N481 Exam 1

what drugs are anti-depressants

SSRI, SNRI, TCAs

SSRI (Selective serotonin reuptake inhibitors)

sertraline (Zoloft)

fluoxetine (Prozac)

citalopram (Celexa)

escitalopram (Lexapro)

paroxetine (Paxil)

SSRI MOA

blocks reuptake of serotonin, increasing the levels in the brain

SSRI use

first line for all anxiety diorders, OCD, and body dysmorphic disorder

adverse effects of SSRI

jitteriness, NA, restlessmess, HA, fatigue, diarrhea, change in appetite, serotonin syndrome

SSRI nursing interventions

increased risk of activation of mania/hypomania in susceptible individuals. delayed clinical response (4-8 weeks for full effect). remain of medicaiton even when symptoms resolve. drugs must be tapered when discontinued to prevent discontinuation syndrome, hyponatremia, avoid alcohol and hermal med consumption, caution in elderly w drug-drug interactions, pregnancy, risk of serotonin syndrome

serotonin syndrom symptoms

shivering

hyperreflexia

increased temp

vital sign changes

encephalopathy

restless

sweating

SNRI (selective serotonin-norepinephrine reuptake inhibitors)

venlafaxine

duloxetine

SNRI use

first line antianxiety — GAD, off-label for OCD

adverse effects of SNRI

similar to SSRI

SNRI nursing interventions

same as SSRI

TCA (tricyclic antidepressants)

imipramine

clomipramine

desipramine

nortriptyline

doxepin

TCA use

second or third line: PD, PTSD, GAD

adverse effects of TCA

anticholinergic effects, dissiness, somnolence, cardoivascular effects, higher risk overdose/drug toxicity

anti-anxiety disorder

benzodiazepines

non-benzodiazepine anxiolytic

benzodiazepines

alprazolam (xanax)

oxazepam

trizolam

lorazepam

clonazepam (klonopin)

benzodiazepines MOA

Primarily acts on GABA, depress NT in limbic and cortical area

use of benzodiazepines

short term anxiety treatment

adverse effects of benzodiazepines

sedation, dizziness, datigue, CNS depression, driving/cognitive impairment.

nursing implications of benzodiazapines

frequently linked to rebound anxiety and demenita in older adults, higher mortality, fall risk. dependence and tolerance can develop, avoid combining with opioids

reversal agent: flumazenil

non-benzodiazepine anxiolytic

buspirone

use of buspirone

partial serotonin agonist, weak dopamine antagonist