adverse effects than tricyclics and MAOIs
- Very few drug-drug or drug-food interactions
- Still takes 4 to 6 weeks to reach maximum clinical effectiveness
- SSRI’s first line for depression
Newer Generation:
SSRI Examples
- fluoxetine (Prozac)
- paroxetine (Paxil)
- sertraline (Zoloft)
- fluvoxamine (Luvox)
- citalopram (Celexa)
- escitalopram (Lexapro)
Newer Generation:
SNRI Examples
- venlafaxine (Effexor)
- duloxetine (Cymbalta)
- desvenlafaxine (Pristiq)
Newer Generation:
what are Specialized antidepressants?
Examples
*“hybrid” blends of antidepressant drugs that have benefits such as decreased side effects
- trazodone (Desyrel, Oleptro)
- bupropion (Wellbutrin)
- nefazodone (Serzone)
- mirtazapine (Remeron)
What are Newer Generation antidepressants used for?
Depression Bipolar disorder Obesity Eating disorders Obsessive-compulsive disorder Panic attacks or disorders Social anxiety disorders Posttraumatic stress disorders (PTSD) Myoclonus Treatment of various substance abuse problems (bupropion [Zyban] is used for smoking cessation treatment)
Newer Generation Antidepressants:
side effects
CNS: Headache, dizziness, tremor, nervousness, insomnia*, fatigue
GI: Nausea, diarrhea, constipation, dry mouth
Sexual Dysfunction*
Weight Gain*
Weight loss
Sweating
Newer Generation:
SSIR’s benefits and disadvantages
Benefits:
- Safer
- Dosage often does not need to be titrated (increases compliance)
- Less common sympathomimetic effects (increased heart rate and hypertension)
- Fewer anticholinergic effects
- less screening
Disadvantages:
- weight gain and sexual dysfunction
- Severe interactions if taken with St. John’s Wort (natural remedy)
- Serotonin syndrome
- No specific treatment for overdose
Newer Generation:
Selective norepinephrine reuptake inhibitors
(SNRI’s) - side effects
Abnormal dreams, sweating, Constipation, dry mouth, loss of appetite, weight loss, Tremor, abnormal vision, headaches, nausea, Vomiting, dizziness, and loss of sexual desire
what is serotonin syndrome?
- excessive levels of serotonergic transmission causes serotonin toxicity
- results in autonomic instability andneuromuscular hyperactivity
- symptoms: Delirium, tachycardia, hyperreflexia, shivering, agitation, sweating, muscle spasms, coarse tremors
- Severe Symptoms: Hyperthermia, seizures, renal failure, dysrhythmias, disseminated intravascular coagulation (DIC)
Treatment: stop taking medications containing serotonin
give benzodiazapine to treat shivering, sweating, ect
-in severe casesgive antidote: serotonin 2a agonist
antidepressant treatment timescale:
up to two weeks
assess patient is doing ok, taking meds, and dealing with side effects
antidepressant treatment timescale:
2-4 weeks
symptoms should be improving and side effects lessening
antidepressant treatment timescale:
6 weeks
check adherence and treatment effectiveness.
-if treatment is not effective - consider new treatment
antidepressant treatment timescale:
6 months
-depression should be better and patient should be functioning normally
antidepressant treatment timescale:
after properly well
continue treatment for at lease 4-6 months after feeling better
-discuss how to come off meds with Dr
antidepressants:
withdrawal syndrome
-occur following the interruption, dose reduction or discontinuation of SSRIs or SNRIs
Symptoms:
flu-like, headache, nausea, visual disturbances, anxiety, dizziness, and tremors
-to avoid client should taper the dose gradually when discontinuing the medication.
anxiolytics
Nursing considerations for the elderly
monitor closely for over-sedation and profound CNS depression
Anxiolytics:
therapeutic effects
- Improved mental alertness, cognition, and mood
- Fewer anxiety and panic attacks
- Improved sleep patterns and appetite
- Less tension and irritability, -fewer feelings of fear, impending doom, and stress
- More interest in self and others
Antidepressants:
Nursing considerations
- Many cautions, contraindications, and interactions exist
- Inform patients takes several weeks to see therapeutic effects
- Monitor patients closely during this time, assess for suicidal tendencies, provide support, therapeutic effects and adverse effects
- Assist patients with ambulation/ movement as falls may occur due to drowsiness or postural hypotension
- Tricyclics may need to be weaned and discontinued before undergoing surgery to avoid interactions with anesthetic drugs
- caffeine and smoking decreases effectiveness
- inform patients of tyramine-containing food
A patient is admitted to the emergency department. The patient’s heart rate is 112 beats/min; he is sweating, has muscle tremors, and is agitated. The patient says, “I was depressed and took more of the pills the doctor gave me so I would feel better.”
1) What does the nurse suspect is happening with this patient?
2) What treatment does the nurse expect to implement?
1) Serotonin syndrome
2) stop taking medications containing serotonin, and give benzodiazapine to calm them down (shivering, sweating, ect) could also give antidote in severe cases: serotonin 2a agonist
The patient was admitted to the hospital for observation and has now recovered. Which information will the nurse include in patient teaching about SSRIs?
A) It usually takes 4 to 6 weeks until you will experience benefits from the medication.
B) The patient must avoid foods that contain tyramine.
C) If the patient develops an upset stomach when taking this medication, he should discontinue use.
D) The patient should take the medication at bedtime to enhance sleep.
A) It usually takes 4 to 6 weeks until you will experience benefits from the medication.
Several months later the patient returns to the health care provider’s office for follow-up regarding use of the SSRI. The patient tells the nurse that he is feeling better and stopped taking the SSRI yesterday. He doesn’t plan on taking the medication again. When talking with the patient, which knowledge should guide the nurse’s response?
A) Drug dependency will develop, so it is appropriate to stop therapy after a few months.
B) Drug therapy must be stopped as soon as the patient feels better to avoid serotonin syndrome.
C)The patient is the best person to determine when the drug therapy should end.
D) A 1- to 2-month taper period is indicated to prevent adverse effects of abrupt drug discontinuation. – avoid withdrawal
D) A 1- to 2-month taper period is indicated to prevent adverse effects of abrupt drug discontinuation. – avoid withdrawal
