Antidepressive Flashcards by criselda catindig

Feverfew herb interfere with

SSRI antidepressant like fluoxetine Prozac

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St. John’s wort herb interfere with (x), causing s/s

SSRI antidepressant, causing serotonin syndrome (HA, dizziness, sweating, agitation)

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what herbs leads to palpitation, heart attack, and HTN crisis when taken with which type antidepressants?

Ginseng, ephedra, ma-huang, and St. John’s wort when taken with Monoamine Oxidase Inhibitors (MAOIs)

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why do pts use herbal remedies

pt want to self-treat

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is there a need for collaboration when taking herbal remedies?

yes, colloborate between herbalist, MD, accupuncturist to treat the anxiety (not the actual mood d/o)

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list 4 types of antidepressants?

monoamine oxidase inhibitors (MAOIs), tricyclic antidepressant (TCA), selective serotonin reuptake inhibitors (SSRI), non-selective serotonin reuptake inhibitor (NSRI)

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Action of monoaminie oxidase inhibitor (MAOI)

monoamine oxidase usually inactivate norepinephrine, dopamine, epinephrine, and serotonin. So you MAOIs block that, so neurotransmitters increase in level.

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Monoamine oxidase enzymes are found

in liver and brain

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what are types of monoamine oxidase enzymes?

MAO-A and MAO-B enzymes

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what is the difference between MAO-A and MAO-B enzymes?

MAO-A enzyme typically inactivate dopamine in brain. MAO-B enzyme typically inactivate norepinephrine and serotonin.

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are MAOI agents selective or nonselective to MAO-A or MAO-B

nope. The agent works on both enzymes

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when do you prescribe MAOI agents?

for Atypical Depression not responding to other treatment

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List 3 types of MAOIs

phenelzine sulfate Nardil, isocarboxazid Marplan, tranylcypromine sulfate Parnate

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what foods cause HTN crisis with MAOIs

Cheese (cheddar, swiss, bleu), bananas, raisins, pickled foods, red wine, beer, cream, yogurt, chocolate, coffee, italian green beans, liver, yeast, soy sauce, pickled herring, sausage, pepperoni

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what effect do contraindicated food have with MAOIs?

sweating, tremors, bounding HR, high BP, high temp.

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what sort of drugs caust HTN crisis with MAOIs?

CNS stimulants or sympathomimetics (vasoconstrictors and cold medication containing phenylephrine and pseudoephedrine); diet pills, meth, DEXTROMETHOPRHAN, other antidepressants, Meperidine demorol d/t dopamine

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What chemical in foods cause HTN crisis with MAOIs?

tyramine

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why do you avoid tyramine containing foods with MAOIs?

it has sympathomimetic-like effects that can cause HTN crisis

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S/E of MAOIs

CNS stimulation: agitation, restlessness, insomnia, orthostatic hypotension, and anticholinergic effects

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St. John’s wort herb does what?

decrease reuptake of neurotransmitters serotonin, norepinephrine, dopamine

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When do you stop taking herbal supplements?

1-2 weeks before surgery.

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how to eat tyramine containing foods with MAOIs?

if high, avoid. If moderate, eat occasionally. If low, eat in limited quantities.

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What do you do in a HTN crisis?

VS, cooling measure, ice pack/bath, bear hug

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What are collaborative invervention for HTN crisis?

IV fluids, benzodiazipine for muscle rigidity, short acting antiHTN meds

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TCA or Lithium should be decreased in what type of pt

Asian pt, and all antidepressant should be decreased for Hispanic pt.

if taking herbal remedies with antidepressant,

antidepressive dose may need to be modified or herb needs to be d/c'd

herbal remedies interact with antidepressants, especially

MAOIs and SSRI

tricyclic antidepressants (TCA) action

block reuptake of norepinephrine and serotonin; also block histamine receptors

S/E of TCA

anticholinergic effect, orthostatic hypotension (rise slowly), sedation, cardiac toxicity, seizures

See effect of TCA in

2-4 weeks

if TCA does not work

slowly w/d and prescribe another antidepressant

TCA treats

major depression, neuralgia, pruritic, bulemic, cataplectic, narcoleptic adjunct, enuretic, panic, ulcer, OCD

TCA should do this

elevate mood, increase interest in ADLs, decrease insomnia

TCA has a (x) action

sedative action

W/D s/s of TCA with stopped abruptly

n/v, anxiety, akathisia (inability to be still)

half life of TCA

up to 10-50 hrs; look for cumulative drug effect

A/E of TCA

cardiac toxicity/dysrhythmia. blood dyscrasias: leukopenia, thrombocytopenia, and agranulocytosis

anticholinergic effect s/s

tachycardia, urinary retention, constipation, dry mouth, and blurred vision.

allergic reaction to TCA s/s

skin rash, pruritus, petechiae, sexual dysfunction, impotence, amenorrhea

which TCA cause Extrapyramidal S/s

Amitriptyline Elavil

which TCA cause neuroleptic malignant syndrome

Clomipramine Anafranil

TCA (x) seizure threshold, so do what?

decrease seizure threshold. Adjust TCA dose.

