Pharmacology Ati Depressive Disorders (Chapter 8; Unit 2)

Front 1

what are the 4 main groups of antidepressants?

Back 1

1) SSRIs (Selective serotonin inhibitors)

2) Atypical antidepressants

3) Tricylic antidepressants (TCAs)

4) MAOIs (monoamine oxidase inhibitors)

Front 2

when a depressive client is admitted to the hospital and before the therapeutic effects have taken place what does the nurse want to do?

Back 2

put client on suicide watch

Front 3

what are the SSRIs used to treat depressive disorders?

Back 3

1) fluoxetine (Prozac)

2) citalopram (Celexa)

3) escitalopram (Lexapro)

4) paroxetine (Paxil)

5) sertraline (Zoloft)

6) vilazodone (Viibryd)

Front 4

Citalopram

Back 4

Celexa

Front 5

cilazodone

Back 5

Viibryd

Front 6

therapeutic uses of fluoxetine

Back 6

major depression, OCD, bulimia nervosa, premenstrual dysphoric disorders (PMDD), panic disorders, postraumatic stress disorder

Front 7

what are the adverse effects of fluoxetine?

Back 7

1) sexual dysfunction

2) CNS stimulation

3) weight loss early in treatment, possible weight gain late in treatment

4) serotonin syndrome

5) withdrawal syndrome

6) hyponatremia

7) rash

8) sleepiness, faintness, lightheadedness

9) GI bleeding

10) bruxism

Front 8

what are the symptoms of the adverse effects CNS stimulation when taking fluoxetine?

Back 8

inability to sleep, agitation, anxiety

Front 9

what are the nursing interventions for the adverse effects of fluoxetine?

Back 9

1. sexual dysfunction -- inform of effects and tell provider, can manage sexual dysfunction through lower dosage, med holiday, and using adjunct medications

2) cns stimulation -- notify provider dose made need to be lowered, take dose in morning, advise against caffeinated drinks, teach relaxation techniques to promote sleep

3) weight changes -- monitor weight, regular exercise and healthy diet

4) serotonin syndrome -- observe for manifestations, notify provider and withhold med

5) withdrawal syndrome -- taper dose

6) hyponatremia -- baseline, monitor

7) rash -- treatable with antihistamine or withdrawal of med

8) sleepiness etc -- advise not common but can occur, advise avoid driving/heavy machinery

9) GI bleeding -- hx of GI problems/taking coagulant meds

10) bruxism -- report to provider, mouth guard, change or add low dose buspirone

Front 10

What Pregnacy Risk Category are most SSRIs? which 2 increase the risk of birth defects? late in pregnancy what can SSRIs do?

Back 10

C; fluoxetine and paroxetine; increases risk of withdrawal symptoms or pulmonary hypertension in the newborn

Front 11

when taking fluoxetine with __________, risk of serotonin syndrome is increased

Back 11

MAOIs, TCAs, and St. John's wort

Front 12

fluoxetine can increase levels of __________

Back 12

TCAs and lithium

Front 13

med/food interactions of fluoxetine

Back 13

1. MAOIs, TCAs, and St. John's wort increases risk of serotonin syndrome

2. fluoxetine can displace warfarin from bound proteins resulting in increased warfarin levels

3. fluoxetine can increase levels of TCAs and lithium

4. fluoxetine can supress platelet aggregation and increase risk of bleeding when used with NSAIDs or anticoagulants

Front 14

if fluoxetine is given with warfarin (Coumadin) what are nursing interventions?

Back 14

monitor the client's PT (prothrombin time) and INR (international normalized ratio) levels; asess for indications of bleeing and need for dosage adjustment

Front 15

how long should an MAOI be discontinued before starting an SSRI?

Back 15

14 days

Front 16

how long should the client wait to start taking an MAOI when on fluoxetine?

Back 16

5 weeks

Front 17

what is the selected prototype medication for atypical antidepressants?

Back 17

bupropion HCL (Wellbutrin)

Front 18

bupropion HCL

Back 18

Wellbutrin

Front 19

MOA of bupropion HCL (Wellbutrin)

Back 19

not fully understood, likely inhibits dopamine uptake

Front 20

therapeutic usess of bupropion HCL (Wellbutrin)

Back 20

depression treatment, alternative to SSRI for clients unable to tolerate sexual dysfunction side effects of SSRIs, aid to quit smoking, prevention of seasonal pattern depression

Front 21

which meds can aid with the adverse effect of fluoxetine that causes exual dysfunction

Back 21

sildenafil (Viagra) and buspirone (BuSpar), also bupropion (Wellbutrin) is an antidepressant with fewer sexual side effects

Front 22

sildenafil

Back 22

Viagra

Front 23

adverse effects of bupropion HCL (Wellbutrin)

