Depression + Bipolar Flashcards by Sarah R

what are some overall nursing considerations for antidepressants? (5)

slow onset: 1-3 weeks; max 12
wean off
no PRN use
suicide risk: mostly seen with <25 yrs old
start low + go slow

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what are the 3 monoamine neurotransmitters?

norepinephrine, serotonin + dopamine

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what will you see with changes in both biochemistry + symptoms with antidepressants? (referring to time frame)

biochemistry: quick changes
symptoms: slow changes

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what are the 5 classes of antidepressants?

SSRIs
SNRIs
tricyclic antidepressants
MAOIs
atypical antidepressants

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what antidepressant drug class tends to be our 1st line? (b/c of SE profile)

+ what would be our last choice drug class?

SSRIs

last = MAOIs

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what is our SSRI prototype?

fluoxetine (Prozac)

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what is the MOA of fluoxetine?

slow reuptake of serotonin into presynaptic nerve terminals = MORE serotonin in synaptic cleft

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what antidepressant has the BEST safety profile? (w/same efficacy as the others) <3

SSRIs

fluoxetine

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what is most prominent + significant SE of SSRIs?

sexual dysfunction

“SSRI = Sex Sucks”

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aside from sexual dysfunction, what are some other SE of SSRIs? (5)

nausea
weight gain (when nausea resolves)
nervousness
insomnia
anxiety

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should SSRIs be used in pregnancy?

not late in pregnancy - can cause pulmonary HTN + withdrawal in infant

*can they be used earlier in pregnancy?? if you know will you send me an edit to this card

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with SSRI use, patients are at an increased risk of what?

bleeding (esp. GI)

-older adults, hx of GI bleed, anticoag or NSAID use increases this risk

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what is serotonin syndrome?

getting too much serotonin - from taking multiple meds that affect synthesis or reuptake of serotonin - LIFE THREATENING

LONG LIST OF MEDS!!

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when can serotonin syndrome occur?

2-72 hours after treatment starts?

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what are the s+s of serotonin syndrome? (5)

mental status change
tremors
fever + sweating
HTN
ataxia

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what is tx for serotonin syndrome?

STOP the SSRI + give supportive therapies (aimed at treating the symptoms - orientation, keep patient safe/fall precautions, antipyretic, keep linens dry, antihypertensives)

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what are s+s serotonin withdrawal syndrome? (7) + why does it happen?

b/c of abrupt discontinuation….

dizziness
HA
nausea
sensory disturbances
tremor
anxiety
dysphoria (“general unhappiness with life”)

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when can serotonin withdrawal syndrome occur? + how long can it last? (time frame)

days to weeks after cessation of drug –> can last 1-3 WEEKS

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how can we prevent serotonin withdrawal syndrome?

slowly taper drug + educate patient on this!

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what is the prototype of SNRIs?

venlafaxine (Effexor)

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what is the MOA of venlafaxine?

block reuptake of serotonin + norepinephrine

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what are the SE of venlafaxine?

nausea
HA
HTN
nervousness
insomnia
somnolence
sweating

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what is the MOA of imipramine?

Study These Flashcards

inhibit reuptake of serotonin + norepinephrine

also blocks ACh receptors and/or histamine

what is prototype of tricyclic antidepressants?

Study These Flashcards

imipramine

“ines”

when are tricyclic antidepressants usually scheduled? why?

at bedtime - can cause sedation

what SE of tricyclic antidepressants is common during initial treatment?

sedation

what are SE of tricyclic antidepressants? (2 - one broad, one specific)

1. anticholinergic: can't pee, can't see, can't spit, can't shit 2. orthostatic hypotension (you can't do all of those things while you're riding your bike)

what antidepressant is associated with a high risk of overdose - large doses are lethal and can cause cardiac toxicity (avoid with suicidal patient)?

tricyclic antidepressants

what drug-drug interactions occur with tricyclic antidepressants (broad, not specific)?

1. MAOIs (duh they suck with everything) 2. sympathomimetics 3. anticholinergics

what effect would you see with someone on tricyclic antidepressants + other CNS drugs?

increased sedation

what is MAO?

enzyme that converts our MAO NTs into active products; is also in foods (which explains the drug-food interactions b/c liver needs MAOs to break down MAO foods)

what is MOA of MAOIs? (say that 5 times fast)

inhibit breakdown of NE + dopamine + serotonin

how long does the action of MAOIs last?

the "lifetime" of the neurotransmitter - 2 weeks

when can you see full effect of MAOI use?

4-8 weeks

what are the 4 prototypes for MAOIs? *KNOW THEM ALL*

SPIT: 1. Selegiline 2. Phenelzine 3. Isocarboxiazide 4. Tranylcypromine

what AE comes from the drug-food interactions between MAOIs + tyramine foods?

hypertensive crisis

how long is the washout period between MAOIs and new drugs [that could interact with MAOIs]?

14 days "MA, OI! NO NEW FRIENDS for 14 DAYS!!!"

name some tyramine foods that interact with MAOIs?

all the good things... avos, caffeine, wine, aged cheeses, meats, bananas, chocolate, yogurt, fava beans

do we need to know what specific reaction we would see with MAOIs + specific drugs?

......... ??? make an edit if you think so!

what is the prototype for atypical antidepressants?

bupropion (Wellbutrin)

bupropion is similar in structure to what?

amphetamine

what are the pros of bupropion? (2)

1. no weight gain | 2. no sexual dysfunction (can actually increase)

what are the SE of buproprion?

1. seizures 2. agitation 3. HA 4. psychotic symptoms

patients with which disorder should avoid use of bupropion?

seizure disorders (SE of bupropion is seizures)

what is DOC for bipolar (per Knowlton)?

lithium

what is lithium known as? (therapeutic class)?

mood stabilizer

what is the therapeutic range for lithium? what is optimal?

0. 4-0.1 mEq/L | 0. 4-0.8 is BEST <3

TOXIC levels are seen at what number for lithium?

1.5 mEq

lithium acts like ______; what scenarios r/t this would we see an increased risk of lithium toxicity?

salt - when Na is low in the body, it will hold onto lithium to compensate 1. diarrhea 2. dehydration 3. poor oral intake 4. diuretics 5. acute renal failure

what are the s+s of lithium toxicity? (6)

1. tremors 2. N/V 3. polyuria 4. muscle weakness 5. ataxia 6. EKG changes ...can lead to convulsions, coma, death

how do we treat lithium toxicity?

we just manage symptoms; unless > 2.5, we can give dialysis

AE of lithium (a fuck ton - 7)

1. GI: N/V/D 2. HYPOthyroidism + goiter 3. tremors 4. renal damage 5. polyuria 6. edema 7. birth defects

how can we mitigate the AE of GI disturbances with lithium?

give with food + split up doses

how could we mitigate hand tremors with lithium use? (2 options)

lower dose or give with BB

what nursing intervention would you implement for patient with polyuria on lithium therapy?

encourage good oral intake of fluids + monitor their levels

what drug-drug interactions exist with lithium? (2)

1. NSAIDS - can impact kidneys + therefore toxicity | 2. diuretics - can increase risk of toxicity

Depression + Bipolar Flashcards

(56 cards)