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Exam #2 Medications Flashcards

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1
Q

Tricyclic medications acronym (All Nurses Identify Client’s Depression Treatment Daily)

A

All- Amitriptyline/Elavil
Nurses-Nortriptyline/Pamelor
Identify- Imipramine/Tofranil
Client’s- Clomipramine/Anafranil
Depression- Doxepin/Sinequan
Treatment-Trimipramine/Surmontil
Daily- Desipramine/Norpramin

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2
Q

Saying for Tricyclic antidepressant about dosage?

A

Start low, go slow

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3
Q

Side effects of tricyclic antidepressants?

A
  • Anticholinergic effects* (dry mouth, blurred vision, photophobia, photosensitivity*, urinary retention, constipation, tachycardia)
  • Histamine Blockade: Sedation, hypotension, weight gain*
    -Cardiovascular: dysrhythmias, MI, heart block*
    -Reduced seizure threshold*
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4
Q

How long does it take for tricyclic medications to take effect?

A

-At least 4-6 weeks
-6-8 weeks for full effect

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5
Q

Nursing interventions for tricyclic medications

A

-Monitor for postural hypotension and VS
- Do not stop med abruptly

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6
Q

Adverse effect of consuming Trymaine while taking tricyclic meds

A

Hypertensive crisis

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7
Q

Client education for tricyclic medications

A
  • 6-8 weeks for full effect of medication
    -Take at bedtime to avoid dehydration
    -Do not stop abruptly
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8
Q

Contraindications for tricyclic medications

A

-pregnancy, seizure disorders, severe
heart disease, untreated narrow angle
glaucoma and renal insufficiency
- Use cautiously with other SSRI’s

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9
Q

SSRI’s medication acronym (Patient Feels Safe From Criticism)

A

Patient-Paroxetine/ Paxil
Feels- Fluoxetine/ Prozac
Safe- Sertraline/ Zoloft
From-Fluvoxamine/ Luvox
Criticism- Citalopram/ Celexa

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10
Q

SSRI medications

A

Paroxetine/ Paxil
Fluoxetine/ Prozac
Sertraline/ Zoloft
Fluvoxamine/ Luvox
Citalopram/ Celexa
Additional- Lexapro

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11
Q

What is the first line for depression, panic disorders, trauma, or stressor related disorder treatment

A

SSRI’s

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12
Q

Side effects for SSRI’s

A
  • Fatigue, dry mouth, tremor
  • sexual dysfunction or lack of sex drive
  • Delayed ejaculation /erection (male)
  • Delayed orgasm (female)
  • If one SSRI, then all
  • Weight gain (long term), weight loss, nausea, diarrhea
  • insomnia, hypersomnia
    -Headache
    -Convulsions, respiratory difficulties
    -Dizziness, drowsiness
    -Jaundice, agranulocytosis
  • Rarely anxiety and sweating
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13
Q

What are the most common side effects of SSRI medications?

A
  • Convulsions, respiratory difficulties
  • Diarrhea, weight gain (long term),
  • Dizziness, drowsiness, dry mouth.
    -Jaundice, agranulocytosis
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14
Q

How long does it take for SSRI’s to take effect?

A

2-4 weeks

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15
Q

Serotonin syndrome manifestations

A
  • abdominal pain, GI bleeding, weight changes, Nausea
    – sweating (diaphoresis)
    – increase T, P
    – Hypo or hypertension
    – altered muscle tone, hyponatremia
    – altered LOC, fatigue, drowsiness
    – cardiovascular shock
    – death
    -tremor

-

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16
Q

Manifestations of serotonin syndrome according to the depression power point (major manifestations)

A
  • Confusion, agitation, disorientation, halls, delirium,
  • seizures,
  • labile BP,
    -incoordination, hyperreflexia,
  • FEVER!
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17
Q

What to do if serotonin syndrome is suspected?

A

withhold med and notify the provider

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18
Q

What should you not take with SSRI’s

Study These Flashcards
A
  • St john’s wart (Serotonin syndrome)
  • certain OTC med (serotonin syndrome_
  • Alcohol (CNS depression)
19
Q

How quickly can serotonin syndrome begin

Study These Flashcards
A

2-72 hours after treatment begins

20
Q

MOAI’s acronym (Many Nurses Pray)

Study These Flashcards
A

Many- Marlpan/Isocarboxazid
Nurses-Nardil/Phenelzine
Pray- Parnate/Tranycypromine

21
Q

MOAI’s medications

Study These Flashcards
A

Marlpan/Isocarboxazid
Nardil/Phenelzine
Parnate/Tranycypromine
Additional- Emsam/ selegine (Patch)

22
Q

MOAI’s side effects

Study These Flashcards
A

-Orthostatic hypotension*
- Weight gain*
-anticholinergic*
-sexual dysfunction
- insomnia
- hypertensive crisis with Trymaine, SSRI’s and tricyclics

23
Q

MOAI’s have side effects similar to

24
Q

What medication causes hypertensive crisis if Tyramine
containing foods and other monoamine drugs are consumed?

