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nurs 3514 mental health > week 7: m&a depression and bipolar disorder > Flashcards

week 7: m&a depression and bipolar disorder Flashcards

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1
Q

what are the causes of depression?

A

physical, cognitive distortions (cbt Aaron beck), genetic vulnerability and psychosocial factors (life events/circumstances), aces trauma loss

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2
Q

what are the approaches to treatment/care?

A

pharmacological, ECT, TMS, Psychotherapy Mindfulness, Psychosocial, Education
Health promotion, Health and Wellness

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3
Q

Pharm approach: selective serotonin reuptake inhibitors SSRI’s give examples

A

Fluoxetine (Prozac), Paroxetine (Paxil), Citalopram (Celexa) Safer in overdose; cardiac toxicity decreased

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4
Q

Selective serotonin and norepinephrine reuptake inhibitors SSNRI’s

A

Venlafaxine (Effexor)

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5
Q

atypical antidepressants

A

Trazadone (Desyrel), Buproprion, Remeron

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6
Q

Fluoxetine (Prozac) Paroxetine (Paxil) Escitalopram Sertraline Citalopram (Celexa) are examples of

A

SSRIs

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7
Q

what are the indications and MOA for ssri’s

A

indicator: Anxiety Depression OCD PTSD
Mechanism of Action: Blocks the reuptake of serotonin into the presynaptic cell - this increases the amount present in synapse and magnifies its effects

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8
Q

Assess for symptoms of serotonin syndrome: agitation, fever, hr,
bp diaphoresis, tremors, diarrhea, delirium)
LFT, CBC, Renal fx what class of drugs?

A

SSRI’s

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9
Q

side effects ad education or ssri’s

A

the S’s: S’s
Stomach upset
Dysfunction Serotonin syndrome Difficulties
Suicidal thoughts, Sexual, Sleep

education: Full effects not felt for 2-4 weeks Interaction: St. John’s wort (SS), warfarin, digoxin Discontinuation Syndrome: flu like symptoms, nausea, electric shock sensations, headaches, vertigo, anxiety, irritability, insomnia, gi bleed, NO etoh

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10
Q

indications and names for SSNRI

A

Name: Duloxetine Venlafaxine (Effexor)
Indications: Anxiety Depression Neuropathic pain,
“vexed and depressed”

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11
Q

MOA and wha to monitor for in SSRNI’s

A

Mechanism of Action
Inhibits serotonin and norepinephrine reuptake in the presynaptic nerve, thereby increasing availability
Monitor
Assess for symptoms of serotonin syndrome: agitation, fever, hallucinations, diaphoresis, tremors)

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12
Q

side effects and education for ssnri’s

A

Side Effects
* Same as SSRIs plus * Hypertension
* Adrenergic effects
* Tachycardia
Education
* Full effects not felt for 2-4 weeks
* Interaction: St. John’s wort (SS)

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13
Q

what are some atypical antidepressants?

A

Trazodone = SARI
Buproprion (Wellbutrin) = NDRI Mirtazapine (Remeron) = Tetracyclic

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14
Q

what are some indications, MOA and things to monitor with atypical antidepressants?

A

Indications
Depression Neuropathy Fibromyalgia Anxiety Insomnia, Mechanism of Action: Increases effects of serotonin and norepinephrine in the CNS by slowing the rate of reuptake

Monitor for Orthostatic hypotension, anticholinergic - someone getting dried out: dry mouth, dry eyes, constipation

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15
Q

what are the side effects and education piece to atypical antidepressants?

A

Side Effects: Sedation Arrhythmias
Sweating Orthostatic hypotension Anticholinergic effects
Education
* Change positions slowly
* Sugarless candy or gum for dry mouth * Increase fiber and fluid to prevent
constipation

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16
Q

what are some side effects related to stopping SSRIs

A

flu like symptoms, nausea, “electric shock” sensation, headaches, vertigo - gait instability, anxiety/irritability, insomnia

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17
Q

what is serotonin syndrome and what are the symptoms associated with it?

