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Psych > WK2 - depressive medications > Flashcards

WK2 - depressive medications Flashcards

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1
Q

when can patients see improvement with antidepressants

A

not until 4-6 weeks

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2
Q

what improves first with antidepressants…..physiological or psychological symptoms

A

physiological

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3
Q

what should a patient look for in improvement of antidepressants

A

improved sleep, less daytime fatigue and crying, and increased frustration tolerance

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4
Q

what happens if meds are discontinued when patient feels better

A

relapse may occur. meds usually needed for 6-9 months past symptom relief up to 12-24 months

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5
Q

T/F antidepressants are not addictive

A

True

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6
Q

abrupt stopping of meds will result in

A

withdrawal- nausea, anxiety, insomnia, flu-like symptoms

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7
Q

T/F You should not drink alcohol on antidepressants

A

True

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8
Q

First line therapy for antidepressants

A

SSRIs

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9
Q

adverse reactions in tricyclic antidepressants

A

anticholinergic

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10
Q

effective for unconventional depression

A

MAOIs

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11
Q

possible side effects of SRIs

A 
Drowsiness
Nausea 
*Dry mouth
Insomnia
Diarrhea
Nervousness, agitation or restlessness
Dizziness
*Sexual problems
*Tension headache
*Blurred vision
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12
Q

SRI Nursing Implications

A

effectiveness takes 4-8 wks

side effects diminish in 4-6 wks

Report suicidal ideation, extreme agitation, fever, increased blood pressure, manic symptoms

Sleep hygiene
Avoid caffeine if anxious
Teach relaxation techniques

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13
Q

abrupt discontinue of SRIs may cause

A

electrical surges’; ‘brain shivers’ in the head or body; ‘pins and needles’ feelings on skin; blackouts; short-term memory loss; feeling like on the verge of unconsciousness.

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14
Q

Symptoms of Serotonin Syndrome

A

Mental status changes: Agitation, confusion, restlessness, lethargy, delirium, irritability, dizziness, hallucinations

ANS: Diaphoresis, flushing, fever, tachycardia, mydriasis
Neuromuscular: Myoclonus (muscle twitching or jerks), hyperreflexia, tremors

GI: N/V/D

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15
Q

serotonergic med not discontinued may progress to

A

Worsening myoclonus, hypertension, rigor, acidosis, respiratory failure, rhabdomyolysis

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16
Q

60% of patients that get serotonin syndrome develop

A

within 6 hrs of either 1st dose of new med, change of dosin, or intentional overdose….can be fatal

17
Q

how to treat serotonin syndrome

A

Stop or reduce medications contributing to SS depending on severity of symptoms as directed by the prescriber.

Benzodiazepines such as diazepam or lorazepam can help control agitation, seizures and muscle stiffness.

Oxygen: maintain normal oxygen levels

Intravenous (IV) fluids: to treat dehydration and fever

Provide symptomatic and supportive care

Symptoms usually resolve within 24 hours but can take several weeks to go away completely

18
Q

Drugs to control heart rate and blood pressure such as:

A

For tachycardia or hypertension:
esmolol (Brevibloc)
nitroprusside (Nitropress)

For hypotension:
Phenylephrine (Neo-Synephrine)
epinephrine

19
Q

what to give if SS Tx are not working

A

Serotonin-production blocking agents. medications such as cyproheptadine HCL (Periactin) can help by blocking serotonin production.
Dosing: Comes in 4mg tablets; weight-based dosing; 2yrs. – adult

20
Q

TCA have increased danger of what

A

death by overdose than SRIs

Increased & potentially fatal CNS depression with ETOH, other CNS antidepressants

21
Q

what should we check before initiating TCA

A

check ECG for cardiac d/o

Check for hx of seizure d/o (seizures are rare)

22
Q

Initial early treatment symptoms of TCA may include

A

early morning awakening, feeling worse in am, some worry and anxiety.

23
Q

TCA Nursing interventions

A

Dry mouth: sugar-free hard candy/gum

GI upset: take med with food
Diarrhea: eat frequent small meals

Constipation: increase fiber/fluids in diet/exercise

Insomnia: Sleep hygiene/change dosing time of med; if causes insomnia take in am

Orthostasis: keep hydrated; get up slowly

Sexual side effects: erectile dysfunction medications

Urinary hesitancy: run water while trying to void; check amount voiding

24
Q

Action of MAOIs

A

blocks enzyme Monoamine oxidase which is used to metabolize the monoamines SE, NE and Dopamine

25
Q

Common MAOI S/E

A 
Dry mouth
Nausea
Diarrhea or constipation
Headache
Drowsiness
Insomnia
Dizziness or lightheadedness
Skin reaction at patch site
26
Q

What should patient avoid when taking MAOIs

A

tyramine rich foods to prevent hypertension crisis

27
Q

symptoms of hypertension crisis

A 
Occipital headache
Palpitations
Nausea
Vomiting
Hypertension but 
   Orthostatic hypotension
     possible
Dyspnea/SOA
Mental status changes
Blurred vision
Sweating
Neck stiffness or soreness
Dilated pupils
Photophobia
Tachycardia OR bradycardia
Chest pain
Disturbed cardiac rate/rhythm
28
Q

treatment of hypertensive crisis

A

Regitine (phentolamine) an alpha andrenergic blocker; vasodilator

Procardia (Sublingual nifedipine) a calcium channel blocker; relaxes cardiac muscle

29
Q

facts on bupropion

A

Contraindicated in eating d/o and hx of seizures

Less sexual side effects

Considered “energizing”

Used in smoking cessation (Zyban)

30
Q

trazodone is often given at

A

bedtime for sedation wtih another AD

31
Q

mirtazpine is good for….

A

sleep

32
Q

SSRIs side effects

A

low S/E possible mild nausea, H/A, stomach ache

33
Q

Improvement with SSRIs may be seen in

A

1-2 weeks

34
Q

when can you see full effect of SSRIs

A

12 weeks

35
Q

TCA’s are potentially lethal in

A

ODs and dysrhythmias

36
Q

other treatments for depression

A

phototherapy

electroconvulsive ECT

Vagal nerve stimulation

deep brain stimulation

transcranial magnetic stimulation

acupuncture or message therapy

st john’s wart, SAMe, omega 3 fatty acids

Exercise

Decrease caffeine and alcohol

Relaxation techniques (meditation, guided imagery, massage)

Psych (12 decks)

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