25
What are Trymaine containing foods?
- Aged cheeses – Pickled or smoked fish – Lunchmeats – Soy sauce – Draft Beer – Wine – Yogurt -Caviar -Raisins -Yeast products -Broad beans -Meat tenderizer -Chocolate; colas -Coffee; tea -Sour cream -Smoked and processed and smoked meats Beef and chicken liver -Canned figs, raisins, fava beans
26
Chemical Monomaine drugs
- Any product containing ephedrine, phenylephrine hydrochloride or phenylpropanolamine = OTC cold, allergy & congestion meds -Tricyclic antidepressants -Narcotics - esp. Demerol - Some antihypertensive meds - Sedatives -General anesthetics - Stimulants -Diet pills
27
Client education MOAI
- Other side effects similar to TCA. - Wait 2-3 weeks between an MAOI and SSRI or TCA and 5 weeks between Prozac and MAOIs. - NO stimulant type drugs or narcotics. - NO OTC meds without approval from MD -Provide clients taking MAOIs with a list of foods containing tyramine-think aged foods and pickled foods. Always choose fresh foods! -Teach client and family to observe for and report S&S (hypertensive crisis) to physician immediately
28
Nursing interventions MOAIs
-rarely used for initial treatment
29
Hypertensive Crisis manifestations
* Severe occipital headache * Marked increase in blood pressure * N&V * Nuchal rigidity * Palpitations and chest pain * Fever and sweating * Can lead to stroke, coma and death
30
Hypertensive Crisis treatment
* Discontinue MAOI immediately * ER * Short-acting antihypertensive therapy * Examples -IV Regitine, sublingual Nifedipine * External cooling devices for fever
31
Precautions and contraindications for MOAI
Precautions: Avoid foods containing tyramine, Antihypertensives have additive hypotensive effect Contraindicated: SSIRs, tricyclics, heart failure, CVA, and renal insufficiency
32
Atypicals acronym (Most Nurses Do Become Very Tired)
Most-Mirtazpine (Remeron) Nurses-Nefazodone (Serzone) Do-Duloxetine (Cymbalta) Become- Bupropion (Wellbutrin) Very-Venlafaxine (Effexor) Tired- Trazodone (Desyrel)
33
Atypical antidepressants medications
Mirtazpine (Remeron) Nefazodone (Serzone) Duloxetine (Cymbalta) Bupropion (Wellbutrin) Venlafaxine (Effexor) Trazodone (Desyrel) Additional-
34
Venlafaxine (Effexor)
venlafaxine (tx MDD, GAD, SAD (social anxiety d/o), and PD (panic d/o) * Inc. serotonin, norepinephrine, dopamine
35
Nefazodone (Serzone)
Serzone – nefazodone * Inc. serotonin * Use if anxiety/sexual dysfunction w/ SSRI
36
Mirtazpine (Remeron)
Remeron – mirtazapine * Inc. serotonin & norepinephrine * For sedation
37
Bupropion (Wellbutrin)
Wellbrutin – bupropion * Inc. dopamine and norepinephrine, * Risk of anxiety, seizures, insomnia * Stop smoking - Zyban
38
Atypical antidepressant side effects
Trazodone- priapism, sedation
39
Interaction between alcohol and antidepressants
- Adds to the CNS depression of antidepressant meds - Impairment occurs after fewer drinks than in person not taking these meds Alcohol and Anti Depressants
40
What is the goal of antidepressants?
Target symptoms
41
General depression medication teaching
- Do not abruptly stop taking medication (titrate and report adverse effects) -Therapeutic effects can often take weeks -Notify provider with thoughts of suicide or adverse effects like serotonin syndrome or hypertensive crisis -Avoid alcohol and other substances-some foods specifically with MAOis -Monitor for serotonin syndrome (agitation, confusion, halls) within first 72 hours -Assess for and teach to avoid OTC meds.
42
Risk of suicide with antidepressants
- When the mood begins to lift may have enough energy to carry out a plan to commit suicide - Highest risk 1-6 weeks - Pay special attention to a sudden lift in mood - Family and significant supportive others need this information
43
When is the highest risk for suicide with antidepressants
1-6 weeks
44

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