Unit 26 Medications for Mood Disorders Flashcards
What receptors do antidepressants effect?
Serotonin and Norepinephrine
What are the Antidepressant categories?
Selective Serotonin Reuptake Inhibitors (SSRI’s)
Selective Serotonin-Norepinephrine Reuptake Inhibitors (SSNRI’s)
Heterocyclic Antidepressants (trcyclics-TCA’s)
Monamine Oxidase Inhibitors (MAOI’s)
MISC
How long could antidepressants take to work?
up to 6-8 weeks
could not work right away
During the “first break” treatment how long should the patient be on the antidepressants for?
6-12 months
What are adverse effects common to most antidepressants?
Anticholinergic effects (dry mouth, blurry vision, constipation, drowsiness, difficulty urinating)
- Weight gain
- Sexual side effects
(Withdraw effects may occur)
What is the black box warning for antidepressants?
-Watch for personality changes leading to suicide
(PT will physically feel better but mind needs to catch up)
-Greater risk for suicide because they begin to have more energy
Name and describe Selective Serotonin Reuptake Inhibitors. What Rx has a specific washout period?
fluoxetine (Prozac) *washout period
paroxetine (Paxil)
sertraline (Zoloft)
citalopram (Celexa)
First line therapy for depression
Useful for anxiety, eating disorders, OCD
Side effects: Insomnia/somnolence (sleepiness)
Anxiety, agitation, restlessness, nausea
Watch out for SSRI discontinuation because of serotonin syndrome!
What is Serotonin Syndrome?
Potentially life threatening serotonin overdose to anything that increases serotonin.
Other meds that contribute are:
MAOI’s, St. John’s Wort, and Lithium.
No lab test, just supportive treatment.
What are Serotonin Syndrome symptoms? (think the clinical triad)
Cognitive symptoms: Mental confusion, hypomania, hallucinations, agitation, headache, coma, vivd dreams
Autonomic: Shivering, sweating, fever, hypertension, tachycardia, nausea, diarrhea (flu-like symptoms)
Somatic: myoclonus/clonus (muscle twitching), hyperreflexia, tremor.
Name and describe Selective Serotonin/Norepinephrine Reuptake Inhibitors (SSNRI’s).
venlafaxine (Effexor)
may increase BP
duloxetine (Cymbalta)
Can also treat fibromyalgia
Side effects/less effects:
Less weight gain
Less sexual dysfunction
Better at treating anxiety
Name and describe Heterocyclics/TCA’s.
amitriptyline (Elavil)
clomipramine (Anafranil)
imipramine (Tofranil)
- oldest class
- 70% effective
- Also inhibits NE and 5-HT2 reuptake
- Start low, go slow
- 4-8 weeks for full effect
- also for chronic pain
- OVERDOSE DANGEROUS so usually only given 1 week prescriptions
Side effects/Adverse reactions: *
- *Anticholinergic effects such as dry mouth, blurred vision, constipation, difficulty urinating)
- Photosensitivity
- Decreased seizure threshold
Name and describe Monamine Oxidase Inhibitors (MAOI’s).
- phenelzine (Nardil)
- isocarboxazid (Marplan)
- tranylcyromine (Parnate)
- Has many Rx and food interactions (such as *Tyramine)
- Inhibits monamine oxidase enzyme that breaks down NE and 5-HT2
- Assume the drug is not safe with anything Rx or OTC unless you have other info!
- Give adequate washout time of 10 days prior to OR Sx or other meds
Side effects: Orthostatic hypotension Edema Constipation Hypomania Insomnia
What is Tyramine and what foods contain it?
- Natural product of bacterial fermentation that displaces NE from storage vessels which increases BP.
- MUST BE AVOIDED WHEN TAKING MAOI’s
Found in: Anything aged Wine Cheese Pepperoni Beer Processed foods
Regarding antidepressant medications, when could a hypertensive crisis happen?
A hypertensive crisis will happen if you mix MAOI’s with Tyramine.
S/S are same as those of severe HTN: Headache Nosebleeds Tachycardia N/V Diaphoresis Chest pain/come/stroke
What medications are also now used as adjunct medication with antidepressants?
Atypical antipsychotics medications
“pine, oles, ones”
What are the four categories for Mood Stabilizing drugs?
- LITHIUM
- Anticonvulsants
- Antipsychotics
- Benzodiazepines
Describe Lithium.
- 1st line for Bipolar
- Affects dopamine, NE, 5-HT2, acetylcholine, GABA
- Takes 7-10 to control hyperactivity so meanwhile give an antipsychotic
- Affected by sodium/fluid balance
- Has narrow therapeutic index
- NOT metabolized by liver, goes straight to kidney
- 90% effective in pure mania
What are the Indications/contraindications for Lithium?
Indicated/effective for:
- Elation
- Flight of ideas
- Irritability
- Anxiety
- Insomnia
- Psychomotor agitation
- Attention deficit/ distractibility
Contraindications:
- Renal/thyroid/heart disease
- Pregnancy
- Diuretics
- Many OTC meds
What is essential in Lithium monitoring?
- Draw blood 12 hrs after dose
- 3 times a week
- Gradually decreasing
- Every 6 months for duration of treatment
- Include renal/thyroid tests
What is the therapeutic Lithium level and the expected side effects?
0.5-1.2 mEq/L is the therapeutic level (if out of range = toxic)
Expected side effects:
- Initial GI upset (TAKE WITH MEALS)
- Fine tremor
- MILD polyuria
- Increased WBC
- Weight gain
What is the mild Lithium toxicity level and the side effects?
Mild toxicity level is approximately 1.5
Side effects:
- Lethargy, decreased concentration
- Weakness, slight ataxia (gait abnormality)
- Coarse hand tremors
- Return of GI upset
What is moderate Lithium toxicity and the side effects?
1.5-2.5
Side effects:
- Severe diarrhea
- N/V
- Moderate ataxia, weakness
- Lethargy, slurred speech
- Irregular tremor
- Blurred vision
What is the severe Lithium toxicity level and the side effects?
> 2.5
Side effects:
- Nystagmus (rapid eye movement)
- Dysarthria (not able to form words)
- Hyperreflexia
- Hallucinations
- Oliguria (sign of renal failure)
- Confusion/seizures/come/death
If the nurse sees Lithium toxicity symptoms, what should be done?
Hold/stop Rx, get level, follow orders
