mood disorder meds

Question 1

antidepressants

Answer 1

• mood elevators
• MAOI
• TCA
• SSRI
• NSRI

Question 2

mood stabilizers

Answer 2

• keep mood in a range
• for bipolar dx
• lithium
• off label use of anticonvulsants

Question 3

herbal remedies for mild depression

Answer 3

• gingko biloba

- St John’s wort (decreased reuptake of serotonin, norepinephrine, and dopamine)

Question 4

MAOI action

Answer 4

inhibits MAO = increases norepinephrine, dopamine, epinephrine, and serotonin

Question 5

MAOI names

Answer 5

• tranylcypromine sulfate (Parnate)
• Phenelzine sulfate (Nardil)
• isocarboxazid (marplan)

Question 6

MAOI indication

Answer 6

mild, reactive, and atypical depression that does not respond to antidepressants or TCAs

Question 7

MAOI adverse effect

Answer 7

• HTN crisis

- serotonin syndrome

Question 8

drug/food & drug/drug interaction MAOI

Answer 8

• *cause HTN crisis
• tyramine containg foods (aged cheese, pickled foods, red wine, pepperoni)
• ginseng, ephedra, ma-huang, St John’s wort
• brewer’s yeast
• diet pills
• dextromethorphan
• other antidepressants, TCAs
• CNS stimulants
• sympathomimetics

Question 9

MAOI poisoning

Answer 9

• HTN crisis
• CNS stimulation
• orthostatics hypotension
• anticholinergic
• severe toxicity: hyperthermia, Sz, respiratory depression

Question 10

nursing interventions of MAOI poisoning

Answer 10

• VS
• cooling measures
• IV fluids
• benzo for muscle rigidity
• short acting antihypertensive

Question 11

TCA action

Answer 11

• blocks the reuptake of norepinephrine and serotonin
• elevates mood
• increased interest in daily living and activity
• decreased insomnia

Question 12

TCA names

Answer 12

• amitriptyline (Elavil)
• trimipramine (surmontil)
• doxepin (sinequan)

Question 13

onset of TCA

Answer 13

• works right away for pain

- take 2 weeks to work for depression

Question 14

s/s of TCA

Answer 14

anticholinergic effects

Question 15

anticholinergic syndrome

Answer 15

• inhibition of muscarinic cholinergic neurotransmission
• sinus tachycardia
• ileus
• urinary retention
• HTN
• tremulousness
• myoclonic jerking

Question 16

these meds causes anticholinergic syndrome

Answer 16

• anticholinergics
• antihistamines
• antipsychotics
• antispasmotics
• cyclic antidepressants
• mydriatics
• plants (datura)

Question 17

TCA toxicity interventions

Answer 17

• ABCs
• GI decontamination
• ECG abnormality - Na Bicarb drip
• control agitation
• fever control
• pysostigmine

Question 18

SSRI action

Answer 18

blocks reuptake of serotonin into the nerve terminal of the CNS

Question 19

SSRI indications

Answer 19

• MDD

- anxiety (OCD, panic, phobias, PTSD)

Question 20

SSRI types

Answer 20

• fluoxetine (prozac)
• paroxetine (paxil)
• fluvoxamine (luvox)
• sertraline (zoloft)
• citalopram (celexa)
• escitalopram (lexapro)

Question 21

s/e of SSRI

Answer 21

• tolerable s/e that go away by 2-4 wks
• dry mouth
• blurred vision
• insomnia
• HA
• nervousness
• anorexia
• n/d
• suicidal ideation
• sexual dysfunction
• *does not cause sedation, hypoTN, anticholinergic, or cardiotoxicity as the TCAs do

Question 22

drug/food interaction SSRI

Answer 22

grapefuirt = toxicity

-wide margin of safety; won’t die from OD - GI stuff happens

Question 23

lithium

Answer 23

• calming effect without impairing intellectual activity
• affects thyroid function
• increased lithium = decreased Na = increased UO

Question 24

onset of lithium

Answer 24

within a week

Question 25

s/e lithium

Answer 25

• dry mouth
• thirst
• increased urination
• wt gain
• bloated
• metallic taste
• edema
• tremors (can be disabling)

Question 26

drug/drug interaction lithium

Answer 26

NSAIDs on a continuous basis increase levels of lithium

Question 27

contraindication of lithium

Answer 27

cardiac “sick sinus syndrome”