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Psychopharmacology

Antidepressants

QuestionAnswer
Which neurotransmitter is stimulated by benzodiazepines? GABA
Name 4 Benzodiazepine drugs Xanax (alprazolam); Ativan (lorazepam); Librium (chlordiazepoxide); Valium (diazepam); Klonopin (clonazepam)
What are the side effects of benzodiazepines? drowsiness, hangover, sedation, lethargy, transient hypotension,
What are the nursing interventions for someone on benzodiazepines? Monitor liver function tests, CBC, Hct, BP
What are the benefits of Buspar over benzodiazepines? Lower sedative properties, lower potential for dependence; 7-10 days before signs of improvement; 3-4 weeks for optimal effect
What are the side effects of Buspar? slurred speech, dizziness, drowsiness, light-headedness
What are the three classes of antidepressants? SSRI (SSNRI), tricyclic, MAOI
What is the most widely used class of antidepressant? SSRI's
Give 5 examples of SSRIs. Zoloft (sertraline); Prozac (fluoxetine); Paxil (paroxetine); Celexa (citalopram); Lexapro (escitalopram)
What are the side effects of SSRIs? N&V, diarrhea sometimes, increased risk of suicidal ideation, decreased libido, if insomnia occurs take in morning
What is the mechanism of action for SSNRI's? SSNRI's inhibit the reuptake of serotonin and norepinephrine
Give 2 examples of SSNRIs. Cymbalta (dultoxetine), Effexor (vanlafaxine)
What are the signs & symptoms of serotonin syndrome? Restlessness, Agitation, Diaphoresis, Muscle Rigidity,Ataxia, Shivering, Low-grade fever, Disorientation, Confusion, Seizures, Coma
What is the treatment for serotonin syndrome? Discontinue med; give anticonvulsant for seizure; lorazepam for agitation; diazepam for rigidity
What is the action of tricyclic antidepressants? They block reuptake of serotonin, norepinephrine,& dopamine.
Give 3 examples of tricyclic antidepressants? Elavil (amitriptyline); Sinequan (doxepin); Tofranil (imipramine)
What are the side effects of tricyclic antidepressants? Anticholingergic effects; sedation; orthostatic hypotension; parkinsonism; seizure; arrhythmias; heart failure; increased risk for suicidal ideation
What is the greatest concern re: overdose with tricyclic antidepressants? Cardiac effects
What is the action of MAOIs. blocks the metabolic destruction of norepinephrine, dopamine, and serotonin by the enzyme monamine oxidase
Give 2 examples of MAOIs. Nardil (phenelzine); Parnate (tranylcypromine)
What are the side effects of MAOIs? Orthostatic hypotension, Drowsiness, Sedation, Anticholingergic effects, Increased risk for suicidal ideation
What is a dangerous interaction & adverse reaction to MAOIs? Hypertensive crisis caused by tyramine ingestion.
What foods contain tyramine? Well-ripened cheese, yeast extract, red wines, pickled herring, sauerkraut, overripe bananas, figs, avocados, chicken livers, beer, fava beans, coffee, tea, colas, chocolate
What medications, including over-the-counter meds, can cause interactions with MAOI's? Cold, allergy or decongestive medications containing ephedrine, phenylephrine HCL, or phenylpropanolamine. other antidepressants, Cocaine & other stimulants,Methyldopa & levodopa, Opiod narcotics -Morphine, & appetite suppresants.
What is the interval necessary between the use of MAOIs and other classes of antidepressants? 14 days
What teaching is needed related to instructions after stopping MAOIs? Instruct the client that dietary and drug restrictions should be maintained for 14 days.
What is discontinuation (withdrawal) syndrome with regard to antidepressants. Abruptly stopping antidepressants can cause headache, fatigue, muscle aches, nausea, cold sweats, nightmares and altered heart beat. Do not stop them abruptly. They should be tapered.
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