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PHARM FINAL > Mental Hlth - Antidepressants > Flashcards

Mental Hlth - Antidepressants Flashcards

1
Q

Depression: Drug Therapy

A
  • Inhibit effects of monoamine oxidase
    > enzyme breaks down neurotransmitters
  • Blocks reuptake of neurotransmitters
  • Regulate receptor sites and/or breakdown
  • Goal: more neurotransmitter in synaptic cleft
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2
Q

Serotonin Syndrome CMs

A
  • Common
    > delirium
    > agitation
    > HTN/tachy
    > sweating
    > clonus (muscle spasms)
    > hyperreflexia
    > tremors
    > shivering
  • Severe
    > hyperthermia
    > seizures
    > rhabdomyolysis
    > renal failure
    > cardiac dysrhythmias
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2
Q

Antidepressants - General

indication
BB
contra
caution
d-d

A
  • Indication: depression
    > allows 4wks for therapeutic effect
  • Black Box: incrd risk for suicidal ideation
    > esp. children & young adults
  • Contraindications: seizure disorders
  • Caution: older adult more susceptible to AE; pregnancy/lactation
  • Drug-Drug:
    > more than 1 antidepressant incrs risk for AE & serotonin syndrome
    > Serotonergic drugs: fentanyl, St. John’s Wort
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3
Q

1st Generation Antidepressants

A
  • Tricyclic
  • MAOIs
  • more significant AEs
  • toxicity lethal
  • pregnancy cat D/X
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4
Q

2nd Generation Antidepressants

A
  • SSRI
  • SNRI
  • more tolerable AEs, still bothersome
  • Pregnancy cat C
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5
Q

Amitriptyline - Class & MOA

A
  • Class: Tricyclic Antidepressant (TCA)
    > 1st gen
  • MOA: reduce reuptake of serotonin & NE into nerves
    > blocks cholinergic, histaminergic, adrenergic, dopaminergic receptors
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6
Q

Amitriptyline - Use & Caution

A
  • Use: refractory to other treatment
  • Caution: cardiovascular disease, seizure disorder
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7
Q

Amitriptyline - Drug/Drug & AEs

A
  • Drug-Drug: MAOIs (Phenelzine)
  • AEs:
    > sedation
    > anticholinergic effects
    > weight gain
    > overdose: cardiac dysrhythmias & seizures (usually lethal)
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8
Q

Amitriptyline - Nursing Considerations

A

Admin at HS
general slide

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9
Q

Phenelzine - Class & MOA

A
  • Class: Monoamine Oxidase Inhibitor (MAOI)
  • MOA: irreversible inhibits MAO allowing neurotransmitters to accumulate in synaptic cleft (including dopamine)
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10
Q

Phenelzine - Use & Caution

A
  • Use:
    > depression refactory to other treatment
    > Parkinson’s disease
  • Caution: cardiovascular disease
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11
Q

Phenelzine - Drug/Drug/Food

A
  • Drug-Drug:
    > sympathomimetic (Epinephrine, Norepinephrine)
    > serotonergic drugs (SSRI-Citalopram)
  • Drug-Food:
    > tyramine incrs BP & risk for HTN crisis
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12
Q

Phenelzine - AEs & Nursing

A
  • AEs:
    > orthostatic hypoten
    > sexual dysfunc
    > severe: HTN crisis
  • Nursing: avoid tyramine foods; wait 2-6wks MAOI to SSRI (incr risk serotonin syn)
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13
Q

Food Containing Tyramine

A
  • High
    > aged cheeses: cheddar, blue, swiss
    > smoked/pickled/cured meats: sausage, pepperoni
    > yeast extracts
    > red wines
  • Moderate-Low
    > avocado
    > pasteurized light & pale beer
    > distilled spirits: vodka, giv
    > non-aged cheeses
    > chocolate & caffeinated beverages
    > fruit: bananas, grapes, pineapple
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14
Q

Citalopram (Celexa) - Class & MOA

A
  • Class: Selective Serotonin Reuptake Inhibitors (SSRI)
    > 2nd gen
  • MOA: blocks reuptake of serotonin incring lvls in synaptic cleft
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15
Q

Citalopram (Celexa) - Uses & AEs

A
  • Use:
    > 1st line treatment of depression
    > OCD
    > panic attacks
    > PTSD
  • AEs
    > dry mouth
    > sexual dysfunc
    > prolonged QTc
    > modest weight gain
    > insomnia more likely; take in AM
16
Q

Citalopram (Celexa) - Nursing Consideration

A

Slowly taper due to withdrawal syndrome

17
Q

Antidepressants Lifespan - Children

A
  • Long term effects not clearly understood
  • Some studies; efficacy poor, incrd risk for suicidal ideation
18
Q

Antidepressants Lifespan - Pregnancy

A
  • Caution, benefit vs risk
  • Neurological, cardiac, resp effects of fetus
19
Q

Antidepressants Lifespan - Older Adults

A
  • More susceptible to AEs
  • Reduce dose
20
Q

Duloxetine (Cymbalta) - Use, AEs, & Nursing

A
  • Use:
    > depression
    > anxiety
    > off-label: neurpathic pain, fibromyalgia
  • AEs
    > GI effects: nausea, anorexia, weight loss
  • Nursing: general
21
Q

Antidepressant Care Plan

assessment
intervention
evaluate

A
  • Assessment
    > indication for drug: depression, suicidal ideation
  • Intervention
    > admin in AM if causes insomnia or HS if causes drowsiness
  • Teach
    > report suicidal ideation
    > therapeutic effects up to 4 wks
    > do not discontinue abruptly
  • Evaluate
    > therapeutic response, AE, teaching, compliance

PHARM FINAL (22 decks)

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