NUR 325: Mental Health / Withdrawal

Question 1

Medication classes of Antidepressants

Answer 1

Selective serotonin reuptake inhibitors (SSRI)

Serotonin and Norepinephrine reuptake inhibitors (SNRI)

Tricyclic antidepressants

MAO inhibitors

Benzodiazepines

Question 2

Nursing considerations of antidepressants

Answer 2

SSRI & SNRI are first line- safety risk
Asses suicide risk
After starting drug- monitor 4-8 weeks for efficacy

Question 3

MOA for SSRI
fluoxetine (Prozac) - & pronounce

Answer 3

inhibitors of serotonin at nerve endings
More serotonin is available at the nerve endings

Question 4

Adverse effects of SSRI

Answer 4

weight gain
GI- N/V/D, constipation, dry mouth
CNS- headache, nervousness, insomnia
Sexual dysfunction
serotonin syndrome
withdrawal syndrome
Suicidal risk
Neonatal effects if pregnant

Question 5

What is serotonin syndrome?

Answer 5

2-72 hours after treatment, altered mental status, increased occurrence with MAOIs and other serotonergic drugs

Question 6

withdrawal syndrome of SSRI

Answer 6

dizziness, H/A, sensory disturbances, tremor, anxiety, dysphoria

Question 7

fluoxetine (Prozac)

Answer 7

Less sever/fewer s/e
less drug/drug interactions

Avoid use with MAO inhibitors

Question 8

MOA of venlafaxine (Effexor)

Answer 8

Blocks neuronal activity of serotonin and norepinephrine

Question 9

Adverse effects of venlafaxine

Answer 9

nausea, headache, anorexia, insomnia, somnolence, sexual dysfunction, withdrawal syndrome, sweating, blurred vision, increased LFTs (duloxetine)

Question 10

Tricyclic Antidepressants

Answer 10

amitryptaline (Elavil)

Question 11

MOA of amitryptaline (Elavil)

Answer 11

Block reuptake of 2 monoamine transmitters, norepinephrine & serotonin (intensify the effect), making more available in the synapse

Question 12

Adverse effects of amitryptaline (Elavil)

Answer 12

sedation
orthostatic hypotension
anticholinergic effects
sexual dysfunction
cardiac toxicity

Question 13

Monoamine Oxidase Inhibitors (MAOI)

Answer 13

phenelzine (Nardil)

Question 14

MOA of phenelzine (Nardil)

Answer 14

Inhibits MAO- enzyme found in the liver, intestinal wall and terminals of neurons
MAO converts norepi, 5-HT, and dopamine to inactive product

decreased MAO increases availability of neurotransmitters at the nerve endings

Question 15

adverse effects of phenelzine (Nardil)

Answer 15

food/drug interactions
CNS stimulation
orthostatic hypotension
rapid increase in BP, stroke, coma

drug interactions!

Question 16

Atypical Antidepressants

Answer 16

buproprioin (Wellbutrin)

Question 17

MAO of buproprion (Wellbutrin)

Answer 17

is unclear

Question 18

side effects of buproprion

Answer 18

seizure, agitation, headache, dry mouth, constipation, weight loss, GI upset, dizziness, tremor

Question 19

ketamine

Answer 19

low/dose intranasal administration that can be used to treat extreme pain

can rapidly help with suicidality and other serious symptoms of depression

Question 20

Adverse effects of ketamine

Answer 20

perceptual disturbances dissociation

Question 21

MOA of trazadone (Oleptro)

Answer 21

second-line agent
blockade of 5-HT reuptake

Question 22

Benzodiazepines

Answer 22

alprazolam (Xanax)
diazepam (valium)
lorazepam (Ativan)

Question 23

MOA of
alprazolam (Xanax)
diazepam (valium)
lorazepam (Ativan)

Answer 23

Enhance inhibitory effects of GABA in the CNS

Question 24

Adverse effects of
alprazolam (Xanax)
diazepam (valium)
lorazepam (Ativan)

Answer 24

CNS depression (decreased LOC)
w/d effects
memory loss
respiratory depression

Question 25

benzo nursing considerations & antidote

Answer 25

Teratogenic- avoid while pregnant
do not mix w other medications
avoid grapefruit or fatty foods
Antidote: flumazenil (Romazicon)