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38 Cards in this Set

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What are antidepressants used for?
treatment of various forms of endogenous depression , often in conjunction with psychotherapy
Some other uses (7) for antidepressants are and the names of the antidepressants that treat the uses are?
anxiety treatment (doxepin)
enuresis in children
(imipramine)
chronic pain syndromes
(amitriptyline, doxepin,
imipramine,
nortriptyline)
smoking cessation (bupropion)
bulimia (fluoxetine)
obsessive-compulsive disorder
(fluoxetine, sertraline)
generalized anxiety disorder
(venlafaxine, paroxetine)
Define enuresis and which tricyclic antidepressant treats it in children?
involuntary discharge of urine after the age at which bladder control should have been established in children

imipramine can treat this condition in children
Many of the tricyclic antidepressants can treat (1) or have these properties (2)?
1 chronic pain syndromes
2 have significant
anticholinergic
properties
(which explains many of
their side effects;
amitriptyline
amoxapine
doxepin
imipramine
nortriptyline
3 have significant sedative
properties
Antidepressant activity is most likely due to preventing the reuptake of ______, ________, and _____ in presynaptic neurons, resulting in accumulation of these neurotransmitters.
dopamine
norepinephrine
serotonin
The MAJOR classes of antidepressants are?
tricyclic antidepressants
selective serotonin reuptake
inhibitors
The selective serotonin reuptake inhibitors are likely to cause?
insomnia
Contraindications for antidepressants are?
hypersensitivity
narrow-angle glaucoma
pregnancy
lactation
immediately following MI
Use antidepressants cautiously in older patients and those with pre-existing _______ disease.
cardiovascular
Elderly men with _______ enlargement may be more susceptible to urinary retention.
prostatic
What symptoms do the antidepressants with anticholinergic effects display?
dry eyes
dry mouth
blurred vision
constipation
Antidepressants require slow titration and onset of therapeutic response may be ____ to ___ weeks.
2 to 4
Which group of antidepressants may cause hypertension, tachycardia, and convulsions when used with MAO inhibitors?
tricyclic antidepressants
Which group of antidepressants may prevent therapeutic response to some antihypertensives?
tricyclic antidepressants
Which group of antidepressants may cause additive CNS depression with other CNS depressants?
tricyclic antidepressants
Which group of antidepressants that have sympathomimetic activity may be enhanced when used with other sympathomimetics?
tricyclic antidepressants
Which group of antidepressants that have anticholinergic activity may be enhanced when used with other drugs possessing anticholinergic properties?
tricyclic antidepressants
What may occur with concurrent use of MAO inhibitors and:

amphetamines
methyldopa
levodopa
domamine
epinephrine
norepinephrine
desipramine
imipramine
guanethidine
reserpine
vasoconstrictors
ingestion of tyramine-
containing foods?
hypertensive crisis
What 5 life-threatening symptoms may occur with meperidine or other opioid analgesics and MAO inhibitors?
hypertension
hypotension
coma
convulsions
death
What additive complication can occur when combining MAO's with antihypertensives or spinal anesthesia?
additive hypotension
What additive effect can occur with MAO's and insulin or oral hypoglycemic agents?
additive hypoglycemia
Which group (1) and which 2 drugs in the miscellaneous listing should not be used in combination with or within weeks of MAO inhibitors?
1 selective serotonin reuptake inhibitors (SSRIs)

2 bupropion
venlafaxine
Risk of adverse reactions using antidepressants may be increased by using which type of drugs?
vascular headache suppressants

ex:
almotriptan
frovatriptan
rizatriptan
naratriptan
sumatriptan
zolmitriptan
What assessments should the nurse monitor for?
mental status and affect
suicidal tendencies, esp.
during early therapy
restrict amount of drug
available to patient
TOXICITY AND OVERDOSE:
What are symptoms of hypertensive crisis which may be brought on by concurrent ingestion of MAO inhibitors and tyramine-containing foods?
chest pain
enlarged pupils
nausea
nuchal rigidity
photosensitivity
severe headache
vomiting
What is the treatment for hypertensive crisis?
IV phentolamine (Regitine) which is an agent for pheochromocytoma and belongs to the pharmaceutical class alpha-adrenergic blockers
Three potential nursing diagnoses?
Coping, ineffective
individual
Injury, risk for
Knowledge deficit, related to
medication regimen
Administer drugs that are sedating at bedtime to avoid excessive drowsiness during waking hours, and administer drugs that cause insomnia in the morning. Drugs that may cause insomnia include?
SSRIs:
fluoxetine
fluvoxamine
paroxetine
sertraline


MAO inhibitors:
phenelzine
tranylcypromine
Patient/Family teaching tips?
Avoid alcohol and other CNS
depressants
Avoid OTC drugs.
Educate about hypertensive
crisis.
Dizziness and drowsiness may
occur
Educate about orthostatic
hypotension.
Notify doctor of constipa-
tion, dry mouth, urinary
retention.
Notify doctor of herbal
remedies.
Emphasize psychotherapy.
If MAO inhibitors are discontinued, don't consume OTC drugs or foods and beverages with tyramine for at least 2 weeks or it may precipitate?
hypertensive crisis
Effectiveness of therapy can be demonstrated by? (4)
resolution of depression
decrease in anxiety
control of bedwetting in
children over 6 yo
management of chronic neuro-
genic pain
Name 5 groups of antidepressants?
MAOIs
SSRIs
tetracyclic antidepressants
tricyclic antidepressants
miscellaneous
Name 2 monamine oxidase inhibitors?
phenelzine Nardil

tranylcypromine Parnate
Name 5 SSRIs?
citalopram Celexa

fluoxetine Prozac, Prozac Weekly, Sarafem

fluvoxamine Luvox, Faverin, Fevarin, Dumyrox

paroxetine Paxil, Paxil CR

sertraline Zoloft
Name 1 tetracyclic antidepressant?
mirtazapine Remeron, Remeron Soltabs
Name 6 tricyclic antidepressants?
amitriptyline {Apo-Amitriptyline}, Elavil, Endep, {Levate}, {Novotriptyn}

amoxapine Asendin, Asendis, Defanyl, Demolox, Moxadil

desipramine Norpramin, {Pertofane}

doxepin Sinequan, {Triadapin}, Zonalon

imipramine {Apo-Imipramine}, {Impril}, Norfranil, {Novopramine}, Tipramine, Tofranil, Tofranil PM

nortriptyline Aventyl, Pamelor
Name 4 miscellaneous antidepressants?
bupropion
Wellbutrin, Wellbutrin SR, Zyban

nefazodone Serzone

trazodone Desyrel, Trialodine, Trazon

venlafaxine Effexor, Effexor XR
ACLS guidelines have recommended _______ NOT be used unless hyperkalemia, tricyclic antidepressant overdose, and/or preexisting metabolic acidosis is documented.
bicarbonate