Psyh Ati Ch. 20 Meds For Depression

Front 1

PTs with major depression

Back 1

May require hospitalization w/implementation of close observation an suicide precautions until antidepressant medications reach their peak effect

Front 2

Four Main groups of antidepressant medications

Back 2

1. Tricyclic antidepressants
2. Selective serotonin reuptake inhibitors (SSRI)
3. MAOIs
4. Atypical Antidepressants

Front 3

Tricyclic Antidepressants (TCAs)

Back 3

Tofranil
Sinequan
Aventyl
Asendin
Surmontil
Elavil

Front 4

Purpose of Elavil (tricyclic antidepressants) expect pharm action

Back 4

Block reuptake of norepi and serotonin and synaptic space -thereby intensifyin effects of neurotransmitters

Front 5

Tricyclic antidepressants Therapeutic Uses

Back 5

Depression
Depressive episodes of bipolar episodes

other uses: chronic pain
enuresis

Front 6

Elavil - TCA - Side Effects: orthostatic hypotension

Back 6

-Instruct PT about signs of postural hypotension. If occur - advise PT to sit or lie down. Ortho hypo can be minimized by getting up slow, or changing positions slowly

-Monitor hospitalized PT's blood pressure and HR for ortho changes. If sig decrease in BP and or increase in HR is noted, do not administer the medication, and notify the provider

Front 7

Anticholonergic Effects of Elavil (TCA)

Back 7

Dry mouth, blurred vision, photoba, urinary hesitancy/retention, constipation, tachycardia

Front 8

ways to minimize anticholinergic effects w/ TCA - Elavil

Back 8

-Chew sugarless gum
-Sip water
-Wear sunglasses when outdoors
- Eat foods high in fiber
-increased fluids to 2-3L/day
-void just before taking med

Front 9

TCA - ELAVIL - Sedation

Back 9

-usually diminishes over time
-advise PT to avoid hazardous activities, such as driving, if sedation is excessive
-Advise PT to take med at bedtime to minimize daytime sleepiness and to promote sleep

Front 10

TCA - Elavil Toxicity

Back 10

Toxicity resulting in cholinergic blockade and cardiac toxicity e/b dysrhythmias, mental confusion, and agitation, which are followed by seizures, coma, and possible death

Front 11

TCA - Elavil Toxicity NI

Back 11

-Give a 1 week supply of med to PTs who are acutely ill
Obtain PT baseline ECG
Monitor VS frequently
Monitor PT for signs of toxicity
Notify MD if signs occur

Front 12

cONTRAINDICATIONS For Elavil

Back 12

-Preg category C
-Contra for seizure disorders
use w/caution w/ Pt's w/coronary artery disease; diabetes, liver+kidney+ respiratory disorders, urinary retention + obstruction, angle closure glaucoma, benign prostatic hypertrophy, and hyperthyroidism

Front 13

Don't take w/Elavil (tca)

Back 13

- MAOIS (causes hypertension)
- Antihistamines + anticholinergic agents - results in additive effects
- direct-acting sympathomimetics may result in increased effects of these meds - because uptake is blocked by TCAs
-Alcohol, benzodiazepines, opioids, and antihistamines may result in additive CNS depression

Front 14

SSRI Meds

Back 14

Citalopram (Celexa)
Escitalopram (Lexapro)
Paroxetine (Paxil)
Sertraline (Zoloft)

Front 15

Expect pharm action of prozac/ssri

Back 15

Selectively block reuptake of monoamine neurotansmitter serotonin in the synaptic space, thereby intensifying the effects of serotonin

Front 16

Therapeutic uses of SSRIs

Back 16

Major Depression
OCD
Bulimia nervosa
premenstrual dysphoric disorders
panic disorders
posttraumatic disorder

Front 17

Side Effects of Prozac

Back 17

Sexual dysfunction, CNS stimulation (inability to sleep, agitation, anxiety), Occurence of wt loss early then wt gain after long term treatment, withdrawal syndrome, rash, hyponatremia, sleepiness, GI bleeding, bruxism

Front 18

Prozac CNS stimulation s/e NI

Back 18

Advise to take in morning
Avoid caffeine beverages
Teach relaxation techniques to promote sleep

Front 19

Serotonin Syndrome Symptoms + Side Effects

Back 19

May begin 2 to 72 hr start of treatment
Mental confusion
agitation
fever
anxiety
hallucinations
hyperreflexia
diaphoresis
tremors