A

excess serotonin, can be life threatening
side effects: MSE changes ex delirium, fever, tachycardia, hypertension, tremor, diarrhea, neuromuscular symptoms

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18
Q

what do these stand for ?
SSRIS
SNRI
NRIS
NDRI
SNDI
TCA
MAOIS
hint these are medications for depression antidepressants

A

selective serotonin reuptake inhibitors
serotonin norepinephrine reuptake inhibitors
noepinephrine reuptake inhibitors
norepinephrine dopamine reuptake inhibitors
serotonin norepinephrine disihibitors
tricyclic antidepressants
monoamine oxidase inhibitors

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18
Q

what are some causative drugs for serotonin syndrome?

A

SSRIs
SNRIs
TCAs
Buspirone
MAOIs
Lithium
St. John’s Wort Trazadone
LSD, MDMA, cocaine, Amphetamines

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19
Q

what is neurons ?

A

the cells that makes up our central nervous system

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19
Q

true or false: for serotonin syndrome: it is a quick onset and consist of triad of clinical features: Mental status changes Neuromuscular abnormalities Autonomic hyperactivities

A

true

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20
Q

true or false. they have the head and tail end- connected tot eh next one to the next one ( neuro pathways )

A

true

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20
Q

good way to remember serotonin syndrome:

A

H Hyperthermia
A Agitation, delirium,
R confusion
M Restlessness,
F Reflexes
U Myoclonus - twitch/jerk
L Fast heart rate
Unconsciousness Loss of GI control (n/d)

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21
Q

how do the neurons communicate?

A

the neurons communicate through neuro transmitters on their end
on head is connected to another tail