Back 23

1. headache, dry mouth, GI distress, constipation, increased heart rate, nausea, restlessness, and insomnia

2. supresses appetite and often causes weight loss

3. seizures

Front 24

nursing interventions for the adverse effects of buproprion HCL (Wellbutrin)

Back 24

1. headache etc -- observe for effects, notify physician, treat headache with mild analgesic, advise to sip on fluids to treat dry mouth and increase dietary fiber to prevent constipation

2. supressed appetite/weight loss -- monitor weight/food intake

3. seizures -- avoid admnistering to clients at risk for seizures such as a client whose had a head injury, monitor for seizures/treat accordingly

Front 25

buproprion HCL (Wellbutrin) is a Pregnancy Risk Category ______

Back 25

B

Front 26

buproprion HCL (Wellbutrin) is contraindicated in clients taking ______ (how do they interact, what is the nursing intervention)

Back 26

MAOIs; MAOIs such as phenelzine increase the risk of toxicity; MAOI should be discontinued 2 weeks prior to beginning treatment with bupropion

Front 27

duloxetine

Back 27

Cymbalta

Front 28

mirtazapine

Back 28

Remeron

Front 29

reboxetine

Back 29

Edronax

Front 30

trazadone

Back 30

Desyrel

Front 31

what are the atypical antidepressants for depressive disorders?

Back 31

1. venlafaxine (Effexor)

2. duloxetine (Cymbalta)

3. mirtazapine (Remeron)

4. reboxetine (Edronax)

5. trazodone (Desyrel)

Front 32

MOA of venlafaxine (Effexor) and duloxetine (Cymbalta)

Back 32

inhibit serotonin and norepinephrine reuptake thereby increasing amount of neurotransmitters available in brain for impulse transmission; also minimal amount of dopamine blockade

Front 33

MOA of mirtazapine (Remeron)

Back 33

increases release of serotonin and norepinephrine and thereby increases amount available for impulse transmission

Front 34

MOA of reboxetine (Edronax)

Back 34

selectively inhibits reuptake of norepi increasing amount available for impulse transmission

Front 35

MOA of trazodone (Desyrel)

Back 35

moderate selective blockade of serotonin receptors which allows more serotonin to be available for impulse transmission

Front 36

adverse effects symptoms for venlafaxine (Effexor) and duloxetine (Cymbalta)

Back 36

headache, nausea, agitation, anxiety, and sleep disturbances

Front 37

nursing implication for venlafaxine (Effexor) and duloxetine (Cymbalta)

Back 37

1) inform of adverse effects

2) monitor for hyponatremia especially in older adults

3) monitor for weight loss

4) discuss way to manage interference with sexual functioning

5) advise not to discontinue abruptly

Front 38

nursing implications of mirtazapine (Remeron)

Back 38

1) therapeutic effects may occur sooner with less sexual dysfunction than SSRIs

2) mirtazapine generally well tolerated, may experience sleepiness that can be exacerbated by other CNS depressants (alcohol, benzodiazepines), weight gain, elevated cholesterol

Front 39

nursing implications of reboxetine (Edronax)

Back 39

1. similar results as SSRIs

2. generally well tolerated but may experience adverse effects

3. weight gain and sleepiness do not occur

4. med should not be combined with MAOI

Front 40

adverse effects of reboxetine (Edronax)

Back 40

dry mouth, decreased BP, constipation, sexual dysfunction, urinary hesitancy/retention

Front 41

nursing implications of trazodone (Desyrel)

Back 41

1) usually used with another antidepressant, sedation is a potential problem, may be indicated for a client who has insomnia caused by an SSRI

2) priapism is a potential adverse effect, instruct to seeks immediate medical advice

Front 42

priapism

Back 42

when erect penis does not return to flaccid state

Front 43

name the TCAs (tricyclic antidepressants) for depressive disorders

Back 43

1. amitriptyline (Elavil)

2. imipramine (Togranil)

3. Doxepin (Sinequan)

3. nortiptyline (Aventyl)

4. amoxapine (Asendin)

5. trimipramine (Surmontil)

Front 44

what is the MOA of amitriptyline (Elavil)

Back 44

blocks reuptake of norepi and serotonin in the synaptic space, thereby intensifying effects of neurotransmitters

Front 45

what are the therapeutic uses of amitriptyline (Elavil)

Back 45

depression, depressive episodes of bipolar disorders
other uses: neuropathic pain, fibromyalgia, anxiety disorders, insomnia

Front 46

what are the adverse effects of amitriptyline (Elavil)?