Front 20

Withdrawal Syndrome (Prozac side effect) Symptoms + NI

Back 20

Headache, nausea, visual disturbances, anxiety, dizzy, tremors

Taper dose gradually

Front 21

Hyponatremia Side Effect (Prozac) NI

Back 21

Obtain balance serum sodium, and monotor level periodically

Front 22

Side Effect Prozac - sleepiness, faintness, lightheadedness NI

Back 22

Advise these SE are not common but can occur. Avoid driving if these side effects occur

Front 23

Side Effect GI bleeding prozac - NI

Back 23

Use caution w/Pts w/hx of GI bleeding, ulcers, and those taking other meds that affect blood coag

Front 24

Prozac Contraindications

Back 24

Preg category C
May increase risk of birth defects. Other SSRIs should be used.
Contra in PTs taking MAOIs or TCAs
Use caution w/liver and or renal dysfunction, cardiac disease, seizure disorders, ulcers, and a hx of GI bleeding

Front 25

Medication/Food Interaction SSRIs (St. John's wort, MAOI, TCA)

Back 25

Concurrent use w/MAOIs, TCAs, St. John's Wort increases the risk of serotonin syndrome

**MAOIs should be d/ced 14 days prior to starting SSRI. Prozac should be cd/ed 5 weeks before starting MAOI

Advise against st john's wart

Front 26

Medication/Food Interaction SSRIs +warfarin

Back 26

concurrent use can displace warfarin from bound protein and result in increased warfain levels

Montior PT PTT and INR
Assess for signs of bleeding and need for dosage adjustment

Front 27

Medication/Food Interaction SSRIs TCA + Lithium

Back 27

concurrent use TCA + Lithium may result in increased levels of these meds

avoid concurrent use

Front 28

Medication/Food Interaction SSRIs + NSAIDS and anticogs

Back 28

Can further surpress platelet aggregation, thereby increasing risk of bleeding

Advise pt TO MONITOR FOR SIGNS OF BLEEDING AND TO NOTIFY md IF OCCUR

Front 29

Monoamine Oxidase INhibitors (MAOIs) mEDS

Back 29

Isocaroxazid (Marplan)
Tranylcypromine (parnate)
Selegiline (Emsam) - transdermal patch
Phenelzine (Nardil)

Front 30

MAOI Nardil expect pharm action

Back 30

Block MAO-A in brain, increasing amount of norepi, dopamine, and serotonin available for transmission impulses. An increased amount of those neurotran at nerve endings intensifies response and relieves depression

Front 31

MAOI Nardil Therapeutic Uses

Back 31

Atypical depression
Bulimia nervosa
OCD

Front 32

Side Effects of MAOI - Nardil

Back 32

CNS stimulation, orthostatic hypotension, hypertensive crisis, local rash associated w/transdermal prep

Front 33

Side Effects of MAOI - Nardil --> CNS stimulation

Back 33

anxiety, agitation, hypomania, mania

Advise PT to observe for symptoms and notify MD if occur

Front 34

Side Effects of MAOI - Nardil--> Ortho hypo

Back 34

Monitor BP and HR for othostatic changes
Hold med and notify MD if significant changes
Advise PT to change positions slowly

Front 35

Side Effects of MAOI - Nardil--> Hypertensive Crisis

Back 35

Results from intake of dietary tyramine - severe hypertension as a result of intensive vasoconstriction and stimulation of the heart. Manifestations may include: headache, nausea, increased HR + BP

Administer phentolamine (Regitine) IV, a rapid-acting alapha-adrenergic blocker, or nifedipine (Procardia)
-Provide continuous cardiac monitoring and resp support as indicated

Front 36

Contraindications/Precautions MAOI - Nardil

Back 36

Preg cat C
-Contra in PTs taking SSRIS, or PT w/pheochromocytoma, heart failure, cardivascular and cerebral vascular disease, and/or severe renal insufficiency
-Caution w/ diabetes and/orseizure disorders, or those taking TCAs

Front 37

Transdermal selegiline

Back 37

Contra for PTs taking carbmazepine (tegretol) or oxcarbazepine (Trileptal). Concurrent use of meds may increase blood levels of MAOI

Front 38

Medication/Food Interactions MAOI - Nardil [indirect acting sympathomimetic]

Back 38

-->Ephedrine, amphetamine can promote the release of norepinephrine and lead to hypertensive crisis

Advise PT that over the counter decongestants and cold remedies frequently contain medications with sympathomimetic action and should therefore be avoided

Front 39

Concurrent use w/TCAs can lead to.... (MAOI - Nardil)

Back 39

hypertensive crisis

concurrent use of maois and tcas should be used cautiously

Front 40

MAOI + SSRI

Back 40

Can lead to serotonin syndrome - avoid concurrent use

Front 41

Antihypertensives + MAOIs (Nardil)

