NRSG 2700 Unit 1

Mood disorders

a change in emotion that impairs the pts ability to effectively deal with normal activities of daily living

Types of mood disorders

MDD, dysthymic disorder, bipolar disorder, manic and hypomanic episodes, and cyclothymic disorder

Major depressive disorder (MDD)

someone has a depressed/down mood for a minimum of 2 weeks. HAS to be present everyday or almost everyday

MDD other disorders include

Postpartum depression and Seasonal affective disorder

Postpartum depression

depression which onset occurs after someone gives birth

Seasonal affective disorder

depression that occurs w changes of seasons

Depression is one of the ____ known mental health conditions

oldest

Depression is one form of the most frequently ____ mental health conditions

diagnosed

Depression etiology is still not very well ____

understood

A client is prescribed a SSRI (fluoxetine), if no therapeutic effect is achieved by ___, the client should follow up with the provider

6-8 weeks

Which medication is noted to be similar to Venlafaxine, is used int he management of SAD and ADHD

Bupropion

Dysthymic disorder

a mild chronic depression, not as severe in ADLs and it lasts a minimum of 2 years (THIS HAS TO OCCUR)

Mania episodes

intense excitement and doing activities you normally don’t do

Cyclothymic disorder

alternates between mild depression and hypomania

Manic episode

mania symptoms last a week or more impacting social functioning 

Bipolar disorder

patient alternates between mania and major depressive disorders 

MDD/antidepressant neurotransmitters are

low norepinephrine, serotonin, and dopamine.

Treatment of depression includes

cognitive and behavioral therapy, exercise, sleep patterns, meditation, ECT, VNS, rTMS, social support, nature therapy, diet, herbal therapies

Antidepressants drugs used to

enhance, elevate, or stabilize mood

Antidepressant MOAs are

Use NT to block enzymatic breakdown of norepinephrine

Use NT by slowing the reuptake of serotonin

BBW of antidepressants

may increase risk of suicidal thinking and behavior in children, adolescents, and young adults. Pts of ALL ages should be monitored closely. 

The majority of pts who commit suicide have what

MDD

Pts that have previously attempted suicide are that a ___ risk of suicidal thinking and attempting

higher

Antidepressant classes

MAOIs, TCAs, SSRIs, and atypical antidepressants 

Serotonin syndrome

is a serious medical condition that can occur when a patient is taking multiple medications that affect the metabolism aka serotonin, synthesis, or reuptake of serotonin causing neurotransmitters to accumulate in the neurons of CNS and causes several S/S to occur that can be fatal if untreated. 

Serotonin syndrome can occur within ____ hours of taking the first dose of medication or as late as ____ weeks after beginning therapy

2, several

How to treat serotonin syndrome

discontinue medication and is resolved within 24hrs. May need mechanical ventilation and muscle relaxants. Death is left untreated

Serotonin syndrome S/S

mental statue changes and not themselves, HTN, tremors/shaking, sweating, hyperpyrexia/fever, ataxia (impaired movement)

Drugs that cause Serotonin syndrome

SSRIs, MAOIs, TCAs, lithium, St Johns Wort, opioids, triptans

MAOIs

antidepressants that block actions of MAO

MAOIs things to know

have serious adverse effects and low safety margin. Pt can experience hypertensive crisis combined w foods high in tyramine. Rarely used unless other antidepressants don’t work. 

Most serious adverse effect with MAOIs

hypertensive crisis when combined with foods high in tyramine

Foods high in tyramine

aged cheese, processed meat, tomatoes, alcohol, etc

What drug is the drug of choice for depression/most prescribed

Fluoxetine

Phenelzine class and MOA

monoamine oxidase inhibitor, blocks action of MAO and slows destruction of neurotransmitters 

Phenelzine TE

effective antidepressant but only use when pt can’t use other antidepressants. Used off-label for anxiety, panic, migraine, and prophylaxis

Phenelzine cautions

no pts with cardiovascular disease, hepatic impairment, CKD, or pheochromocytoma, no-one with epilepsy (increase seizures), severe/frequent headache, HTN (w tyramine foods), and dysrhythmias

Phenelzine side effects

Anticholinergic effects (no pee, see, spit, poop), orthostatic htn (happens when pt DOESN’T eat tyramine foods), insomnia, SUICIDAL(BBW), vision changes, constipation, dry mouth, nausea, anorexia, insomnia, respiratory depression

Phenelzine interactions

serotonin syndrome, foods high in tyramine(HTN crisis)

Phenelzine NC/T

signs of hypertensive crisis, monitor vision w long-term therapy, discontinued 2-3 weeks before initiation of other meds, don’t take OTC meds without approval, monitor BP and pulse and glucose if DM, minimize intake of tyramine, avoid caffeine and chocolate

Imipramine class and MOA

tricyclic antidepressant, blocks reuptake transport of norepinephrine and serotonin and muscarinic receptors

