Drug Tx for Depression- Mental Health
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| Tricyclic Side Effects | Anticholinergic (dry mouth, blurred vision, constipation, urinary retention), orthostatic hypotension, tachycardia, drowsiness.
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| Tricyclic pt. teaching and interventions | Given at bedtime (drowsiness). Take 1-4 wks to work. Lethal in OD (cardio toxic, usually not prescribed to cardia pt). Not ideal for gerian (anticholinergic s/e). Often used to treat nerve pain (diabetic neuropathy)
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| Elavil | Tricyclic
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| Ascendin | Tricyclic
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| Norpramin | Tricyclic
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| Sinequan | Tricyclic
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| Anafranil | Tricyclic
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| SSRI and SNRI Side Effects | Minimal anticholinergic effects. Anxiety. Nervous energy. Insomnia. Sexual dysfunction. Long term wt. gain.
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| SSRI and SNRI pt. teaching and interventions | Good for elderly (reduced anticholinergic effects). Considered first choice drugs to treat depression. Taken in AM (if drowsy, switch to PM). Take 1-4 wks to work. Not to be taken in pregnant (fetal heart defects).
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| Prozac | SSRI- strongest "chief" SSRI. Wt. loss initially.
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| Paxil | SSRI
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| Zoloft | SSRI- can cause wt. loss
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| Celexa | SSRI
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| Lexapro | SSRI
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| Cymbalta | SNRI
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| Effexor/Pristique | SNRI
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| Remeron | SNRI- causes wt. gain
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| Vestra | SNRI
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| Wellbutrin | Misc.- Good to stop smoking w/
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| Desryel | Misc.- Tricyclic of choice, but is actually a bicyclic. Help sleep. Fewest anticholinergic effects.
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| MAOI Side Effects | Hypertensive Crisis...Headache, flushing, chest pain, epistaxis (nose bleed), dizziness, neck pain.
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| MOAI pt. teaching and interventions | Last choice drugs for depression. Must avoid Tyramine, Tryptophan, & Epinephrine- put instructions in writing. Any symptoms, go to ER! Every OTC cold product has epinephrine. Need 2 wk gap between any other psych drug & MAOI (serotonin syndrome)
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| Foods you can not eat while taking MAOI's | Avacodos, figs, brown/ripe bananas, processed meats, wine, beer, real cheese, bakery breads, chocolate, liver, salmon. No soy, no caffeine.
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| Nardil | MAOI
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| Parnate | MAOI
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| EMSAM | MAOI
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| Lithium Carbonate | Anti-manic drug prescribed for bipolar disorder.
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| How long does Lithium take to be effective? | 10-21 days
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| Usual dosage of Lithium | 300-600 mg, usually given BID or TID
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| Range of Lithium | 0.5-1.5 mEq
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| Ideal/therapeutic Lithium level | 0.8-1.2 mEq
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| Lithium toxicity | Blood levels greater than 1.5 mEq
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| Lithium Side Effects | Nausea, fine tremors, headache, polydipsia, polyuria, muscle weakness, wt. gain.
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| Early Lithium toxicity | N&V, abdominal pain, diarrhea.
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| Advanced Lithium toxicity | Tremors, slurred speech, ataxia, seizures.
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| Pt. teaching for Lithium | 2000-3000 mL fluid/day. Maintain normal salt intake, eat balanced diet. Do not take Ibprofen/NSAID's (Lithium toxicity). Low potassium=Lithium toxicity.
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