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411 Mental Health Exam 1 > Module 3: Depressive Disorders & Antidepressants > Flashcards

Module 3: Depressive Disorders & Antidepressants Flashcards

1
Q

How are antidepressants chosen?

A

Chosen based on:

  • Symptoms
  • Safety
  • Adverse effect profiles
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2
Q

How long do most antidepressants take to have an effect?

A

2-8 weeks (never meant as PRN)

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3
Q

How should antidepressants be discontinued?

A
  • Slow tapering necessary to avoid discontinuation syndrome
  • Do not discontinue abruptly
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4
Q

What life-threatening condition can result from taking antidepressants?

A

Serotonin syndrome from overactivity of serotonin or an impairment of the serotonin metabolism

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5
Q

Ideal treatment for patients with severe or recurrent MDD (Major Depressive Disorder)?

A

psychotherapy + pharmacotherapy

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6
Q

Antidepressants have a high risk of doing what to patients with bipolar disorder?

A

Inducing mania

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7
Q

What is a concern with most antidepressants (even MAOIs)?

A

Orthostatic hypotension

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8
Q

Antidepressants black box warning?

A

Increased risk of suicidal thoughts and behaviors in patients aged 24 and younger.

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9
Q

Primary nursing assessment for depressive disorders?

A
  • SAFETY!
  • Assess presence of suicidal ideation
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10
Q

Define anhedonia.

A

The inability to experience joy or pleasure. You may feel numb or less interested in things that you once enjoyed

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11
Q

Biological nursing assessment for depressive disorders?

A
  • History and Physical
  • Substance and Medication Use
  • Behaviors impacted by MDD:
    • Nutrition, sleep, energy etc.
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12
Q

Psychosocial nursing assessment for depressive disorders?

A
  • Mood and affect
  • Thought content
  • Cognition and memory
  • Social Support
  • Stress and Coping
  • Components of MSE
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13
Q

Nursing interventions in the Psychosocial Domain?

A
  • Establishing recovery and wellness goals
  • CBT (Cognitive Behavioral Therapy)
  • Thought stopping and positive self talk
  • Support groups
  • Patient and family teaching
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14
Q

Nursing interventions associated with Psychotherapeutic Management?

A

Nurse patient relationship :

  • Accept patients as they are
  • Assist in focusing on their strengths
  • Validate their feelings
  • Establish trust
  • Point out small visible accomplishments and strengths
  • Don’t attempt to manipulate patients from feeling depressed
  • Don’t argue with a patient over hallucinations delusions or negative beliefs
  • Spend time with patients to manage their social isolation
  • Provide decision making opportunities for patients that can manage
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15
Q

Nursing interventions for Pharmacotherapy?

A

Monitor efficacy, side effects, and interactions

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16
Q

What are some additional therapies for depressive disorders?

A
  • Electroconvulsive Therapy (ECT)
  • Ventilate the patient, monitor vital signs, help with reorientation to a person, place, time
  • Benzodiazepine PRN for agitation
17
Q

Nursing intervention for Bright Light Therapy?

A
  • Familiar with the adverse side effects (nausea, eye irritation)
  • Contraindications include glaucoma, cataracts and the use of photosynthesizing medications
18
Q

What does norepinephrine help with?

A
  • Stress response
  • Flight or fight
  • Circadian rhythms
  • Energy
  • Arousal
19
Q

What does dopamine help with?

A
  • Pleasure
  • Reward
  • Attention
  • Reinforcement
20
Q

What does serotonin help with?

A
  • Appetite
  • Social rank
  • Well-being
  • Sleep
21
Q

What are the classifications of antidepressants?

A
  • Selective serotonin reuptake inhibitors (SSRls)
  • Selective serotonin-norepinephrine reuptake inhibitors (SNRls)
  • Norepinephrine dopamine reuptake inhibitors (NDRls)
  • Monoamine Oxidase Inhibitors (MAOls)
  • Serotonin-2 antagonist/serotonin reuptake inhibitor (SARI)
  • Tricyclic antidepressants (TCA) are nonselective
22
Q

List examples of SSRIs.

A
  • Paroxetine (Paxil)
  • Fluoxetine (Prozac)
  • Citalopram (Celexa)
  • Escitalopram (Lexapro)
23
Q

SSRI mnemonics?

A

Sexual Dysfunction
Serotonin syndrome
Stomach upset
Size increase (weight gain)
Restlessness
Insomnia
Suicidal ideation
Sodium loss

24
Q

SSRIs risks?

A
  • Bleeding risk
  • Careful with NSAIDS, anticoagulants
25
Q

List examples of SNRIs.

A
  • Venlafaxine (Effexor)
  • Duloxetine (Cymbalta)
26
Q

SNRIs adverse effects and considerations?

A
  • Similar to SSRIs
  • Monitor for hypertension (they can still have postural hypotension!)
27
Q

List an example of NDRIs.

A

Bupropion (Wellbutrin, Zyban)

28
Q

NDRIs nursing considerations?

A
  • Less sedating than SSRI/SNRIs
  • Fewer sexual side effects
29
Q

List examples of TCAs.

A
  • Amitriptyline (Elavil)
  • Nortriptyline (Aventyl, Pamelor)
30
Q

TCAs risk?

A

As effective as SSRIs but with more serious side effects and a higher lethal potential of CARDIAC TOXICITY

31
Q

TCAs Mnemonic?

A

T - think
- Think how the drug works: Increase serotonin and norepinephrine

C - Cardiac

  • Watch out for the heart: Orthostatic hypotension/dizziness

A - Anti- A lot
- Antidepressant (suicidal Ideation)
- Anticholinergic (delirium, seizures)
- Antihistamine (sleepiness, weight gain)

32
Q

List examples of MAOIs.

A
  • Phenelzine (Nardil)
  • Selegiline (Emsam)
33
Q

MAOIs nursing considerations?

A
  • Wash out period: There must be a 2-week (14 day) wash out!
  • This washout period is BOTH directions
  • Patients should be closely monitored and educated about hypertensive crisis (avoid tyramine)
34
Q

What to avoid during hypertensive crisis?

A
  • Anything high in tyramine
  • Sympathomimetic agents (adrenergic)
35
Q

What foods are high in tyramine?

A
  • Cheese
  • Alcohol- Beer and Wine
  • Cured/Aged/smoked meats (salami, pepperoni, fish, etc.)
  • Fermented foods (sauerkraut, kimchi)
  • Fava beans
  • Avocado
  • Caffeine!!
36
Q

Which antidepressants are at risk for Serotonin Syndrome?

A
  • SSRIs
  • SNRIs
  • MAOIs
37
Q

Serotonin Syndrome S/S?

A
  • Shivering
  • Hyperreflexia
  • Increased temperature
  • Vital sign abnormalities
  • Encephalopathy
  • Restlessness
  • Sweating
38
Q

Serotonin Syndrome nursing interventions?

A
  • Stop the serotonergic agent
  • Cool and hydrate the patient
  • May require hospitalization
  • May administer cyproheptadine (an antihistamine with some anti-serotonergic action)
  • Sedation with benzodiazepines
  • Monitor vital signs

411 Mental Health Exam 1 (4 decks)

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