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Psychopharmacology
Antidepressants
Question | Answer |
---|---|
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. |