Chapter 16 - Drugs for Emotional and Mood Disorders

Question 1

Sertraline Class: SSRI

Answer 1

Action:
Slow the reuptake of serotonin into presynaptic nerve terminals, making them less
sensitive and making the postsynaptic receptors more sensitive

Uses:
Treatment of depression because of their reduced side effects

Contraindications:
Allergy to this product or SSRI’s

Adverse Effects:
Sexual dysfunction, nausea, headache, weight gain, anxiety, and insomnia.

Patient Teaching:
- Do not discontinue abruptly
- Avoid alcohol and other CNS depressants
- Serotonin Syndrome: agitation, nausea, vomiting, diarrhea, twitching, sweating,
shivering; report to the prescriber immediately

Pregnancy Category: C

Question 2

Imipramine Class: Tricyclic Antidepressant

Answer 2

Action:
Inhibiting the presynaptic re-uptake of both norepinephrine and serotonin.

Uses:
Mainly for major depression and occasionally for milder situational depression

Contraindications:
Pregnancy, allergy to this medication or carbamazepine, acute MI

Adverse Effects:
Orthostatic hypotension and (rarely seen) cardiac dysrhythmias. Sedation is a
common complaint initially but ebbs after several weeks of treatment

Patient Teaching:

• Report urinary retention immediately
• Avoid alcohol and other CNS depressants
• Photosensitivity
• To rise slowly; orthostatic hypotension
• • Decreases ACH
• • sexual dysfunction

Pregnancy Category: D

Question 3

Phenelzine Class: MAOI

Answer 3

Action:
Decrease the effectiveness of the enzyme monoamine oxidase. The MAOIs limit the
breakdown of norepinephrine, dopamine, and serotonin in CNS neurons. This creates higher levels of
these neurotransmitters in the brain to facilitate neurotransmission and alleviate the symptoms of depression

Uses:
Depression

Contraindications:
Patients with cardio or cerebrovascular disease, haptic or renal impairment

Adverse Effects:
Orthostatic hypotension, headache, insomnia, and diarrhea. A primary concern is that these agents interact with a large number of foods and other medications, sometimes with serious effects. MAOI inhibitors are used in patients who don’t respond to
other antidepressants and who are likely to comply with strict food restrictions.

Patient Teaching:

• • larger side effect profile
• • most drugs shouldn’t be taken with MAOIs
• • can cause rebound hypotension
• • strong food/drug reaction containing tyramine (aged/fermented food) - cheese, chocolate, sausage, alcohol
• • strong drug/drug reaction
• • hypertensive crisis

Pregnancy Category: C

Question 4

Lithium Carbonate Class: Antimanic

Answer 4

Action:
Sodium transport across cell membranes

Uses:
Bipolar disorder; Sometimes lithium is used in combination with other drugs to treat
bipolar disorder.

Contraindications:
Pregnancy, breastfeeding, children under the age of 12, hepatic disease, brain
trauma, organic brain syndrome, schizophrenia, severe cardiac/renal disease, severe dehydration

Adverse Effects:
Headache, lethargy, fatigue, recent memory loss, nausea, vomiting, anorexia,
abdominal pain, diarrhea, dry mouth, muscle weakness, hand tremors, reversible
leukocytosis, and nephrogenic diabetes insipidus.

Patient Teaching:

• Do not use while pregnant; will harm fetus
• Do not operate machinery until lithium levels stable
• Minor toxicity: vomiting diarrhea, poor coordination, fine motor tremors, weakness
• Major toxicity: coarse tremors, severe thirst, tinnitus, diluted urine
• • 1 - 3 weeks for full therapuetic effects
• • narrow window for therapuetic effects
• • maintain adequate fluids and salt intake
• • avoid things that dehydrate
• • side effects: edema, weight gain, dry mouth

Pregnancy Category:

Question 5

Lithium Values to Know!

Answer 5

Therapuetic serum levels for acute mania: 1 - 1.5 mEq/L
For maintenance: 0.5 - 1.5 mEq/L

Over 1.5 mEq/L is high and over 2 mEq/L is toxic.

Signs of toxicity: 1.5 - 2 mEq/L, 2 - 3.5 mEq/L, above 3.5 mEq/L

Question 6

Methylphenidate Class: Stimulant

Answer 6

Action:
Stimulate specific areas of the CNS that heighten awareness and increase focus

Uses:
ADHD

Contraindications:
Children under 6 years old, allergy to this medication, anxiety, history of Gilles de la Tourette’s syndrome, glaucoma, anorexia nervosa, tartrazine dye allergy

Adverse Effects:
Insomnia, nervousness, anorexia, and weight loss. It is a Schedule II controlled
substance and is in pregnancy-risk category C.

Patient Teaching:

• Decrease caffeine consumption
• Do not stop abruptly
• Avoid hazardous activities
• • dependence and abuse
• • have to be physically present for refills
• • cardiovascular risk
• • # 1 drug, has a lot of research and cheap
• • monitor height and weight daily
• • mointor sleep patterns

Pregnancy Category: C