antidepressants and mood stabilizers

Question 1

what herbs increase serotonin levels

Answer 1

ginkgo bilboa and St.Johns wart, Feverfew

Question 2

what is the MOA for SSRIs

Answer 2

block the uptake of neurotransmitter serotonin which increase level of usable serotonin

Question 3

when should you use SSRIs

Answer 3

major depression
anxiety disorders
prevention of migraine HA
decrease premenstural tension syndrome
eating disorders
substance use disorder

Question 4

what drug is an SSRI

Answer 4

FLuoxetine

Question 5

What are some advantages to taking fluoxetine

Answer 5

less sedation
less hypotension
less anticholinergic efffects
less cardiotoxiciity

Question 6

what are some side effects of SSRI

Answer 6

HA ,nervousness
blurred vision, insomnia
dry mouth, GI upset
sexual dysfunction
the side effects decrease over 1-4 weeks

Question 7

what are some adverse reactions to SSRI

Answer 7

SI
Seizures
hypoglycemia
osteoporosis

Question 8

when should you not admin fluoxetine

Answer 8

if allergic
if using MAOI
hypotension

Question 9

use caution when giving SSRI to….

Answer 9

breastfeeding
current SI
liver/kidney disease
glaucoma

Question 10

what does SSRI interact with

Answer 10

alcohol
other CNS depressants
Grapefruit juice

Question 11

what is the MOA of SNRI

Answer 11

inhibit the reuptake of serotonin and norepinephrine

Question 12

what drug is an SNRI

Answer 12

duloxetine

Question 13

when should SNRI be used

Answer 13

major depression
general anxiety disorder
social anxiety

Question 14

what are some side effects of duloxetine

Answer 14

drowsy, dizzy, insomnia, HA
photosensitivity
ejaculation dysfunction

Question 15

what are some adverse reactions of SNRI

Answer 15

nephrotoxic
tachycardia, HTN
ortho hypotension
SI, seizures
Steven johnson syndrome

Question 16

what does SNRI interact with

Answer 16

St. johns wart
other CNS depressants
alcohol
MAOI

Question 16

what are the contraindications for duloxetine

Answer 16

pregnancy, breastfeeding
anticoagulant therapy- increase risk for bleeding
current SI
using MAOIs

Question 17

what is the MOA of tricyclic antidepressants

Answer 17

blocks the uptake of neurotransmitters norepinephrine and serotonin in brain
blocks the histamine receptors causing sedation

Question 18

when does the onset of tricyclic antidepression occur

Answer 18

1-3 weeks

Question 19

what are some side effects of tricyclic antidepressants

Answer 19

CNS disturbances- dizzy, sedation
dry mouth and eyes
urinary retention, sexual dysfunction
weight gain

Question 20

what drug is an tricyclic antidepressant

Answer 20

amitriptyline

Question 21

what is amitriptyline used for

Answer 21

major depression

Question 22

what are some adverse reactions for amitriptyline

Answer 22

SI
cardiotoxicity
EPS, NMS, ortho hypotension

Question 23

what does tricyclic antidepressant interact with

Answer 23

alcohol and other CNS depressants

Question 24

what are contraindications for amitriptyline

Answer 24

CV disease HTN usiing MAOIs

Question 25

what drug is a misc. antidepressant

Answer 25

trazodone

Question 26

what is the classification of trazodone

Answer 26

serotonin modulator

Question 27

what is the MOA of misc. antidepressant and what is the protien binding

Answer 27

inhibits reuptake of serotonin highly protein bound

Question 28

what is the peak action of the misc. antidepressant

Answer 28

2-4 weeks

Question 29

what is trazodone used for

Answer 29

major depression

Question 30

what are some side effects of trazodone

Answer 30

dizzy dry mouth erectile dysfunction N and V blurry vision

Question 31

what are some adverse reactions to trazodone

Answer 31

SI hypotension arrythmias QT prolongation serotinin syndrome

Question 32

what does misc. antidepressants interact with

Answer 32

CNS depressants SSRI and SNRI digoxin phenytoin antifungal/antivirals NSAIDS antihypertensives St john wart, kava kava, valerian

Question 33

what should you asses when giving antidepressants

Answer 33

check baseline VS and weight for compairson get hx of depression episodes check mental status and for SI check meds for antidepressants and other phychotropics liver and renal function allergies