Back 46

1. othostatic tension

2. anticholinergic effects

3. sedation

4. toxicity

5. decreased seizure threshold

6. excessive sweating

Front 47

what are the anticholinergic effects of amitriptyline (Elavil)

Back 47

dry mouth, blurred vision, photophobia, urinary hesitancy/retention, constipation, tachycardia

Front 48

toxicity as a result of amitriptyline when treating depressive disorder can result in _____ EVB ___________

Back 48

result in cholinergic blockade and cardiac toxicity as evidenced by dysrhythmias, mental confusion and agitation (followed by seizures, coma and possible death)

Front 49

nursing implications for the adverse effect orthostatic hypotension of amitriptyline when treating a depressive disorder

Back 49

1. orthostatic hypotension -- instruct about effects of postural hypotension (lightheadedness, dizziness)l if occur advise client to sit or lie down, ortho hypo is minimized by changing position slowly

2. monitor BP and HR for clients in hospital for orthostatic changes before admin and 1 hour after; significant decrease in BP or increase in HR means don't admin and notify provider

Front 50

nursing implications for the adverse effect anticholinergic effects of amitriptyline when treating a depressive disorder

Back 50

ways to minimized anticholinergic effects

1. chewing sugarless gum

2. sipping on water

3. wearing sunglasses when outdoors

4. eating foods high in fiber

5. participating in regular exercise

6. increasing fluid intake to at least 2 to 3L a day from beverages and food sources

7. voiding just before taking medication

(notify provider if persists)

Front 51

nursing implications for the adverse effects sedation, toxicity, decreased seizure threshold, excessive sweating of amitriptyline when treating a depressive disorder

Back 51

1. sedation -- effect usually diminishes over time, advise to avoid hazardous activities like driving/heavy machinery, advise to take at bedtime to minimize daytime sleepiness/promote sleep

2. toxicity -- obtain clients' baseline ECG, monitor vitals and signs of toxicity, notify provider

3. decreased seizure threshold -- monitor clients with seizure disorders

4. excessive sweating -- change linens frequently

Front 52

TCAs are Pregnancy Risk Category _________

Back 52

C

Front 53

use amitriptyline (TCAs?) cautiously in clients who have __________________

Back 53

coronary artery disease, diabetes, liver/kidney/respiratory disorders, urinary retention/obstruction, angle-closure glaucoma, benign prostatic hyperplasia, and hyperthyroidism

Front 54

when using amitriptyline (TCAs?) with a client with an increased risk for suicide, what is important to know

Back 54

should receive a 1-week supply of medication at a time due to the lethality of overdose

Front 55

TCAs contraindicated for patients with ________ disorders

Back 55

seizure

Front 56

med/food interactions of amitriptyline (Elavil) when treating depressive disorders

Back 56

1. MAO/St. Jonh's wort (increased serotonin syndrome)

2. antihistamines/other anticholinergic agents have additive anticholinergic effects

3. increased effects of epi and dopamine (direct-acting sympathomimetics) because uptake into nerve terminal blocked by TCA and remain longer in synaptic space

4. TCAs decrease effects of ephedrine, aphetamine (indirect-acting sympathomimetics) because uptake into nerve terminals is blocked and are unable to reach site of action

5. aclohol, benzodiazepines, and antihistamines caused additive CNS depression

Front 57

name the MAOIs (monoamine oxidase inhibitors)

Back 57

1) phenelzine (Nardil)

2) isocarboxazid (Marplan)

3) tranylcypromine (Parnate)

4) selegiline (Emsam)

Front 58

phenelzine

Back 58

Nardil

Front 59

isocarboxazid

Back 59

Marplan

Front 60

tranylcypromine

Back 60

Parnate

Front 61

selegiline

Back 61

Emsam

Front 62

how is selegiline (Emsam) administered?

Back 62

transdermally

Front 63

MOA of MAOIs

Back 63

bloack MAO in the brain increasing amount of norepi, dopamine, and serotonin available for transmission so impulses; increased amount of these neurotrans at nerve endings intensifies responses and relieves depression

Front 64

therapuetic uses of phenelzine (Nardil)/MAOs

Back 64

depression, bulimia

Front 65

adverse effects of phenelzine (Nardil) when treating depressive disorders

Back 65

1. CNS stimulation

2. orthostatic hypotension

3. hypertensive crisis resulting from intake of dietary tyramine

4. local rash with transdermal preparation

Front 66

how does a hypertensive crisis result as an adverse effect of phenelzine (Nardil)? what occurs in the body? what are the symptoms?