TCA serum range should be

100-200 ng/mL

TCA interact with what drugs

ETOH, hypnotics, sedatives, barbituates potentiate CNS depression,

What happens when you take TCA amitriptyline with MAOIs?

cardiovascular instability and toxic psychosis.

TCA amitriptyline with antithyroid meds does what?

increase risk of dysrhythmia

What to do if pt has TCA toxicity

ABC (airway), GI decontamination (can't lavage), ECG abn tx with sodium bicarbonate drip (increase blood alk which slow Na influx when acidic to decrease dysrhythmia); control agitation/fever; controvertial admin of physostigmine (blocks acetylcholine)

what is polydrug therapy? Should you do this?

giving several antidepressants or antipsychotics together. Avoid doing this.

Mrs Teal said to learn which TCA

imipramine Tofranil

Imipramil tofranil treats

major depression

what kind of antidepressant is imipramil tofranil

TCA

Nursing Consideration with imipramil tofranil

take at HS to decrease danger from sedative effect. Take with food to decrease GI irritation. Avoid taking with ETOH or other CNS depressants.

Common s/e of imiprmine tofranil

drowsiness, dry mouth, hypotension, delayed micturition (delayed peeing when you want to pee).

therapeatuic range of imipramil tofranil

150-250 ng/mL

Imipramil tofranil max for elderly

150 mg/d

Imipramil tofranil max for adults

300 mg/d

anticholinergic mnemonic

dry as a bone (poor skin turgor; dry mucous membrane), blind as a bat (dilated), hot as a hare (high temp), red as a beet (flushed), mad as a hatter (confused/psychotic)

anticholinergic syndrome

inhibition of muscarinic cholinergic neurotransmission (acetocholine receptors blocked)

s/s of anticholingergic syndrome

sinus tachycardia, ileus, urinary retention, HTN, tremulousness, myoclonic jerking

what cause anticholinergic syndrome

anti: cholinergics, histamines, psychotics, spasmotics; cyclic antidepressants, mydraitics to dilate pupils, plants like datura

what kinds of plants cause anticholinergic syndrome?

datura, morning glory seeds, jimson weed, loco week , georgia o'keeffe

Selective serotonin reuptake inhibitor action

block reuptake of serotonin into the nerve terminal of CNS; so enhancing its transmission at serotonergic synapse

SSRI treats

major depressive d/o and anxiety d/o such as OCD, panic, phobias, PTSD; eating d/o, drug abuse, decrease premenstrual tension syndrome, preventing migraine HA, decrease aggressive behavior in boderline personality d/o.

SSRI are used more than (x) to treat depression

TCA

SSRI are (x) expensive than TCA

SSRI are less expensive than TCA

SSRI does not block

dopamine, norepinephrine, cholinergic and alpha1-adrenergic receptors.

List 3 SSRIs

Fluoxetine Prozac, fluvoxamine Luvox, sertraline zoloft

SSRI s/e to teach

sexual dysfunction (men will stop taking this d/t decrease sexual arousal; or women will become anorgasmic); these s/e cease over 2-4 weeks; there's also weight gain in some pts

ssri s/e

dry mouth, blurred vision, insomnia, HA, nervousness, anorexia, nausea, diarrhea, suicidal ideation, GI distress, restlessness.

who should not take SSRI

pt with suicidal ideation

which SSRI shoud OCD take

fluvoxamine luvox,

most prescribed SSRI

sertraline zoloft

FDA approved (x) dose of fluoxetine prozac

90 mg/wk

SSRI interact with which food? What happens?

grapefruit leads to toxicity

List an Atypical (heterocyclic) antidepressant?

bupropion Wellbutrin

You should not take MAOIs with (or p 14 days of)

atypicial (heterocyclic) antidepressants like bupropion Wellbutrin

Do not take atypical heterocyclic antidepressant bupropion Wellbutrin with (or p 14 days of)

MAOI

another name for atypical antidepressant?

heterocyclic antidepressant

cost of SSRI

Expensive!

SSRI has (x) of safety

wide margin; get GI pain, not die

SSRI does what in children

increase suicide rate in children

SSRI fluoxetine prozac therapeautic range

90-300 ng/mL

SSRI a/e

seizures, hyponatremia, palpitations, chest pain

SSRI fluoxetine prozac + ETOH does this

more CNS/respiratory depression, hypotension

SSRI starts to work in

1-2 weeks; at 2 weeks, pt may commit suicide.