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Pharm 2 > depression and mood stabilization > Flashcards

depression and mood stabilization Flashcards

1
Q

what is depression

A
  • mood disorder
  • interferes with everyday life for several weeks or longer
  • affects people of all ages
  • women more than men
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2
Q

what feelings are associated with depression

A
  • sadness
  • loss
  • anger
  • frustration
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3
Q

describe the pathophysiology of depression

A

immune factors: increased CRF and activation of HPA axis

monoamine neurotransmitter dysfunction: deficiency of norepi and serotinin

neuroendocrine factors: downregulation (decreased sensitivity of cortisol receptors)

other factors: genetic and environmental factors

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4
Q

describe newer antidepressants

A
  • SSRIs and SNRIs
  • first line tx
  • effective and safer
  • 4-6weeks for full effect
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5
Q

describe older antidepressants

A
  • TCA and MAOIs
  • more adverse effects
  • require more monitoring
  • more cost effective
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6
Q

give and example of a tricyclic antidepressant

A

imipramine

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7
Q

describe the action of tricyclic antidepressants (imipramine)

A

blocks the reuptake of norepi and serotonin at the presynaptic nerve endings

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8
Q

what are tricyclic antidepressants (imipramine) used for

A

treatment of depression

also for bedwetting in adolescents

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9
Q

whats the PO onset for tricyclic antidepressants (imipramine)

A

2-6hrs

use caution in older adults and children

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10
Q

what are some adverse effects of tricyclic antidepressants (imipramine)

A
  • sedation
  • orthostatic hypotension
  • cardiac dysrhythmias

black box warning: TCAs are more toxic in overdose then other antidepressants and suicide is the leading cause of death in adolescents - increased risk of suicide in children, adolescents and young adults ages 18-24

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11
Q

whats a contraindication of tricyclic antidepressants (imipramine)

A

cardiac abnormalities and MI

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12
Q

describe administration of tricyclic antidepressants (imipramine)

A
  • PO given at bedtime to reduce bedtime sedation
  • start with small dose and increase slowly
  • pre-post mood assessment
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13
Q

what are some nursing implications of tricyclic antidepressants (imipramine)

A
  • do NOT give with MAOIs
  • or with antidepressants, herbs, grapefruit juice, or alcohol
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14
Q

describe patient education for tricyclic antidepressants (imipramine)

A
  • take only as prescribed
  • take with a glass of water and food if GI upset occurs
  • do not stop abruptly
  • do not crush or chew pills
  • avoid alcohol
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15
Q

give an example of an SSRI

A

fluoxetine

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16
Q

describe the action of SSRIs (fluoxetine)

A

blocks the reabsorption of serotonin in the brain

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17
Q

what are SSRIs (fluoxetine) used for

A
  • treatment of depression
  • anxiety, OCD
  • bulimia
  • PMDD
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18
Q

whats the PO onset of SSRIs (fluoxetine)

A

6-8hrs

use caution in older adults and children

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19
Q

what are some adverse effects of SSRIs (fluoxetine)

A
  • GI symptoms
  • CNS stimulation
  • serotonin syndrome (symptoms vary from mild to severe and can cause death)

black box warning: suicide is the leading cause of death in adolescents - increased risk of suicide in children, adolescents, and young adults ages 18-24 taking an antidepressant

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20
Q

whats a contraindication of SSRIs (fluoxetine)

A

known sensitivity

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21
Q

describe administration of SSRIs (fluoxetine)

A
  • PO daily with food
  • sugar free gum or candy to counteract dry mouth
  • pre/post mood assessment
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22
Q

what are some nursing implications for SSRIs (fluoxetine)

A
  • do NOT give with MAOIs
  • also dont give with antidepressants, herbs, grapefruit juice, and alcohol
23
Q

describe patient education for SSRIs (fluoxetine)

A
  • take only as prescribed
  • take with a glass of wtaer and food if GI upset occurs
  • do not stop abruptly
  • do not crush or chew pills
  • avoid alcohol
24
Q

give an example of an SNRI

A

venlafaxine

25
Q

describe the action of SNRIs (venlafaxine)

A

inhibits the neuronal uptake of serotonin as well as inhibits the uptake of norepi in the brain

26
Q

what are SNRIs (venlafaxine) used for

A

treatment of depression
- GAD
- social phobia
- panic disorder

27
Q

whats the onset of PO SNRIs (venlafaxine)

A

6-8hrs

use caution in older adults and children

28
Q

what are some adverse effects of SNRIs (venlafaxine)