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21
important to know regarding serotonin syndrome: Stop serotonergic agent Supportive Care (O2, IV, BP support, BB) Sedation with benzodiazepines Medical therapy (cyproheptadine - block serotonin production
yuppers true
22
name the 3 common neurotransmitter emphasis in this class
dopamine, noepinephrine , serotonin
22
what is Electroconvulsive Therapy (ECT)?
**the most effective acute treatment for depression** Electrical currents passed through the brain induce a seizure resulting in changes in brain chemistry, bilateral or unilateral ect
23
what drug is used for treatment resistant depression?
IV Ketamine
24
what is a synapse?
the distance the tall and the head of the neuron, higher the chance of the receptors to take up neuro transmitters
24
how is IV ketamine given for depression
In most cases medications/”boosters” will be required to sustain the effects Administered as an inpatient or as an outpatient Course is 8 treatments (2-3x/week)
25
what are the side effects of iv ketamine?
➢Dissociative symptoms lasting up to 4 hours, ➢ hallucinations, ➢vivid or distressing dreams, ➢nausea & vomiting, ➢increased saliva production & dizziness, ➢blurred vision, ➢increased HR & BP, ➢change in motor skills (e.g., clumsiness)
26
recall that the medications for depression are ssri selective serotonin and norepinephrine reuptake inhibitors atypical antidepressants what are the examples of these
SSRIs: fluoxetine , prozac, parozetine, citalopram Selective serotonin and norepinephrine reuptake inhibitors : venlafaxine atypical antidepressants : trazadone, buproprion, remeron
26
what are the nursing interventions for iv ketamine?
➢Monitoring tolerance to procedure & comfort care ➢VS intermittently during the infusion ➢PRN Ondansetron for nausea ➢Patient would need to remain on the unit for a minimum of 2 hours post treatment. ➢Teaching: not to drive/operate hazardous equipment/ activities for 24 hours after as reflexes may be slowed/ impaired ➢Documentation
27
what is transcranial magnetic stimulation?
An electromagnetic coil is placed on the patient’s scalp. Electric current running through the coil generates a magnetic field that stimulates the brain cells thought to be responsible for depression. pt is conscious, tx takes 30 mins
29
What is a TCA ?
Tricyclic Antidepressants ( TCAS )
31
What is MAOIs?
monoamine oxidase inhibitors
32
what are examples of TCAS and how is it dangerous ?
imipramine, clomipramine its very dangerous in overdose - it can cause cardiotoxicity
35
true or false. TCAs have anticholinergic effects?
true
36
can delirium occur when a person is taking TCAS?
yes this is true
37
what undergoes MAOIs
nardil and parnate
38
how does MAOIs work ?
inhibits the enzyme that breaks down tyramine
39
recall that individuals need special diet low in tyramine to avoid hypertensive crisis when taking MAOIs , what are the examples?
high in tyramine, meats, cheese, leftover of poultry eggs
40
other than depression : what other clinical diagnosis can TCA be used for ?
neuropathy, fibromyalgia , anxiety , insomnia
41
what is the mechanism of action of TCAs ?
increases effects of serotonin and norephinephrine in the CNS by slowing the rate of reuptake
42
what should we monitor for when a pt is on TCAs?
orthostatic hypotension overdose - cardiotoxicity anticholinergic effects delirium
43
what are the side effects ?
sedation, sweating, orthostatic hypotension, anticholinergic effects, arrhythmias, seizures
44
what is the education for tcas?
change positions slowly sugarless candy or gum for dry mouth
45
true or false. Should we increase fiber and fluid to prevent constipation
true
46
what are the TIPS for MAIOs
Tranylcypromine Isocarboxazid Phenelzine Selegiline
47
what are the indication of MAIos
depression
48
what is the MOA of MAOIs?
inhibits monoamine oxidase, thus preventing breakdown of monoamine neurotransmitters. This increases availability of serotonin, melatonin, epinephrine, norepinephrine
49
what should we monitor for in MAOIs
hypertensive crisis serotonin syndrome ( SOB/ nose bleeds )
50
what are the side effects of MAOIs
agitation/anxiety orthostatic hypotension hypertensive crisis
51
what is the education of MAOIs
do not eat food reach in tyramine avoid caffeine
52
true or false. Many medication interaction ( OTC cold meds ) which can result in severe hypertension for MAOIs
true
53
What is the required timeframe to washout period for MAOIs?
2 weeks
54
is it typically slow to work for antidepressant medication?
typically, slow to work (may take 4-6 weeks before anti depressant effect seen)
55
what are the mood stabilizers for anti mania medications
lithium and anticonvulsants
56
what is the serum for lithium
0.6-1.2 therapeutic more than 1.5 toxic hypotension seizure tinnitus
57
what can more than 1.5 toxic cause in lithium
coarse hand tremors, confusion, hypotension, seizure, tinnitus
58
what is the indication for lithium
to treat acute mania in bipolar disorder long term management of bipolar disorder
59
what is the moa for lithium ?
acts on cns may strengthen nerve connections in brain regions involved in regulating mood, thinking and behaviour
60
what should we monitor for lithium ?
creatinine/BUN lithium levels - drawn 12 hours after last dose no ( indirect to lithium levels )
61
what are the side effects of lithium ?
nephrotoxicicity, polyuria, increased thrist, fine hand tremors, hypothyroid, e changes
62
recall that nephrotoxicity, polyuria, increased thirst, fine hand tremors, hypothyroid, e changes are side effects of lithium : what else ?
leukocytosis, GI upset, wt gain, fatigue
63
what should we educate the patient on when there are on lithium ?
no diuretics or nsaids no intake, fluid intake sweating. dehydration, diarrhea, diuretics, illness, not used in pregnancy or breastfeeding
64
the nurse notes that the pt who is taking lithium is experiencing symptoms of lithium toxicity- confusion, slurred speech and incoordination? what should the nurse do next ?
trempors - draw levelsx lithium is within the toxic levels- then the treatment is stop giving the med flush out their kidneys ) incrase iv fluids ) and flush out lithium in their kidney system kidney function testing reoccurrence of manic symptoms
65
what is anticonvulsants
used as a mood stabilizer carbamazepine and valproate most commonly used -- see common side effects
66
what are the newer/anticonvulsants for mood stabilizer
gabapentin, topiramate
67
what undergoes anticonvulsants
carbamazepine valproate gabapentin topiramate
68
what is the indication for use of anticonvulsants
acute mania maintenance of bipolar disorder
69
what is the mechanism of action of anticonvulsants
carbamzepine - decrease symptomatic transmission in CNS valporic acid = increases GABA inhibitory and decrease mania
70
what should we monitor for anticonvulsants
carbamazepine - lfts, cbc ( leukopenia and aplastic anemia ) valproate - lft, platelets, drowsiness, mood, ideations
71
what other medications are used for mood stabilizer
antipyschotics - can directly treat acute mania. pyschosis as well as physiological symptoms ( insomnia, etc ) ---- quetiapine, seroquel most often used ---- for mood and symptom stability may have some effectiveness for stabilization of symptoms over the long term
72
what should we used for short term for agitation for antianxiety
benzodiazepines
73
what undergoes sedative/hypnotics
zoplicone, trazodone, to promote sleep
74
true or false. antidepressants can trigger manic phase
true

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