Pharm: Antidepressants

TRI’S

Amitriptyline

Amitriptyline interactions

Increased CNS effects with alcohol and other CNS depressants

Use with MAOIs can lead to cardiac instability

Amitriptyline S/E

Cardiotoxicity: arrhythmias

Sedation/ dizziness

Anticholinergic effects (blurred vision, dry mouth and eyes, urinary retention, constipation)

Weight gain

GI distress

Sexual dysfunction

Orthotic hypotension

Amitriptyline: Nursing considerations

Teach pt to rise slowly

Teach response is seen in 2-4 weeks

Administer at night if it is causing sedation

Do not withdraw abruptly

Monitor cardiovascular function- avoid use with patients who have cardiac disease

SSRI

Fluoxetine

SSRI function

Block uptake of neurotransmitter serotonin

SSRI uses

Multiple indications including depressive and anxiety disorders

SSRI interactions

Increased CNS effects with alcohol and other CnS depressants

SSRI S/E

Headache, nervousness, restlessness, insomnia, tremors, seizures, GI distress

These decrease over 2-4 weeks

SNRI

Venlafaxine

SNRI action

Inhibit the reuptake of serotonin and norepinephrine increasing these substances in nerve fibers

SNRI: uses

Major depression as well as generalized anxiety disorder and social anxiety disorder

SNRI interactions

Concurrent interaction of venlafaxine and St. John’s wart may increase risk of serotonin syndrome

SNRI S/E

Drowsiness, dizziness, insomnia, headache

Trazodone & Bupropion (Wellbutrin): Action

Affect one or two of the three neurotransmitters serotonin, norepinephrine and dopamine

Trazodone & bupropion: interactions

Do not take with MAOIs and do not use within 12 days after discontinuing MAOIs

MAOIs

Isocarboxazid & phenelzine

MAOIs: action

Monoamine oxidase enzyme cleans up norepinephrine, dopamine, epinephrine, and serotonin by inhibiting MAO, the level of these neurotransmitters rise

MAIOs : uses

Depression not controlled by TCAs and second gen antidepressants

MAIOs interaction

Drugs: vasoconstrictors & cold medicines containing phenylephrine and pseudoephedrine can cause hypersensitive crisis

Food: anything that contains tyramine (some cheeses, cream, coffee, chocolate, bananas, raisins, Italian green beans, liver, pickled foods, sausage, soy sauce, yeast, some nuts, and red wines)

MAOIS S/E

Agitation, restlessness, insomnia, anticholinergic effects, orthotic hypotension, hypersensitive crisis from fatal tyramine interaction

Antidepressant Nursing Interventions

–Monitor vital signs.

–Monitor mood for drug effectiveness.

–Monitor for suicidal tendencies

–Monitor for seizures.

–Warn that foods that contain tyramine can cause a hypertensive crisis with MAOIs.

–Encourage taking drug as prescribed.

–Encourage avoiding alcohol, CNS depressants, and cold medicines.

–Teach to take drug with food if GI distress occurs.

Mood Stabilizers

–Bipolar disorders

–Lithium

–Anticonvulsants:

–Carbamazepine

–Divalproex

–Lamotrigine

–Antipsychotics:

–Olanzapine

–Ziprasidone

–Aripiprazole

Lithium- Prototype Drug

Treats manic episodes in bipolar psychosis

Mood Stabilizer Interventions

NSAIDS may increase levels and caffeine may decrease levels

Lithium S/E

–Headache, drowsiness, dizziness

–Hypotension, dysrhythmias

–Restlessness, slurred speech

–Dry mouth, metallic taste, GI distress

–Tremors, muscle weakness

–Edema of hands and ankles

–Increased urination, blood dyscrasias, nephrotoxicity

Lithium Nursing Interventions

–Monitor vital signs, sodium levels.

–Monitor for drug effectiveness, suicidal tendencies.

–Monitor urine output, renal function tests.

–Encourage adequate fluid intake (1 to 2 L daily).

–Encourage adequate sodium intake ( lithium can deplete sodium)

–Take with food to decrease GI irritation.

–Monitor lithium levels every 1 to 2 months (0.8 to 1.2 mEq/L); toxic range is greater than 1.5 - 2 mEq/L.

–Toxic side effects: persistent nausea, vomiting, severe diarrhea, blurred vision, tinnitus, ataxia, increasing tremors, may progress to confusion, dysrhythmias, seizures, coma

Lithium patient teaching

–Wear medical alert identification.

–Take drug as prescribed and keep medical appointments.

–Don’t drive motor vehicles or operate dangerous equipment until drug effect is known.

–Drug effect may take 1 to 2 weeks.

–Avoid caffeine, crash diets, NSAIDs, diuretics, overheating.

–Appropriate protection from pregnancy because of teratogenic effects.

Expected outcomes: Antidepressants

•Changes in affect, behavior, communication

•Brighter affect, positive mood, improved appetite and sleep patterns

•Less isolation, more prosocial interactions, engagement in therapies, increase in volition

•Decreased verbal negativity (increased positivity), increased speech fluidity

Expected outcomes: Mood Stabilizers

•Increased mood stability (fewer mood swings)

•Decreased hyperactive behavior

•Slower speech pattern

•Decrease in hypersexual behaviors

•Improved sleep patterns

•Improved appetite