A
  • GI symptoms
  • CNS
  • cardiovascular
  • GU

black box warning: suicide is the leading cause of death in adolescents - increased risk of suicide in children, adolescents, and young adults ages 18-24 taking an antidepressant

29
Q

whats a contrindication of SNRIs (venlafaxine)

A

known sensitivity

30
Q

describe administration of SNRIs (venlafaxine)

A
  • PO daily with food
  • extended release should be taken in the morning and evening at approximately the same time
  • if patients have difficulty swallowing extended release capsules can be opened and given in applesauce
  • pre/post mood assessment
31
Q

what are some nursing implications of SNRIs (venlafaxine)

A
  • do NOT give with MAOIs
  • alos dont give with antidepressants, hebrs, grapefruit juice, and alcohol
32
Q

describe patient education for SNRIs (venlafaxine)

A
  • take only as prescribed
  • take with a glass of water and food if GI upset occurs
  • do not stop abruptly
  • avoid alcohol
33
Q

give an example of an MAOI

A

phenelzine

34
Q

describe the action of MAOIs (phenelzine)

A

increases epinephrine, norepinephrine, serotonin, and dopamine in the CNS

35
Q

what are MAOIs (phenelzine) used for

A

treatment of depression as third line

36
Q

whats the onset of PO MAOIs (phenelzine)

A

2-4hrs

more likely to cause hypertensive crisis

37
Q

what are some adverse effects of MAOIs (phenelzine)

A
  • hypertensive crisis - avoid tyramine containing food (aged meats, cheese, and beer)

black box warning: suicide is the leading cause of death in adolescents - increased risk of suicide in children, adolescents, and young adults ages 18-24 taking an antidepressant

38
Q

whats a contraindication of MAOIs (phenelzine)

A

known sensitivity

39
Q

describe administration of MAOIs (phenelzine)

A
  • PO three times daily
  • may need reminder system
  • can be crushed
  • pre/post mood assessment
40
Q

what are some nursing implications for MAOIs (phenelzine)

A
  • do NOT give with SSRIs
  • also do not give with antidepressants, herbs, tyramine foods, and alcohol
41
Q

describe patient education for MAOIs (phenelzine)

A
  • take only as prescribed
  • take with a glass of water and food if GI upset occurs
  • do not stop abruptly
  • avoid alcohol
42
Q

why does antidepressant discontinuation syndrom occur

A

occurs due to sudden termination of most antidepressants

43
Q

what are some symptoms of antidepressant discontinuation syndrom

A

flu like sx
- insomnia
- nausea
- balance
- sensory disurbances
- hyperarousal

44
Q

the nurse is teaching the importance of proper diet to a aptient taking an MAOI for depression. which of the following food selections by the patient indicates further teaching is required?

  1. tossed salad
  2. salami and swiss cheese sammie
  3. hamburger and fries
  4. chicken salad and grapes
A
  1. salami and swiss cheese sammie

aged meats and cheese contain tyramine which should be avoided when taking a MAOI

45
Q

give an example of an atypical antidepressant and describe it

A

bupropion

action: inhibits reuptake of norepi, serotonin, an dopamine

adverse effects: CNS and others

black box warning for serious neuropsyciatric reactions when administered for smoking cessation

46
Q

name and describe a mood stabilizing agent

A

lithium

  • effective in controlling mania in 65-80% of pts by treating and preventing manic episodes
  • decreases frequency and intensity of manic cycles
  • stimulates neuronal growth, reducing brain atrophy in people with long standing mood disorders
47
Q

whats used to treat bipolar disorder

A

lithium carbonate

48
Q

describe the action of lithium carbonate

A

affects synthesis, release, and reuptake of several neurotransmitters in the brain including, acetylcholin, dopamine, GABA, and norepi

49
Q

what is lithium carbonate used for

A

drug of choice in tx of bipolar disorder

50
Q

what are some adverse effects of lithium carbonate

A
  • metallic taste
  • hand tremors
  • GI side effects
51
Q

what are some contraindications/cautions for lithium carbonate

A
  • known sensitivity
  • pregnancy
52
Q

whats a nursing implication for lithium carbonate

A

do NOT give with diuretics

53
Q

describe patient education for lithium carbonate

A
  • take only as prescribed
  • keep scheduled visits for blood tests
  • maintain a normal diet
  • use effective birth control
  • monitor for signs of toxicity

Pharm 2 (34 decks)

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