Question 34

what are some nursing interventions for antidepressatns

Answer 34

check pt mood for drug effectiveness and decreased depression SI VS- for ortho hypo monitor for drug-drug and food interactions tell client not to use alcohol or other CNS depressant when taking drug monitor for side effects/adverse reaction

Question 35

what should you teach the pt when taking antidepressants

Answer 35

take as perscribed do not stop abruptly change positions slowly take at bedtime therapeutic effect can take 1-2 weeks tell pt what herbs it interacts with the S/S of serotonin syndrome do not drive fluoxetine can be used weekly for maintenance avoid alcohol and CNS depressants bc they add to the effect

Question 36

what drug is a mood stabilizer

Answer 36

lithium

Question 37

what is the MOA of lithium

Answer 37

alteration of ion transport in muscle and nerve cells increases receptor sensitivity to serotonin

Question 38

what kind of protein binding is lithium

Answer 38

weak protein binding

Question 39

what is the half life of lithium

Answer 39

18-36 hr

Question 40

what is lithium used for

Answer 40

bipolar disorder-manic episodes.

Question 41

what is the theraputic range of lithium

Answer 41

1-1.5 anything >1.5 may cause toxicitiy

Question 42

what does lithium deplete

Answer 42

sodium

Question 43

what are some side effects of lithium

Answer 43

drowsy, dizzy, memory impairment, HA dry mouth, metallic taste, GI upset edema of hands and ankles, dehydration increased urination

Question 44

what are the adverse reactions to lithium

Answer 44

hyponatremia hypotension dysrhythmias nephrotoxicity leukocytosis

Question 45

what does lithium interact with

Answer 45

increase levels -NSAIDS -haloperidol increase r/f serotonin synd -SSRI -SNRI can cause neurotoxicity -St, johns wart -ephedra -Ginseng -Kava Kava -valerian

Question 46

what are the contraidications of lithium

Answer 46

liver and renal disease pregnancy hyponatremia dehydration cardiac disease

Question 47

what should we asses when giving mood stabilizers

Answer 47

check for SI get baseline VS get health and drug HX -diuretics, tetracyclines. NSAIDS decrease renal Clarence and cause accumulation check neuro and cardiac status check the lithium levels and sodium levels medical and meds hx

Question 48

how should a pt take lithium

Answer 48

with meals to avoid GI upset

Question 49

how is fluoxetine given

Answer 49

PO

Question 50

what is the half life of fluoxetine when is the onset when is the peak

Answer 50

4-6 days 3-4 wk initially 6-8hr

Question 50

what labs should uou asses and what when giving antidepressants

Answer 50

kidney and liver function UO BUN creat hepatic enzyme levels (ALT, AST)

Question 51

what are some S/S of Neuroleptic malignant syndrome(NMS)`

Answer 51

hyperpyrexia muscle rigidity tachycardia cardiac dysrhythmias

Question 52

what conditions should TCAs be avoid

Answer 52

cardiovascular disease hypertension

Question 53

what is the therapeutic effect of antidepressants

Answer 53

pt depression is controlled or gone

Question 54

what is the therapeutic range for lithium

Answer 54

0.5-1.2

Question 55

what food contain tyramine

Answer 55

cheese red wine beer liver bananas yougurt sausage

Question 56

what should people taking MAOIs avoid and why

Answer 56

tyramine food because it causes hypertensive crisis

Question 57

what is the half life of amitriptyline

Answer 57

10-50hr

Question 58

what is the theraputic range for amitriptyline

Answer 58

120-150ng/mL

Question 59

what should be assessed and what labs when giving lithium

Answer 59

hepatic and renal function UO BUN Creat liver enzymes

Question 60

what should you teach a pt who is taking lithium

Answer 60

matain good fluid intake take with meal to avoid gi upset avoid caffeine- can decrease lithium levels matian adequate sodium levels

Question 61

what are some early and late signs of lithium toxicity

Answer 61

early -NVD -drowsy -loss of app. -slurred speech -trembling late -blurry vision -confusion -increased urination -convulsions

Question 62

what is the therapeutic response to lithium

Answer 62

patient decreased or free from bipolar behavior

Question 63

what is the half life of trazodone

Answer 63

10hr