adams chap 15 (partial) Drugs for Mood and behavior (antidepressants and bipolar)

What are the main classes of antidepressants?

Tricyclic antidepressants (TCAs), Selective serotonin reuptake inhibitors (SSRIs), Serotonin norepinephrine reuptake inhibitors (SNRIs), Atypical antidepressants, Monoamine oxidase inhibitors (MAOIs).

What are common symptoms of depression?

Loss of interest, depressed mood, weight loss/gain, loss of energy, insomnia/hypersomnia, suicidal thoughts, low self-regard.

What is the relationship between depression and bipolar affective disorder?

Depression usually predominates in bipolar affective disorder.

What are some common antidepressants to know?

Amitriptyline, Imipramine, Escitalopram, Sertraline, Duloxetine, Venlafaxine, Bupropion, Phenelzine, St. John’s wort.

What factors contribute to the causes of depression?

Genetic, environmental, social, biological factors, and insufficient neurotransmitters (norepinephrine, serotonin, dopamine).

What primary treatment modalities are used for depression?

Pharmacotherapy, psychotherapy, electroconvulsive therapy.

How long does it typically take for symptoms of depression to resolve with treatment?

Symptoms resolve slowly, with initial response in 1-3 weeks and maximal response in about 12 weeks.

What are the potential interactions and effects of St. John's Wort?

Increases suicidal thoughts, increases clotting, and has many drug interactions.

What is a serious risk associated with mixing St. John's Wort and prescription antidepressants?

It can interact in dangerous, sometimes life-threatening ways.

What are SSRIs and why are they preferred for treating depression?

Selective serotonin reuptake inhibitors are popular because they cause little sedation, hypotension, cardiotoxicity, or anticholinergic effects.

What are common side effects of SSRIs?

Headache, nervousness, dry mouth, blurred vision, insomnia, nausea/vomiting, suicidal ideation, sexual dysfunction.

What should be monitored in patients taking SSRIs, especially during the early phase of treatment?

Suicide risk.

What is the triad of symptoms associated with serotonin syndrome?

Cognitive symptoms (headache, agitation), autonomic symptoms (sweating, tachycardia), somatic symptoms (muscle twitching, hyper-reflexia).

How do tricyclic antidepressants (TCAs) work?

They block the reuptake of norepinephrine and serotonin.

What are some side effects of tricyclic antidepressants (TCAs)?

Sedation, anticholinergic effects, may increase suicide risk early in treatment.

What should be avoided when taking monoamine oxidase inhibitors (MAOIs)?

High tyramine foods (e.g., aged cheese, red wine) and certain medications.

What are common atypical antidepressants mentioned?

Bupropion and Trazodone.

What might be a notable effect of bupropion?

Suppresses appetite without causing weight gain.

What is the narrow therapeutic range for lithium?

0.5-1.5 mEq/L.

What is a potential consequence of lithium toxicity?

Diarrhea, dizziness, nausea/vomiting, excessive urine output, muscle twitching, potentially leading to coma.

What crucial role do electrolytes play in patients taking lithium?

Lithium can cause sodium loss, which can lead to dehydration and hyponatremia.

What is the recommended action for patients experiencing adverse symptoms from antidepressants?

Don’t stop the medication suddenly; consult a healthcare provider.

What are the potential risks of antiepileptic drugs used in bipolar disorder treatment?

Teratogenic effects, blood dyscrasias, and potential for agranulocytosis.

What dietary considerations should be taken for patients on MAOIs?

Avoid high tyramine foods to prevent hypertension crises.

What are some behavioral signs that could indicate a risk of suicide?

Increased energy coupled with sadness, saying goodbyes, and giving away possessions.

What type of interactions does St. John's Wort have with prescriptions?

Can decrease effectiveness or increase toxicity of certain medications.

What is the function of mood stabilizers like Lithium?

To even out mood fluctuations and stabilize manic or depressive phases.

