Chapter 23: Fluoxetine & Lithium

Fluoxetine drug class

Antidepressant: selective serotonin reuptake inhibitor (SSRI)

Fluoxetine use

Generally for mood regulation (increases serotonin)

• Bipolar disorder

• OCD

• Panic disorder

• Depression

• Phobias

• PTSD

• Prevention of migraines

BOP Dumdemnem + 3 P’s

Fluoxetine side effects

Side effects decrease over 1-4 wks, 3-4 wks to begin working

• Blurred vision

• Insomnia

• Headache

• Dry mouth

• ED

• Dizziness

• Drowsiness

• Weakness

• Confusion

Fluoxetine nursing consideration/patient education

• Takes 3-4 wks for drug onset

• Male pt: ED

• Female pt: Decreased libido

Fluoxetine life-threatening interactions

Venlafaxine & St. John’s wort can increase risk of

• Serotonin syndrome

• Neuroleptic malignant syndrome (NMS)

Lithium drug class

Monoamine oxidase inhibitors (MAOI)

• Mood stabilizer

Lithium uses

• Bipolar disorder

• Manic episodes

Lithium side effects

Neuro

• Headache

• Memory impairment

• Drowsiness

• Dizziness

Sensory

• Blurred vision

• Metallic taste

• Dry mouth

Hydration & Circulatory

• Polyuria

• Thirst

• Dehydration

• Hypotension

Lithium nursing considerations

• MONITOR sodium intake

• Take with meals

  • Decreases gastric irritation

• AVOID caffeine

  • Aggravates manic phase of bipolar disorder by decreasing lithium lvls

• MONITOR lithium toxicity

Lithium toxicity s/sx

Early Stage of Lithium Toxicity

• Diarrhea

• Drowsiness

• Loss of appetite

• Nausea

• Polyuria

Late Stage of Lithium Toxicity

• Confusion

• Convulsions

• Severe trembling (before bast)

• Blurred vision

Why MAOIs are not the drug of choice for depression

• Too many side effects

• Many drug interactions

• Many food interactions

  • Tyramine in cheese, Wine, Yogurt, Bananas, Chocolate