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Antidepressant Drug
Test 3
| Question | Answer |
|---|---|
| NEUROCHEMICAL THEORY OF DEPRESSION | Neurochemical theory is based on the hypothesis that depression is caused by a decreased availability of the neurotranmitters: Norepinephrine & Serotonin |
| ANTIDEPRESSANTS.Treatment with antidepressants is based on the....... | restoration of normal levels of neurotransmitters. |
| Antidepressants do not cure depression but.... | have shown success with long term use. |
| What are the 3 types of antidepressants? | Tricyclic.Selective Serotonin Reuptake Inhibitor (SSRI).Monoamine Oxidase Inhibitors (MAOI's) |
| Examples of Tricyclic Antidepressants | Elavil.Sinequan.Tofranil |
| 2 types of Tricyclics | Secondary amines.Tertiary amines |
| Secondary amines | drugs that tend to increase the availability of norepinephrine more than serotonin |
| Tertiary amines | drugs that tend to increase sertonin availability more than norepinephrine |
| How does TCA's work? | they block reuptake (happens in presynapse) and increase receptor sensitivity |
| Where are tricyclics absorbed well at? | GI tract |
| How would you administer a tricyclic? | By mouth |
| When are the peak PLASMA levels with a tricyclic? | 2-4 hours |
| Where is tricyclics metabolized at? | Liver |
| How many percent of tricyclics become available in the bloodstream? | 30-70%, alot not absorbed so it takes longer to get into the body system |
| Side effects of tricyclic antidepressants? | Sedation.Improved appetite.Dry mouth.Blurred vision.Photesensitivity.Slowing of GI/GU functions (constipation).Inhibits natural vasoconstriction(narrowing) reaction;stand up really fast your BP can drop & client will get light headed.Other cardiac dysfunc |
| What should the nurse watch for if she is caring for a client on a tricyclic? | Urinary and GI problems |
| Suicide and TCA's | Suicidally depresed clients are treated with antidepressants.Suicide is more common in TCA's.Drugs can sometimes energize clients who have been too depressed to act on their thoughts. TCA's energizes so people are more apt to carry out suicide. |
| About TCA's | Drugs can sometimes energize clients who have been too depressed to act on their thoughts-people are more apt to carry out suicide |
| Why are TCA'S so dangerous? | Because clients start to feel better but the full benefits of the antidepressant are not reached for 2-4 weeks. Make sure when you are teaching the client about this med you tell them that. Also, it doesn't take too much TCA to OD! |
| Nursing Interventions for TCA overdose | Monitor vitals.Maintain open(patent) airway. Use cathartics(laxative) or gastric lavage with activated charcoal.Antidote for severe TCA poisoning is physotigmine(Antilirium)-it reverses the poisoning process |
| What does charcoal do for someone that has overdosed? | Prevents further absorption |
| Client teaching on TCA'S | 2-4 weeks to work.Do not stop drug without consulting MD.Avoid OTC drugs w/o consulting MD.Eye pain to be reported immediately-TCA can cause eye pressure.Inform of side effects that will lessen after adjusted to med(dry mouth,blurred vision,&etc) |
| Selective Serotonin Reuptake Inhibitor-SSRI | Fewer side effects than other antidepressants.First line choice by MOST MD/ARNP's.Inhibit the reuptake of serotonin into presynaptic neurons. |
| Examples of SSRI'S | Prozac(1st SSRI).Lexapro.Zoloft.Paxil |
| SSRI'S side effects | Don't cause the dry mouth,blurred vision,sedation that are commom w/TCA's.GI symptoms are common including nausea,diarrhea,loose stools, and weight loss.CNS symptoms include HA,trmors,and nervousness.Sexual side effects. |
| Safety in SSRI'S | Very safe in elder due to decreased side effect profile.Low potential for overdose. |
| What should be cautioned about SSRI'S? | It can have fatal drug interaction with an Monoamine Oxidase Inhibitor. |
| Serotonin Syndrome | SSRI + any of the following:MAOI's-Monoamine Oxidase Inhibitors.MAOI's(selective).Tryptophan-serotonin precursor.St. John's Wort |
| Signs & Symptoms of Serotonin Syndrome | Mental status changes, headache.Restlessness/agitation.Myoclonus(muscle tightness).Hyperreflexia.Diaphoresis.Shivering,tremor,Ataxia (gait stiffness) |
| Monoamine Oxidase Inhibitors | Only prescribed when TCA'S and SSRI'S are not efective-LAST RESORT |
| Examples of MAOI's | Nardil,Parnate |
| What does a MAOI do? inhibits monoamine oxidase,an enzyme,from metabolizing and inactivating serotonin and norephinephrine | Inhibits monoamine oxidase,an enzyme,from metabolizing and inactivating serotonin and norephinephrine, it allows mood to stay elevated |
| MAOI's side effects | Agitation,Hypotension,Anti-cholinergic effects(dry mouth,blurred vision),serios food interactions(avoid tyramine-rich foods) |
| Examples of tyramine-rich foods | alcohol,pickled foods,fermented foods,smoked foods,sour cream,yogurt,mature cheeses(cheddar,blue,moz,brie),bananas,avocados,fava beans,canned figs,bologna,ch liver,fried fish,liver,meat tenderizer,salami,sausage,caffeinated drinks large amts,chocolate |
| Serious drugs interactions for MAOI's | SSRI's=VERY high risk of fatality.Demerol(meperidine)=HIGH risk of fatality.TCA'S.OTC'S,Other MAOI'S |
| What is the most serious side effect of food/drug interaction? | Hypertension crisis-ICU material |
| Signs & Symptoms of Hypertension crisis | Headache,stiff neck,nausea,vomiting,sweating,dialted pupils,photophobia,tachycardia,bradycardia,sudden nosebleed,chest pain |
| Client teaching with MAOI'S | Therapeutic effect achieved in 2-4 weeks,avoid driving if drowsiness occurs,aviod foos containing tyramine foods,give a written list of high tyramine foods,avoid any other meds without consulting with Dr.,report headache,stiff neck, and palpatations |
| Continued teacjing | MAOI's drug action remains in effect for up to 10 days after the MAOI drug discontinued,teach ALL family members. |
Created by:
dana.burnam222