Imipramine TE

improves depression S/S, nocturnal enuresis, ADHD, insomnia, bulimia, social anxiety disorder, hiccups, neuropathic pain

Imipramine cautions

people with seizures, pregnancy, or lactation, no urinary retention, prostatic hyperplasia, or hyperthyroidism, those with cardiac/MI disease

Imipramine SE

anticholinergic effects (can’ts), orthostatic hypotension, heart block, life threatening dysrhythmias, sedation/sleepy, confusion, dizzy, impaired liver function (jaundice), seizures, SUICIDAL (BBW)

Imipramine inter

high drug inter potential, increased risk of dysrhythmias w antidysrhythmic and thyroid hormone (no pts w heart issues), Serotonin syndrome, increased sedation w other CNS depressants

Imipramine NC/T

report suicidal thought, monitor CV and CNS, report extrapyramidal symptoms, assist with ambulation, don’t use OTC meds unless approved

Fluoxetine class and MOA

selective serotonin reuptake inhibitors (SSRI), block reuptake of serotonin in nerve synapse (blocks reuptake so it can hang out and increase availability and action of serotonin) and increases availability and action. 

Fluoxetine TE

most prescribed cause its drug of choice for depression, used for peds and geriatric pts, decreases anxiety, off-label for eating disorders, autism, and premature ejaculation

Fluoxetine cautions

don’t give to those with bipolar (can precipitate manic attack), suicidal history, no kids under 7, use cautiously with pt with cardiac dysfunction, diabetes, seizures, NOONE with hypersensitivity

Fluoxetine SE

headache, insomnia, personality changes, seizures, n/v, diarrhea, anorexia, flatulence, weight gain or loss, sexual dysfunction, SUICIDAL (BBW)

Fluoxetine Inter

CNS depressants (excessive sedation), NSAIDS or warfarin (increase bleeding), SES and med toxicity (cyp450 enzymes)

Fluoxetine NC/T

optimal effects 2-4 weeks so more quickly than TCAs, monitor for mania when starting therapy, withdrawal symptoms in newborns, hyponatermia, blood glucose with DM and watch for seizures. Abruptly withdrawing may result in withdrawal syndrome aka dizzy, headache, tremor, anxiety, and dysphoria. Report suicidal thoughts, plan pregnancy with provider and can use when pregnant if benefits outweigh risks

Venlafaxine class and MOA

atypical antidepressant, inhibits reuptake of serotonin and norepinephrine in the neuron pro-drug

Venlafaxine TE

improvement in S/S of depression and anxiety. Off-label for neuropathic pain, OCD, hot flashes, prevent migraines

Venlafaxine cautions

cautions for cardiac, hepatic, or renal impairment, anorexia, MI, seizures, suicidal in children under 18 (cause it can impair height and growth), bipolar(can trigger manic episodes). Contraindicated in hypersensitivity if MAOI is being used and lactation

Venlafaxine SE

n/v, dry mouth, CNS (dizzy, insomnia, somnolence), can decrease weight and height in peds pt, may increase BP by 10-15 mmHg of mercury, sexual dysfunction, SUICIDAL (BBW), rare to have rectal or veginal hemorrhage

Venlafaxine inter

Serotonin syndrome and Med toxicity w CYP450 enzymes

Venlafaxine NC/T

monitor BP before and during therapy, monitor weight and neuro status, taper when discontinuing to avoid withdrawal s/s, report thoughts of suicide immediately 

Duloxetine Class and MOA

SNRI, inhibit repute of serotonin and norepinephrine in the neuron

Duloxetine TE

improves depression and anxiety S/S, off label use for stress urinary incontinence

Duloxetine cautions

pts with mania, seizures, HTN, elderly, kids, lactating women, hepatic impairment, alcoholism

Duloxetine SE

abnormal vision photosensitivity, N/V, dry mouth, constipation, insomnia, anxiety, anorexia, bruising, thrombophlebitis, SUICIDAL (BBW)

Duloxetine inter

serotonin syndrome and alcohol (increased liver damage)

Duloxetine NC/T

monitor lab tests (kidney and liver funciton), monitor for anxiety or irritability, check with provider before using OTC meds or herbs, taper when discontinuing to avoid withdrawal symptoms, report thoughts of suicide immediately

Bupropion MOA

no well understood, primary action thought to be dopaminergic. Chemical structure similar to amphetamine

Bupropion TE

improve s/s of depression, SAD, and smoking. Off label for neuropathic pain and ADHD

Bupropion cautions

seizures, drug abuse, bulimia or anorexia, suicidal, or lactating

Bupropion SE

CNS stimulation, agitation, insomnia, tremors, seizures (also in breastfed infants), SUICIDAL (BBW), weight loss and gain, anticholinergic, N/A, DOES NOT cause sexual dysfunction 

Bupropion inter

serotonin syndrome and may increase SE of levodopa

Bupropion NC/T

check formulation w care (different salt forms and dosing schedules), report thoughts of suicide immediately