Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
60 Cards in this Set
- Front
- Back
PTs with major depression
|
May require hospitalization w/implementation of close observation an suicide precautions until antidepressant medications reach their peak effect
|
|
Four Main groups of antidepressant medications
|
1. Tricyclic antidepressants
2. Selective serotonin reuptake inhibitors (SSRI) 3. MAOIs 4. Atypical Antidepressants |
|
Tricyclic Antidepressants (TCAs)
|
Tofranil
Sinequan Aventyl Asendin Surmontil Elavil |
|
Purpose of Elavil (tricyclic antidepressants) expect pharm action
|
Block reuptake of norepi and serotonin and synaptic space -thereby intensifyin effects of neurotransmitters
|
|
Tricyclic antidepressants Therapeutic Uses
|
Depression
Depressive episodes of bipolar episodes other uses: chronic pain enuresis |
|
Elavil - TCA - Side Effects: orthostatic hypotension
|
-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 |
|
Anticholonergic Effects of Elavil (TCA)
|
Dry mouth, blurred vision, photoba, urinary hesitancy/retention, constipation, tachycardia
|
|
ways to minimize anticholinergic effects w/ TCA - Elavil
|
-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 |
|
TCA - ELAVIL - Sedation
|
-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 |
|
TCA - Elavil Toxicity
|
Toxicity resulting in cholinergic blockade and cardiac toxicity e/b dysrhythmias, mental confusion, and agitation, which are followed by seizures, coma, and possible death
|
|
TCA - Elavil Toxicity NI
|
-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 |
|
cONTRAINDICATIONS For Elavil
|
-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 |
|
Don't take w/Elavil (tca)
|
- 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 |
|
SSRI Meds
|
Citalopram (Celexa)
Escitalopram (Lexapro) Paroxetine (Paxil) Sertraline (Zoloft) |
|
Expect pharm action of prozac/ssri
|
Selectively block reuptake of monoamine neurotansmitter serotonin in the synaptic space, thereby intensifying the effects of serotonin
|
|
Therapeutic uses of SSRIs
|
Major Depression
OCD Bulimia nervosa premenstrual dysphoric disorders panic disorders posttraumatic disorder |
|
Side Effects of Prozac
|
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
|
|
Prozac CNS stimulation s/e NI
|
Advise to take in morning
Avoid caffeine beverages Teach relaxation techniques to promote sleep |
|
Serotonin Syndrome Symptoms + Side Effects
|
May begin 2 to 72 hr start of treatment
Mental confusion agitation fever anxiety hallucinations hyperreflexia diaphoresis tremors |
|
Withdrawal Syndrome (Prozac side effect) Symptoms + NI
|
Headache, nausea, visual disturbances, anxiety, dizzy, tremors
Taper dose gradually |
|
Hyponatremia Side Effect (Prozac) NI
|
Obtain balance serum sodium, and monotor level periodically
|
|
Side Effect Prozac - sleepiness, faintness, lightheadedness NI
|
Advise these SE are not common but can occur. Avoid driving if these side effects occur
|
|
Side Effect GI bleeding prozac - NI
|
Use caution w/Pts w/hx of GI bleeding, ulcers, and those taking other meds that affect blood coag
|
|
Prozac Contraindications
|
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 |
|
Medication/Food Interaction SSRIs (St. John's wort, MAOI, TCA)
|
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 |
|
Medication/Food Interaction SSRIs +warfarin
|
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 |
|
Medication/Food Interaction SSRIs TCA + Lithium
|
concurrent use TCA + Lithium may result in increased levels of these meds
avoid concurrent use |
|
Medication/Food Interaction SSRIs + NSAIDS and anticogs
|
Can further surpress platelet aggregation, thereby increasing risk of bleeding
Advise pt TO MONITOR FOR SIGNS OF BLEEDING AND TO NOTIFY md IF OCCUR |
|
Monoamine Oxidase INhibitors (MAOIs) mEDS
|
Isocaroxazid (Marplan)
Tranylcypromine (parnate) Selegiline (Emsam) - transdermal patch Phenelzine (Nardil) |
|
MAOI Nardil expect pharm action
|
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
|
|
MAOI Nardil Therapeutic Uses
|
Atypical depression
Bulimia nervosa OCD |
|
Side Effects of MAOI - Nardil
|
