- move slow - sit/lie down if feeling lightheaded - avoid dehydration - HOLD if significant decr in BP or incr in HR

- usually diminishes over time - take at bedtime - avoid hazardous activities like driving

- self observe wt weekly - good nutrition + exercise to decr risk

- incr antichol effect - incr sedative effect

- fluoxetine - citalopram - escitalopram - paroxetine - sertraline -ine + pram

- depression - OCD - bulimnia - PMS - panic.anxiety - PTSD - bipolar

- sex dysfunction - CNS stimulation [insomnia, agitation, anxiety] - wt change - serotonin syndrome - withdrawal syndrome - hypo-natremia - rash - sleepy, faint, lightheaded, - GI bleed - bruxism

22 Medications for depressive disorder Flashcards by jessica quintos

5 main groups of antidepressant meds

1 tricyclic antidepressants [TCA]
2 selective serotonin reuptake inhibitors [SSRI]
3 serotonin norepinephrine reuptake inhibitors [SNRI]
4 monoamine oxidase inhibitors [MAOIs]
5 atypical antidepressants

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tricyclic antidepressants [TCA]

drug names

amitriptyline
imipramine
doxepin
nortriptyline
amoxapine
trimipramine
desipramine

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tricyclic antidepressants [TCA]

expected pharmacological action

block reuptake of norepinephrine + serotonin in synaptic space
»>intensifies effects of neurotransmitters

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tricyclic antidepressants [TCA]

onset

10-14 or more days before TCA begins to work

-max effects may take 4-8 weeks

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tricyclic antidepressants [TCA]

indication

-depression

OTHERS: neuropathic pain, fibromyalgia, anxiety, insomnia, bipolar, OCD, ADHD

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tricyclic antidepressants [TCA]

A/E

orthostatic hypotension
anticholinergic effects
sedation
toxicity
decr seizure threshold
excess sweating
incr appetite
incr risk of suicide

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orthopnea

teaching

move slow
sit/lie down if feeling lightheaded
avoid dehydration
HOLD if significant decr in BP or incr in HR

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anticholinergic effects

dry mouth
blurred vision
photophobia
urinary hesitancy/retention
constipation
tachycardia

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anticholinergic effects

client teaching

sugarless gum
sip water
sunglasses when out
high fiber
regular exercise (peristalsis)
incr fluid 2-3L
void before admin of med

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sedation

teaching

usually diminishes over time
take at bedtime
avoid hazardous activities like driving

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tricyclic antidepressants [TCA]

signs of toxicity

results in cholinergic blockade + cardiac toxicity

dysrhythmia
mental confusion
agitation
followed by seizure, coma, death

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tricyclic antidepressants [TCA]

how to prevent toxicity

no more than 1 wk supply at a a time
**obtain baseline ECG + cardiac workup
monitor VS frequently
monitor/notify for signs of toxicity

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excessive sweating

frequent linen changes

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incr appetite

self observe wt weekly

- good nutrition + exercise to decr risk

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tricyclic antidepressants [TCA]

*seizure disorders
caution:
**older w cardiac disease
-coronary artery disease
-diabetes
-liver/kidney disorder
-resp disorder
-urinary retention/obstruction
-angle-closure glaucoma
-benign prostatic hypertrophy
-hyper-thyroid

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TCA + MAOIs

can cause severe HTN

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TCA + antihistamine

incr antichol effect

- incr sedative effect

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TCA + direct vs indirect acting sympathomimetics

D:incr effects of meds bc both block the reuptake
ID:decr effect

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TCA should not be used w other CNS depressants such as…

benzo
ETOH
opioid
antihistamine

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SSRI

drug names

fluoxetine
citalopram
escitalopram
paroxetine
sertraline

-ine + pram

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SSRI

pharmacological action

selectively block reuptake of monoamine neurotransmitter SEROTONIN in synaptic space
-intensifies effects of serotonin

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first line of tx for depression

SSRI

low lethality in case of suicide attempt
low A/E
good for dprssn w anxiety or psychomotor agitation

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SSRI

indication

depression
OCD
bulimnia
PMS
panic.anxiety
PTSD
bipolar

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SSRI

A/E

Study These Flashcards

sex dysfunction
CNS stimulation [insomnia, agitation, anxiety]
wt change
serotonin syndrome
withdrawal syndrome
hypo-natremia
rash
sleepy, faint, lightheaded,
GI bleed
bruxism

if sexual dysfunctions (anorgasmia, impotence, decr libido) become intolerable...