Back 66

intake of dietary tyramine; severe hypertension as a result of intensive vasoconstriction and stimulation of the heart; client experience headache, nausea, increased HR and BP

Front 67

nursing interventions for adverse effects of phenelzine (Nardil) when treating depressive disorders

Back 67

1. cns stimulation -- advise of effects/notify provider

2. orthostatic hypotension -- monitor BP and HR, hold med and notify provider of changes, client change positions slowly

3. hypertensive crisis -- administer phentolamine (Regitine) IV which is a rapid-acting alpha-adrenergic blocker or administer nifedipine (Procardia) SL (sublingual) ; provide continuous cardiac monitoring and respiratory support as indicated

4. rash -- choose clean, dry area for application, apply a topical glucocorticoid on the affected area

Front 68

MAOIs are Pregnancy Risk Category _____

Back 68

C

Front 69

MAOIs are contraindicated in clients who ___________

Back 69

are taking SSRIs, have pheochromocytoma, heart failure, cardiovascular/cerebral vascular disease, and severe renal insufficiency

Front 70

use MAOIs cautiously in clients who ________

Back 70

have diabetes, seizure disorders, or taking TCAs

Front 71

transdermal selegiline is contraindicated in clients who are taking _____ (why?)

Back 71

are taking carbamazepine (Tegretol) or oxcarbazepine (Trileptal) which may increase blood levels of MAOIs

Front 72

what are the symptoms of CNS stimulation by phenelzine (Nardil)?

Back 72

anxiety, agitation, mania or hypomania

Front 73

med/food interactions of phenelzine (Nardil)

Back 73

1. indirect-cating sympathomimetic meds (ephedrine, amphetamine) which promote release of norepi and leads to hypertensive crisis

2.TCAs -> hypertensive crisis

3. SSRIs -> serotonin syndrome

4. antihypertensives -> additive hypotensive effect

5. meperidine (Demerol) -> hyperpyrexia

6. tyramine-rich foods -> hypertensive crisis

7. concurrent use of vasopressors (phenylethylamine, caffeine) -> hypertension

Front 74

nursing interventions for med/food interactions of phenelzine (Nardil)

Back 74

1. indirect-acting sympathomimetic meds -> instruct to acoid OTC decongestants and cold remedies which frequently contain drugs with sympathomimetic action

2. TCAs - use cautiously concurrently

3. SSRIs -> avoid concurrent use

4. antihypertensives -> monitor BP, notify provider if BP drops significantly, reduced dosage of antihypertensive may happen

5. meperidine (Demerol) -- alternative analgesic

6. tyramine-rich foods -- assess ability to follow diet, inform client of manifestations to notify provider, provide with written instructions regarding foods/drinks to avoid, advise to avoid taking ANY meds/herbals without provider's approval

7. vasopressors - advise client to avoid foods with these agents

Front 75

which foods are rich in tyramine

Back 75

aged cheese, pepperoni, salami, avocados, figs, bananas, smoked fish, protein dietary supplements, soups, soy sauce, some beers, and red wine

Front 76

which foods are rich with vasopressors

Back 76

caffeinated beverges, chocolate, fava beans, ginseng

Front 77

what are two types of vasopressors

Back 77

caffein, phenylethylamine

Front 78

phentolamine

Back 78

Regitine

Front 79

nifedipine

Back 79

Procardia

Front 80

first therapeutic effects of MAOIs can take up to ________ to onset; full therapeutic effects can take up to how long?

Back 80

1-3 weeks; 2-3 months

Front 81

remember about MAOIs.....

Back 81

take as prescribed on daily basis to establish therapeutic plasma levels, don't discontinue when effects reached as can result in relapse

Front 82

therapy with MAOIs can continue for _________ months after resolution of symptoms and may continue for ____________

Back 82

6 months, a year or longer

Front 83

asses clients for risk of _______ when taking MAOIs b/c _________

Back 83

suicide, antidepressant meds can increase client's risk for suicide particularly during initial treatment

Front 84

antidepressant-induced suicide is mainly associated with clients younger than age ________

Back 84

25

Front 85

overview nursing administration (3 things) for SSRIs

Back 85

1. advise to take med in morning to minimize sleep disturbances

2. advise client to take meds with food to minimize GI disturbances

3. obtain baseline sodium levels for older clients taking diuretic, monitor periodically

Front 86

overview nursing admin (2 things) for atypical antidepressants

Back 86

1. AVOID use with MAOIs

2. advise clients taking bupropion for prevention of seasonal pattern depression to take med beginning in autumn each year and gradually taper dose to discontinue in spring

Front 87

overview nursing admin (2 things) for TCAs

Back 87

1. monitor toxicity manifested by cardiac dysrhythmias

2. administer at bedtime due to sedation and risk for orthostatic hypotension

Front 88

overview nursing admin (2 things) for MAOIs

Back 88

1. give client list of tyramine-rich food so hypertensive crises can be avoided

2. advise to avoid taking other prescription/nonprescription drugs unless approved by provider

Front 89

Nursing eval of medication effectiveness of treatments for depressive disorders

Back 89

1. verbalizing improvement in mood

2. ability to perform ADLs

3. improved sleeping and eating habits

4. increased interaction with peers