CNS stimulation, orthostatic hypotension, hypertensive crisis, local rash associated w/transdermal prep
|
|
Side Effects of MAOI - Nardil --> CNS stimulation
|
anxiety, agitation, hypomania, mania
Advise PT to observe for symptoms and notify MD if occur |
|
Side Effects of MAOI - Nardil--> Ortho hypo
|
Monitor BP and HR for othostatic changes
Hold med and notify MD if significant changes Advise PT to change positions slowly |
|
Side Effects of MAOI - Nardil--> Hypertensive Crisis
|
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 |
|
Contraindications/Precautions MAOI - Nardil
|
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 |
|
Transdermal selegiline
|
Contra for PTs taking carbmazepine (tegretol) or oxcarbazepine (Trileptal). Concurrent use of meds may increase blood levels of MAOI
|
|
Medication/Food Interactions MAOI - Nardil [indirect acting sympathomimetic]
|
-->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 |
|
Concurrent use w/TCAs can lead to.... (MAOI - Nardil)
|
hypertensive crisis
concurrent use of maois and tcas should be used cautiously |
|
MAOI + SSRI
|
Can lead to serotonin syndrome - avoid concurrent use
|
|
Antihypertensives + MAOIs (Nardil)
|
can cause additive hypotensive effects
monitor BP, notify MD if significant drop in bP occurs - as dosage of antihypertensive may need to be decreased |
|
Demerol + MAOI (Nardil)
|
can lead to hyperpyrexia (fever)
Alternative analgesic should be used |
|
tYRAMINE Foods + MAOIS
|
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 |
|
Tyramine Rich Foods
|
aged cheese, pepperonie, salami, avocados, figs, bananas, smoked fish, protein, some dietary supplements, some beers, and red wines
|
|
MAOIS (Nardil) + vasopressors
|
(caffeine, phenylethylamine may result in hypertension)
- avoid caffein beverages, chocolate, dava beans and ginseng |
|
Atypical Antidepressants -
|
WELLBUTRIN - generic = bupropion
|
|
Expected pharm action Atypical Antidepressants
|
acts by inhibiting dopamine uptake
|
|
Atypical Antidepressants therapeutic uses
|
treatment of depression
alternative to SSRIs for PT unable to tolerate sexual dysfunction Aid to quit smoking Prevention of seasonal affective disorder |
|
Atypical Antidepressants Side Effects
|
headache, dry mouth, GI distress, constipation, increased HR, nausea, restlessness, insomnia, suppression appetite = wt loss
|
|
Atypical Antidepressants + Seizures
|
especially at higher dosages
avoid administering to PTs at risk for seizures, such as PT w/head injury |
|
Contraindications Atypical Antidepressants (buproprion)
|
Concurrent use w/MAOIs such as phenelzine (Nardil), may increase risk for toxicity
MAOIS should be d/ced 2 wks prior to starting buproprion |
|
Venlafaxine (effexor) + Duloxetine (Cymbalta) Atypical Antidepressants Pharm Action
|
Inhibit serotonin and norepinephrine reuptake, thereby increasing amt of these neurotransmitters available in the brain for impulse transmission. Minimal amt of dopamine blockade.
|
|
Venlafaxine (effexor) + Duloxetine (Cymbalta) Atypical Antidepressants NI --> Side effects
|
-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 |
|
Mirtazapine (Remeron) Atypical Antidepressant pharm Action
|
Increases releases of serotonin and norepi, thereby increasing amt of these neurotransmitters available for impulse transmission
|
|
Mirtazapine (Remeron) Atypical Antidepressant --> Side effects + NI
|
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 |
|
Reboxetine (Edronax) Atypical Antidepressant Pharm Action
|
Selectively inhibits reuptake of norepi, thereby increasing amt of these neurotransmitters available for impulse transmission
|
|
Reboxetine (Edronax) Atypical Antidepressant Side effects + NI
|
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 |
|
Trazodone (Desyrel) Atypical Antidepressants Pharm Action
|
Has moderate selective blockade of serotonin receptors, thereby increasing the amt of that neurotransmitter available for impulse transmission
|
|
Trazodone (Desyrel) Atypical Antidepressants NI + Side Effects
|
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 |
|
SSRI Nursing Intervention
|
-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 |