- lower dosage - medication holiday - adjunct med - change med (bupropion)

CNS stimulation (insomnia, agitation, anxiety)

- relaxation techniques - dosage reduction - take in AM - avoid caffeine

serotonin syndrome onset

2-72 hr after start of tx | -LETHAL

serotonin syndrome | manifestations

- mental confusion, difficult concentrt, - sialorrhea (drool) - ab pain - diarrhea - agitation - fever - hallucination - hyperreflexia, incoordination - diaphoresis - tremor

serotonin syndrome | nursing action

start symptomatic tx: - CYPROHEPTADINE - med that blocks serotonin inhibitor - muscle rigidity - cooling blankets - anticonvulsant - artificial ventilation - withhold med! notify provider!

hyponatremia is more likely to occur with SSRI when... + nursing actions

older adult taking diuretics | -obtain baseline sodium + monitor periodically

a rash with SSRI is treatable w...

antihistamine or discontinuation of SSRI

bruxism

is a condition in which you grind, gnash or clench your teeth

bruxism | teaching

- report to provider - use mouth guard - add low dose of buspirone - take in AM to avoid sleep disturbnc - dont take w food

pregnancy risk + SSRI

- fluox/paroxetine incr risk of birth defect | - late inpregnancy, can cause pulmo HTN + withdrawal in bb

meds to avoid with SSRI bc incr risk of serotonin syndrome

MAOI (discont 14 days prior) TCA St Johns wORT -if starting MAOI, discont SSRI 5 wks prior

SSRI + warfarin + NSAID + anticoag

incr warfarin level - monitor PT + INR - assess for bleeding

SSRI + TCA + lithium

can incr level of meds

SNRI | drug name

- venlaxafine - duloxefine - desvenlaxafine

SNRI [venlaxafine, duloxefine, desvenlaxafine, levomilnacipran] pharm action

incr amt of neurotransmitters available in brain | -little effect on other neurotransmitters/receptors

SNRI [venlaxafine, duloxefine, desvenlaxafine, levomilnacipran] A/E

- headache - nausea - agitation - anxiety - dry mouth - sleep disturbance - hypo-natremia - wt loss - incr BP - sex

SNRI [venlaxafine, duloxefine, desvenlaxafine, levomilnacipran] teaching

- avoid ETOH | - gradual discontinuation

SNRI [venlaxafine, duloxefine, desvenlaxafine, levomilnacipran] CI

- hepatic disease | - ETOH addiction

TCA should be careful w... and obtain a... before admin

older pt or w hx of cardiac issues | -obtain cardiac workup beforehand

MAOIs | drug names

- phenelzine - isocarboxazid - selegiline (patch) - tranylcypromine

MAOI | pharm action

- black MAO in brain | - incr the amt of norepinephrine, dopamine, + serotonin available

MAOI are first line tx for...

MDD w atypical features aka atypical depression | -mood lifted/brightened in response to positive events or good news

MAOI | A/E

- CNS stim - orthostatic hypotension - hypertensive crisis - rash assoc w selegiline patch

hypertensive crisis

severe HTN fr intense vasoconstriction + stim of heart | -usually fr intake of dietary tyramine

hypertensive crisis | manifestation

- headache - N/V - incr HR - incr BP - diaphoresis - change in LOC

if hypertensive crisis is happening...

admin phentolamine IVE or nifedipine - ---rapid acting, a-adrenergic blocker - continuous cardiac monitoring - resp support

atypical antidepressant | drug name

bupropion trazodone mirtazapine

atypical/bupropion | pharm action

inhibits DOPAMINE reuptake

atypical/bupropion | indications

- alternative to SSRI bc no sex dysfunction - smoking cessation - seasonal dprssn

atypical/bupropion | A/E

- headache - dry mouth - GI distress - constipation - incr HR - nausea - restlessness - insomnia - suppress appetite - seizures in high dosage

atypical/bupropion | CI

- seiuzure disorder - MAOI - eating disorder

trazodone | a/e

priaprism | -prolonged erections that continue hours past sexual stimulation

mirtazapine

SNRI + atypical antidepressant | -stim appetite

antidepressants that can cause serotonin syndrome

- MAOI - SSRI - Lithium - TCA

22 Medications for depressive disorder Flashcards

(58 cards)