Back 41

can cause additive hypotensive effects

monitor BP, notify MD if significant drop in bP occurs - as dosage of antihypertensive may need to be decreased

Front 42

Demerol + MAOI (Nardil)

Back 42

can lead to hyperpyrexia (fever)
Alternative analgesic should be used

Front 43

tYRAMINE Foods + MAOIS

Back 43

Hypertensive crisis can result form intake of dietary tyramine. May inclused - headache, nausea, increased HR + BP

Assess PT ability to follow strict diet
Inform PT of symptoms
Provide PT w/written instructions regarding food + beverages to avoid

Front 44

Tyramine Rich Foods

Back 44

aged cheese, pepperonie, salami, avocados, figs, bananas, smoked fish, protein, some dietary supplements, some beers, and red wines

Front 45

MAOIS (Nardil) + vasopressors

Back 45

(caffeine, phenylethylamine may result in hypertension)

- avoid caffein beverages, chocolate, dava beans and ginseng

Front 46

Atypical Antidepressants -

Back 46

WELLBUTRIN - generic = bupropion

Front 47

Expected pharm action Atypical Antidepressants

Back 47

acts by inhibiting dopamine uptake

Front 48

Atypical Antidepressants therapeutic uses

Back 48

treatment of depression
alternative to SSRIs for PT unable to tolerate sexual dysfunction
Aid to quit smoking
Prevention of seasonal affective disorder

Front 49

Atypical Antidepressants Side Effects

Back 49

headache, dry mouth, GI distress, constipation, increased HR, nausea, restlessness, insomnia, suppression appetite = wt loss

Front 50

Atypical Antidepressants + Seizures

Back 50

especially at higher dosages
avoid administering to PTs at risk for seizures, such as PT w/head injury

Front 51

Contraindications Atypical Antidepressants (buproprion)

Back 51

Concurrent use w/MAOIs such as phenelzine (Nardil), may increase risk for toxicity

MAOIS should be d/ced 2 wks prior to starting buproprion

Front 52

Venlafaxine (effexor) + Duloxetine (Cymbalta) Atypical Antidepressants Pharm Action

Back 52

Inhibit serotonin and norepinephrine reuptake, thereby increasing amt of these neurotransmitters available in the brain for impulse transmission. Minimal amt of dopamine blockade.

Front 53

Venlafaxine (effexor) + Duloxetine (Cymbalta) Atypical Antidepressants NI --> Side effects

Back 53

-Headache, nausea, agitation, anxiety, and sleep disturbances
-Monitor for hyponatremia, especially in older adults
-Monitor PT for wt loss
-Monitor the PT for increases in diastolic BP
-Discuss ways to manage interference with sexual functioning
-Advise PT to avoid abrupt cessation of med

Front 54

Mirtazapine (Remeron) Atypical Antidepressant pharm Action

Back 54

Increases releases of serotonin and norepi, thereby increasing amt of these neurotransmitters available for impulse transmission

Front 55

Mirtazapine (Remeron) Atypical Antidepressant --> Side effects + NI

Back 55

Therapeutic effects may occur sooner, and with less sexual dysfunction than w/SSRIs

This med is generally well tolerated, side effects = sleepiness that can be exacerbated by other CNS depressants, weight gain, and elevated cholesterol

Front 56

Reboxetine (Edronax) Atypical Antidepressant Pharm Action

Back 56

Selectively inhibits reuptake of norepi, thereby increasing amt of these neurotransmitters available for impulse transmission

Front 57

Reboxetine (Edronax) Atypical Antidepressant Side effects + NI

Back 57

Yields similar results to SSRI
Generally well tolerated, experience dry mouth, decreased BP, constipation, sexual dysfunction, and urinary hestitancy + rentention
Wt gain and sleepiness do NOT occur
Avoid concurrent use w/an MAOI

Front 58

Trazodone (Desyrel) Atypical Antidepressants Pharm Action

Back 58

Has moderate selective blockade of serotonin receptors, thereby increasing the amt of that neurotransmitter available for impulse transmission

Front 59

Trazodone (Desyrel) Atypical Antidepressants NI + Side Effects

Back 59

Usually used w/another antidepressant agent. May be indicated for insomnia caused by another SSRI

Priapism may be a serious side effect, and clients should be instructed to seek medical attention ASAP

Front 60

SSRI Nursing Intervention

Back 60

-Advise PT to take these medications in the morning to minimize sleep disturbances
-Advise PT to take these medications w/food to minimize GI disturbances
-Obtain baseline sodium levels for older adult PT taking diuretics; monitor periodically