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Flashcards in Ch. 28 - Antidepressants Deck (29)
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1

Depression:

Mood disorder:
1.) Depressed mood, despair, insomnia
2.) Loss of interest in normal activities
3.) Fatigue
4.) Decreased ability to think
5.) Suicidal thoughts

2

Major Antidepressants Agents:

1.) Tricyclic antidepressants
2.) Selective serotonin reuptake inhibitors (SSRIs)
3.) Serotonin norepinephrine reuptake inhibitors
4.) Atypical antidepressants
5.) Monoamine oxidase inhibitors

3

1.) Tricyclic Antidepressants (TCAs):

1.) amitriptyline (Elavil)
2.) imipramine (Tofranil)
3.) trimipramine (Surmontil)
4.) doxepin (Sinequan)
5.) desipramine (Norpramin)
6.) nortriptyline (Pamelor)
7.) protriptyline (Vivactil)

4

TCA - Action:

1.) Blocks uptake of neurotransmitters:
*Norepinephrine
*Serotonin

5

TCA - Action: cont....

2.) Elevates mood
3.) Increases interest in ADLs
4.) Decreases insomnia
5.) Clinical response ---> 2-4 weeks

6

TCA - Uses:

1.) Major depression
2.) Less expensive than SSRIs
3.) D/c gradually

7

TCA - many side effects:

1.) Anticholinergic effects
2.) Sedation
3.) Orthostatic hypotension
4.) Cardiac toxicity
5.) Seizures
6.) Sexual dysfunction
7.) Blood dyscrasias

8

2.) Selective serotonin reuptake inhibitors (SSRIs):

1.) fluoxetine (Prozac)
2.) sertraline (Zoloft)
3.) paroxetine (Paxil)
4.) citalopram (Celexa)
5.) escitalopram (Lexapro)

9

SSRI - Action:

1.) Block reuptake of serotonin
2.) Fewer SE than TCAs

10

SSRI - Uses:

1.) Major depression (primary)
2.) Anxiety disorders
3.) Obsessive compulsive

11

SSRI - Interactions:

Increased CNS effects w/ alcohol & other CNS depressants
*Don't consume w/ grapefruit juice

12

fluoxetine (Prozac) - Prototype drug (SSRI):

*Dosage
-Initial: 20mg/day in AM
-Max: 80mg/day
*Therapeutic effect: 2-4 weeks

13

fluoxetine (Prozac) - SE:

1.) Decrease over 2-4 weeks
2.) Dry mouth
3.) HA, blurred vision
4.) Nervousness, insomnia, tremors
5.) GI distress
6.) Sexual dysfunction

14

fluoxetine (Prozac) - Adverse reactions:

1.) Hyponatremia
2.)Seizures
3.) Suicidal Ideation

15

fluoxetine (Prozac) - CAUTION:

1.) Severe depression w/ suicidal tendencies
2.) Glaucoma
3.) Seizure disorder
4.) Underweight

16

3.) Serotonin norepinephrine reuptake inhibitors (SNRI):

1.) venlafaxine (Effexor)
2.) duloxetine (Cymbalta)
3.) desvenlafaxine (Pristiq)

17

Serotonin norepinephrine reuptake inhibitors (SNRI) - Action:

Inhibit repute of serotonin & norepinephrine
---> increases these substances

18

Serotonin norepinephrine reuptake inhibitors (SNRI) - Uses:

1.) Major depression
2.) Generalized anxiety
3.) Social anxiety

19

Monoamine Oxidase Inhibitors (MAOI):

1.) tranylcypromine sulfate (Parnate)
2.) isocarboxazid (Marplan)
3.) selegiline (Emsam)
4.) phenelzine sulfate (Nardil)

20

Monoamine Oxidase Inhibitors (MAOI) - Action:

1.) Monamine oxidase ENZYME inactivates neurotransmitters

2.) By inhibiting MAO enzyme ---> levels rise

21

Monoamine Oxidase Inhibitors (MAOI) - Use:

Depression not controlled by TCAs & Second Generation Antidepressants

22

MAOI - Drug Interactions:

Vasoconstrictors & Cold medications
-Hypertensive Crisis

23

MAOI - Herbal Alert:

Ginseng, ephedra, St. John's Wort --->
*Palpitations
*Heart Attack
*Hypertensive Crisis

24

MAOI - Food Interactions:

*Containing tyramine
-aged cheese, red wine, beer, yogurt, processed meats, bananas, raisins, yeast, soy sauce ===> Hypertensive Crisis

25

MAOI - SE:

1.) Agitation
2.) Restlessness
3.) Insomnia
4.) Anticholinergic effects
5.) Orthostatis hypotension

26

Nursing Process - Antidepressants:

-Monitor:
*Drug-drug & food-drug interactions (MAOIs)
*Suicidal tendencies

27

Health Teaching - Antidepressants:

1.) Take as prescribed!
2.) List of foods to avoid (MAOI)
3.) Therapeutic response ----> 2-4 weeks
4.) Possible teratogenic effects

28

Health Teaching - Antidepressants (1):

5.) Avoid:
*Alcohol, CNS depressants, & cold medicines

6.) DO NOT STOP abruptly
>needs to be gradually decreased & monitored

29

Health Teaching - Antidepressants (2):

7.) Take drug at bedtime d/t sedative effects (TCA)

8.) Herbs may interact w/ antidepressants