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Drugs- Mood Disorder
| Term | Definition |
|---|---|
| What are the 3 main antidepressant classes? | SSRIs/SNRIs (2nd generation), TCAs, MAOIs |
| Which antidepressants are first-line for depression? | SSRIs and SNRIs |
| Examples of SSRIs | Fluoxetine, Sertraline, Paroxetine, Escitalopram |
| Examples of SNRIs | Venlafaxine, Duloxetine |
| Example of NDRI | Bupropion (Wellbutrin) |
| Other antidepressants | Trazodone, Mirtazapine |
| How long do antidepressants take to work? | 4–6 weeks |
| Should antidepressants be stopped abruptly? | No |
| Common SSRI side effects | Nausea, headache, insomnia, sexual dysfunction |
| What must be monitored when starting antidepressants? | Suicidal thoughts, especially early therapy |
| What is serotonin syndrome? | Excess serotonin causing potentially life-threatening symptoms |
| Symptoms of serotonin syndrome | Tachycardia, hyperreflexia, tremors, sweating, confusion |
| Severe serotonin syndrome symptoms | Hyperthermia, seizures, dysrhythmias, DIC |
| Drugs that increase serotonin syndrome risk | SSRIs, MAOIs, St. John's Wort, serotonergic drugs |
| What is St. John's Wort used for? | Depression, anxiety, nervousness |
| Major concern with St. John's Wort | Drug interactions and serotonin syndrome |
| What should nurses ask about before antidepressant therapy? | Herbal and OTC medication use |
| What are TCAs? | Tricyclic antidepressants |
| Examples of TCAs | Amitriptyline, Imipramine, Clomipramine |
| When are TCAs used? | Second-line if SSRIs fail |
| Common TCA side effects | Dry mouth, constipation, sedation, orthostatic hypotension |
| Important TCA nursing consideration | Monitor for CNS depression and suicide risk |
| Why dispense small amounts of TCAs? | High overdose risk |
| What are MAOIs? | Second-line antidepressants for resistant depression |
| Examples of MAOIs | Phenelzine, Tranylcypromine, Isocarboxazid, Selegiline |
| Major MAOI danger | Hypertensive crisis |
| Foods high in tyramine to avoid with MAOIs | Aged cheese, wine, smoked meats, yeast extracts |
| Symptoms of hypertensive crisis | Severe headache, palpitations, nausea, high BP |
| Why wear a medication ID bracelet with MAOIs? | Emergency identification |
| MAOIs should NOT be combined with what? | SSRIs, SNRIs, serotonergic drugs |
| OTC medications to avoid with MAOIs | Decongestants |
| What are mood stabilizers used for? | Bipolar disorder and mania |
| Examples of mood stabilizers | Lithium, Valproate, Carbamazepine, Lamotrigine |
| Therapeutic lithium level | 0.6–1.2 mEq/L |
| Lithium toxicity level | >1.5 mEq/L |
| Labs monitored with lithium | Lithium level, kidney function, thyroid function |
| Why maintain hydration with lithium? | Prevent toxicity |
| Drugs that increase lithium toxicity | NSAIDs |
| Lithium teaching | Do not stop abruptly; maintain fluids |
| Valproate monitoring | Liver function tests and ammonia |
| Why avoid valproate in pregnancy? | Birth defects |
| Major carbamazepine risk | Stevens-Johnson syndrome (SJS/TEN) |
| Major lamotrigine risk | Serious rash (SJS) |
| What are antipsychotics used for? | Schizophrenia, bipolar disorder, psychosis |
| First-generation antipsychotic examples | Haloperidol, Chlorpromazine |
| Second-generation antipsychotic examples | Risperidone, Olanzapine, Quetiapine, Aripiprazole |
| First-generation antipsychotics mainly affect what symptoms? | Positive symptoms |
| What are positive symptoms of schizophrenia? | Hallucinations, delusions, agitation |
| What are EPS? | Extrapyramidal symptoms (movement disorders) |
| Examples of EPS | Dystonia, akathisia, pseudoparkinsonism |
| What is tardive dyskinesia (TD)? | Irreversible involuntary movements |
| What is Neuroleptic Malignant Syndrome (NMS)? | Life-threatening antipsychotic reaction |
| NMS symptoms | High fever, muscle rigidity, altered mental status |
| What should be monitored with atypical antipsychotics? | Weight, glucose, lipids |
| Why monitor glucose and lipids? | Metabolic syndrome risk |
| Common antipsychotic side effect | Orthostatic hypotension |
| What movement disorder requires immediate reporting? | Tardive dyskinesia |
| When should provider be notified about antipsychotics? | Suicidal thoughts, NMS, severe EPS, infection |
| Why monitor WBC with clozapine? | Agranulocytosis risk |
| Patient teaching for antipsychotics | Take as prescribed, don't stop abruptly |
| What substances should be avoided with antipsychotics? | Alcohol and CNS depressants |
| General nursing implication for psychiatric meds | Assess mental status and suicide risk |
| Why change positions slowly? | Prevent orthostatic hypotension |
| Why give only small medication amounts? | Reduce overdose risk |
| Why taper psychiatric medications? | Prevent withdrawal/discontinuation syndrome |
| Antidepressants take how long to work? | 4–6 weeks |
| Antidepressants increase risk of what early in treatment? | Suicide |
| MAOI + Tyramine = ? | Hypertensive crisis |
| SSRI + MAOI = ? | Serotonin syndrome |
| Lithium level range | 0.6–1.2 mEq/L |
| Lithium toxicity signs | Tremor, confusion, vomiting, diarrhea |
| Most dangerous antipsychotic reaction | NMS |
| NMS triad | Fever, rigidity, altered mental status |
| Clozapine major adverse effect | Agranulocytosis |
| Most common antipsychotic movement disorder tested? | Tardive dyskinesia |
| Carbamazepine/Lamotrigine major risk | Stevens-Johnson syndrome |
| First-line antidepressants | SSRIs/SNRIs |
| Second-line antidepressants | TCAs and MAOIs |
| Herbal supplement causing serotonin syndrome | St. John's Wort |
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