Pharmacologic Management- Mood Disorders Flashcards
What do cyclic antidepressants do?
Elevate the mood.
What is the chemical structure of cyclic antidepressants?
3 adjacent rings.
What are cyclic antidepressants associated with (problem wise)?
Liver damage and failure.
What is the mechanism of action for cyclic antidepressants?
They partially block the reuptake of norepinephrine and serotonin at the synapse- results in more neurotransmitter in the synapse.
What happens when there are more neurotransmitters in the synapses (with cyclic antidepressants)?
The symptoms alleviate and they are reabsorbed for reuse.
What is the response to cyclics?
Gradual, risk for non-compliance, experiences many side effects before feeling better.
How long may it take for cyclics to start working?
Several weeks to a month.
What is the response to cyclics in the first 1-3 weeks?
Psychomotor retardation is decreased, increased activity, return of sex drive, self care improved, concentration and memory are increased.
What is the response to cyclics from weeks 2-4?
Depressed mood is relieved, less hopeless, less suicidal thoughts.
What is the biggest risk for depressed patients during week 2 of cyclic therapy and why?
Suicide- patient has more energy, thoughts are clearer, and they still may have thoughts so they are more likely to do it.
What are some types of cyclic antidepressants?
Elavil, Anafranil, Norpramin, Tofranil, Aventyl
Which cyclic is used for sleep disorders as well?
Elavil
What cyclic is used for OCD?
Anafranil
What cyclic can be used for urinary problems?
Norpramin
Which cyclic should be used for elders because of its half life?
Desyrl
What are some considerations for cyclic drug therapy?
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.
What should the patient be educated on for cyclic drug therapy?
Understands the effect is delayed, side effects decrease over time, cause anticholinergic effects.
What are some anticholinergic effects from cyclics?
Cant see, cant pee, cant sit, cant shit (or spit).
Dry mouth, blurry vision, urinary retention, constipation, delirium
What do you need to observe elders for during cyclic therapy?
Decreased bowel sounds because of chance for paralytic ileus.
Why should you not suddenly stop cyclics?
cholinergic rebound- increased secretions.
What are Monoamine Oxidase Inhibitors used for?
Used to manage atypical depression or drug resistant depression.
How long to MAO inhibitors take to start working?
3-6 weeks.
What is the mechanism of MAO Inhibitors?
It blocks the action of norepinephrine, serotonin, and dopamin, which causes an increased availability of neurotransmitters.
What are contraindications for MAO inhibitor use?
Parkinsons (already low on dopamine), bipolar (may induce mania), Schizo, diabetes, pregnancy.
What are side effects of MAO inhibitors?
Ortho hypotension, edema, sexual dysfunction, weight gain, insomnia, intoxication signs=too high of a dose
What is some nursing management for patients on MAO inhibitors?
Check BP, Rise slowly, maintain fluid intake, tyramine restricted diet, educate on drug interactions.
Why do patients on MAO inhibitors have to by on a tyramine restricted diet?
Tyramine is used to produce epinephrine and consuming too much tyramine can cause fatal hypertension.
What are symptoms of fatal hypertension?
Stiff neck, nausea, vomitting, diaphoresis.
What are some drug interactions that cause hypotension with MAO inhibitors?
Beta agonist inhalers, theophylline (asthma drugs), aldomet, decongestants, yohimbe, SSRIs
What do selective serotonin reuptake inhibitors (SSRI) do?
Block the reuptake of serotonin; act quickly, minimal side effects, not cardiotoxic, not fatal in overdose.
What are some types of SSRIs
Celexa, Lexapro, Luvox, PRozac, Pristique, Paxil, Zoloft, Cymbalta
What are side effects of SSRIs?
Suicidal tendencies because the patient may feel like they are relapsing to their old self.
What is Bupropion (Wellbutrin)?
Blocks reuptake of seotonin and norepinephrine- take precaution with seizures.
What is Venlafaxine (Effexor)?
Blocks reuptake- causes a lot of weight gain.
