Pharmacologic Management- Mood Disorders

Question 1

What do cyclic antidepressants do?

Answer 1

Elevate the mood.

Question 2

What is the chemical structure of cyclic antidepressants?

Answer 2

3 adjacent rings.

Question 3

What are cyclic antidepressants associated with (problem wise)?

Answer 3

Liver damage and failure.

Question 4

What is the mechanism of action for cyclic antidepressants?

Answer 4

They partially block the reuptake of norepinephrine and serotonin at the synapse- results in more neurotransmitter in the synapse.

Question 5

What happens when there are more neurotransmitters in the synapses (with cyclic antidepressants)?

Answer 5

The symptoms alleviate and they are reabsorbed for reuse.

Question 6

What is the response to cyclics?

Answer 6

Gradual, risk for non-compliance, experiences many side effects before feeling better.

Question 7

How long may it take for cyclics to start working?

Answer 7

Several weeks to a month.

Question 8

What is the response to cyclics in the first 1-3 weeks?

Answer 8

Psychomotor retardation is decreased, increased activity, return of sex drive, self care improved, concentration and memory are increased.

Question 9

What is the response to cyclics from weeks 2-4?

Answer 9

Depressed mood is relieved, less hopeless, less suicidal thoughts.

Question 10

What is the biggest risk for depressed patients during week 2 of cyclic therapy and why?

Answer 10

Suicide- patient has more energy, thoughts are clearer, and they still may have thoughts so they are more likely to do it.

Question 11

What are some types of cyclic antidepressants?

Answer 11

Elavil, Anafranil, Norpramin, Tofranil, Aventyl

Question 12

Which cyclic is used for sleep disorders as well?

Answer 12

Elavil

Question 13

What cyclic is used for OCD?

Answer 13

Anafranil

Question 14

What cyclic can be used for urinary problems?

Answer 14

Norpramin

Question 15

Which cyclic should be used for elders because of its half life?

Answer 15

Desyrl

Question 16

What are some considerations for cyclic drug therapy?

Answer 16

Cardiotoxic- need regular EKGs, need to assess for suicide thoughts, can be fatal, psychotic pts need an antipsychotic as well, higher doses may cause manic symptoms.

Question 17

What should the patient be educated on for cyclic drug therapy?

Answer 17

Understands the effect is delayed, side effects decrease over time, cause anticholinergic effects.

Question 18

What are some anticholinergic effects from cyclics?

Answer 18

Cant see, cant pee, cant sit, cant shit (or spit).

Dry mouth, blurry vision, urinary retention, constipation, delirium

Question 19

What do you need to observe elders for during cyclic therapy?

Answer 19

Decreased bowel sounds because of chance for paralytic ileus.

Question 20

Why should you not suddenly stop cyclics?

Answer 20

cholinergic rebound- increased secretions.

Question 21

What are Monoamine Oxidase Inhibitors used for?

Answer 21

Used to manage atypical depression or drug resistant depression.

Question 22

How long to MAO inhibitors take to start working?

Answer 22

3-6 weeks.

Question 23

What is the mechanism of MAO Inhibitors?

Answer 23

It blocks the action of norepinephrine, serotonin, and dopamin, which causes an increased availability of neurotransmitters.

Question 24

What are contraindications for MAO inhibitor use?

Answer 24

Parkinsons (already low on dopamine), bipolar (may induce mania), Schizo, diabetes, pregnancy.

Question 25

What are side effects of MAO inhibitors?

Answer 25

Ortho hypotension, edema, sexual dysfunction, weight gain, insomnia, intoxication signs=too high of a dose

Question 26

What is some nursing management for patients on MAO inhibitors?

Answer 26

Check BP, Rise slowly, maintain fluid intake, tyramine restricted diet, educate on drug interactions.

Question 27

Why do patients on MAO inhibitors have to by on a tyramine restricted diet?

Answer 27

Tyramine is used to produce epinephrine and consuming too much tyramine can cause fatal hypertension.

Question 28

What are symptoms of fatal hypertension?

Answer 28

Stiff neck, nausea, vomitting, diaphoresis.

Question 29

What are some drug interactions that cause hypotension with MAO inhibitors?

Answer 29

Beta agonist inhalers, theophylline (asthma drugs), aldomet, decongestants, yohimbe, SSRIs

Question 30

What do selective serotonin reuptake inhibitors (SSRI) do?

Answer 30

Block the reuptake of serotonin; act quickly, minimal side effects, not cardiotoxic, not fatal in overdose.

Question 31

What are some types of SSRIs

Answer 31

Celexa, Lexapro, Luvox, PRozac, Pristique, Paxil, Zoloft, Cymbalta

Question 32

What are side effects of SSRIs?

Answer 32

Suicidal tendencies because the patient may feel like they are relapsing to their old self.

Question 33

What is Bupropion (Wellbutrin)?

Answer 33

Blocks reuptake of seotonin and norepinephrine- take precaution with seizures.

Question 34

What is Venlafaxine (Effexor)?

Answer 34

Blocks reuptake- causes a lot of weight gain.