Ch. 28 - Antidepressants Flashcards Preview

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

Depression:

A

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
Q

Major Antidepressants Agents:

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

1.) Tricyclic Antidepressants (TCAs):

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

TCA - Action:

A
  1. ) Blocks uptake of neurotransmitters:
    • Norepinephrine
    • Serotonin
5
Q

TCA - Action: cont….

A
  1. ) Elevates mood
  2. ) Increases interest in ADLs
  3. ) Decreases insomnia
  4. ) Clinical response —> 2-4 weeks
6
Q

TCA - Uses:

A
  1. ) Major depression
  2. ) Less expensive than SSRIs
  3. ) D/c gradually
7
Q

TCA - many side effects:

A
  1. ) Anticholinergic effects
  2. ) Sedation
  3. ) Orthostatic hypotension
  4. ) Cardiac toxicity
  5. ) Seizures
  6. ) Sexual dysfunction
  7. ) Blood dyscrasias
8
Q

2.) Selective serotonin reuptake inhibitors (SSRIs):

A
  1. ) fluoxetine (Prozac)
  2. ) sertraline (Zoloft)
  3. ) paroxetine (Paxil)
  4. ) citalopram (Celexa)
  5. ) escitalopram (Lexapro)
9
Q

SSRI - Action:

A
  1. ) Block reuptake of serotonin

2. ) Fewer SE than TCAs

10
Q

SSRI - Uses:

A
  1. ) Major depression (primary)
  2. ) Anxiety disorders
  3. ) Obsessive compulsive
11
Q

SSRI - Interactions:

A

Increased CNS effects w/ alcohol & other CNS depressants

*Don’t consume w/ grapefruit juice

12
Q

fluoxetine (Prozac) - Prototype drug (SSRI):

A
  • Dosage
    • Initial: 20mg/day in AM
    • Max: 80mg/day
  • Therapeutic effect: 2-4 weeks
13
Q

fluoxetine (Prozac) - SE:

A
  1. ) Decrease over 2-4 weeks
  2. ) Dry mouth
  3. ) HA, blurred vision
  4. ) Nervousness, insomnia, tremors
  5. ) GI distress
  6. ) Sexual dysfunction
14
Q

fluoxetine (Prozac) - Adverse reactions:

A
  1. ) Hyponatremia
  2. )Seizures
  3. ) Suicidal Ideation
15
Q

fluoxetine (Prozac) - CAUTION:

A
  1. ) Severe depression w/ suicidal tendencies
  2. ) Glaucoma
  3. ) Seizure disorder
  4. ) Underweight
16
Q

3.) Serotonin norepinephrine reuptake inhibitors (SNRI):

A
  1. ) venlafaxine (Effexor)
  2. ) duloxetine (Cymbalta)
  3. ) desvenlafaxine (Pristiq)
17
Q

Serotonin norepinephrine reuptake inhibitors (SNRI) - Action:

A

Inhibit repute of serotonin & norepinephrine

—> increases these substances

18
Q

Serotonin norepinephrine reuptake inhibitors (SNRI) - Uses:

A
  1. ) Major depression
  2. ) Generalized anxiety
  3. ) Social anxiety
19
Q

Monoamine Oxidase Inhibitors (MAOI):

A
  1. ) tranylcypromine sulfate (Parnate)
  2. ) isocarboxazid (Marplan)
  3. ) selegiline (Emsam)
  4. ) phenelzine sulfate (Nardil)
20
Q

Monoamine Oxidase Inhibitors (MAOI) - Action:

A
  1. ) Monamine oxidase ENZYME inactivates neurotransmitters

2. ) By inhibiting MAO enzyme —> levels rise

21
Q

Monoamine Oxidase Inhibitors (MAOI) - Use:

A

Depression not controlled by TCAs & Second Generation Antidepressants

22
Q

MAOI - Drug Interactions:

A

Vasoconstrictors & Cold medications

-Hypertensive Crisis

23
Q

MAOI - Herbal Alert:

A

Ginseng, ephedra, St. John’s Wort —>

 * Palpitations
 * Heart Attack
 * Hypertensive Crisis
24
Q

MAOI - Food Interactions:

A
  • Containing tyramine

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

25
Q

MAOI - SE:

A
  1. ) Agitation
  2. ) Restlessness
  3. ) Insomnia
  4. ) Anticholinergic effects
  5. ) Orthostatis hypotension
26
Q

Nursing Process - Antidepressants:

A
  • Monitor:
    • Drug-drug & food-drug interactions (MAOIs)
    • Suicidal tendencies
27
Q

Health Teaching - Antidepressants:

A
  1. ) Take as prescribed!
  2. ) List of foods to avoid (MAOI)
  3. ) Therapeutic response —-> 2-4 weeks
  4. ) Possible teratogenic effects
28
Q

Health Teaching - Antidepressants (1):

A
  1. ) Avoid:
    • Alcohol, CNS depressants, & cold medicines

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

29
Q

Health Teaching - Antidepressants (2):

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

8. ) Herbs may interact w/ antidepressants