NUR 325: Mental Health / Withdrawal Flashcards
Medication classes of Antidepressants
Selective serotonin reuptake inhibitors (SSRI)
Serotonin and Norepinephrine reuptake inhibitors (SNRI)
Tricyclic antidepressants
MAO inhibitors
Benzodiazepines
Nursing considerations of antidepressants
SSRI & SNRI are first line- safety risk
Asses suicide risk
After starting drug- monitor 4-8 weeks for efficacy
MOA for SSRI
fluoxetine (Prozac) - & pronounce
inhibitors of serotonin at nerve endings
More serotonin is available at the nerve endings
Adverse effects of SSRI
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
What is serotonin syndrome?
2-72 hours after treatment, altered mental status, increased occurrence with MAOIs and other serotonergic drugs
withdrawal syndrome of SSRI
dizziness, H/A, sensory disturbances, tremor, anxiety, dysphoria
fluoxetine (Prozac)
Less sever/fewer s/e
less drug/drug interactions
Avoid use with MAO inhibitors
MOA of venlafaxine (Effexor)
Blocks neuronal activity of serotonin and norepinephrine
Adverse effects of venlafaxine
nausea, headache, anorexia, insomnia, somnolence, sexual dysfunction, withdrawal syndrome, sweating, blurred vision, increased LFTs (duloxetine)
Tricyclic Antidepressants
amitryptaline (Elavil)
MOA of amitryptaline (Elavil)
Block reuptake of 2 monoamine transmitters, norepinephrine & serotonin (intensify the effect), making more available in the synapse
Adverse effects of amitryptaline (Elavil)
sedation
orthostatic hypotension
anticholinergic effects
sexual dysfunction
cardiac toxicity
Monoamine Oxidase Inhibitors (MAOI)
phenelzine (Nardil)
MOA of phenelzine (Nardil)
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
adverse effects of phenelzine (Nardil)
food/drug interactions
CNS stimulation
orthostatic hypotension
rapid increase in BP, stroke, coma
drug interactions!
Atypical Antidepressants
buproprioin (Wellbutrin)
MAO of buproprion (Wellbutrin)
is unclear
side effects of buproprion
seizure, agitation, headache, dry mouth, constipation, weight loss, GI upset, dizziness, tremor
ketamine
low/dose intranasal administration that can be used to treat extreme pain
can rapidly help with suicidality and other serious symptoms of depression
Adverse effects of ketamine
perceptual disturbances dissociation
MOA of trazadone (Oleptro)
second-line agent
blockade of 5-HT reuptake
Benzodiazepines
alprazolam (Xanax)
diazepam (valium)
lorazepam (Ativan)
MOA of
alprazolam (Xanax)
diazepam (valium)
lorazepam (Ativan)
Enhance inhibitory effects of GABA in the CNS
Adverse effects of
alprazolam (Xanax)
diazepam (valium)
lorazepam (Ativan)
CNS depression (decreased LOC)
w/d effects
memory loss
respiratory depression
benzo nursing considerations & antidote
Teratogenic- avoid while pregnant
do not mix w other medications
avoid grapefruit or fatty foods
Antidote: flumazenil (Romazicon)