What should be assessed when monitoring the effectiveness of depression treatment?

Verbalization of improved mood, interaction levels, and sleeping/eating patterns.

What is a significant risk factor for depression that should not be ignored?

Suicidal thoughts or behaviors.

What is the importance of patient education when prescribing antidepressants?

To ensure understanding of medication effects, risks, and the importance of adherence to therapy.

How does Duloxetine function as an antidepressant?

It's a serotonin norepinephrine reuptake inhibitor (SNRI) effective for depression and pain.

Why is it critical to ensure a period of time between using MAOIs and SSRIs?

To avoid serotonin syndrome, as both can increase serotonin levels.

What needs to be monitored for patients on Valproic acid?

Watch for blood counts due to thrombocytopenia and evaluate for hepatic toxicity.

What characteristics define bipolar disorder?

Cyclic disorder with recurrent fluctuations in mood and episodes of mania and depression.

A 45-year-old patient diagnosed with major depressive disorder is prescribed sertraline. What is the nurse's priority assessment prior to initiating therapy?

Assess the patient's risk for suicide, especially during the early phase of treatment.

A client is taking amitriptyline for depression and reports difficulty urinating. Which nursing action is most appropriate?

Consult with the healthcare provider to evaluate the persistence of the anticholinergic effects.

A patient on monoamine oxidase inhibitors (MAOIs) is concerned about dietary restrictions. What should the nurse advise?

Avoid high-tyramine foods such as aged cheese and cured meats to prevent hypertensive crisis.

A nurse is teaching a patient about bupropion. What statement by the patient indicates a need for further teaching?

'I can stop taking this medication suddenly if I feel better.'

A client receiving Duloxetine reports increased agitation and muscle rigidity. What condition should the nurse suspect?

Serotonin syndrome, which can occur with increased serotonin levels.

In which of the following scenarios should a nurse withhold lithum medication and consult a physician?

If the patient's serum lithium level is 1.8 mEq/L or greater, indicating potential toxicity.

A patient receiving venlafaxine for depression is experiencing withdrawal symptoms. What did the nurse advise?

Gradually taper the dose under the guidance of a healthcare provider instead of stopping abruptly.

During a medication teaching session, a patient taking a selective serotonin reuptake inhibitor (SSRI) reports experiencing sexual dysfunction. What is the nurse's best response?

'It's common with SSRIs; we can discuss potential alternatives or strategies to manage this.'

While administering mood stabilizers to a patient with bipolar disorder, what is an essential nursing intervention?

Monitor serum electrolyte levels and renal function given the potential risks of lithium.

A nurse is monitoring a patient on St. John's Wort and an antidepressant. What is a critical assessment to perform?

Evaluate for any signs of increased toxicity or decreased efficacy of the antidepressant.

What are common side effects of Duloxetine?

Nausea, dry mouth, insomnia, constipation, dizziness, increased sweating, sexual dysfunction.

What are the therapeutic uses of Venlafaxine?

Primarily used for major depressive disorder, generalized anxiety disorder, and social anxiety disorder.

What are the adverse effects of Bupropion?

Risk of seizures, particularly at higher doses, insomnia, dry mouth, headache, anxiety.

What are contraindications for taking Amitriptyline?

Hypersensitivity to tricyclic antidepressants, recent myocardial infarction, concurrent use with MAOIs.

What should be monitored in patients taking Lithium?

Serum lithium levels, renal function, thyroid function, and signs of toxicity.

What are potential side effects of St. John's Wort?

Photosensitivity, gastrointestinal symptoms, allergic reactions, and risk of serotonin syndrome when combined with other antidepressants.

What nursing interventions should be considered for patients on SSRIs?

Monitor for changes in mood or behavior, assess for suicidal thoughts, evaluate for side effects, and educate about the potential delay in therapeutic effect.

What are adverse effects of Sertraline?

Headache, drowsiness, insomnia, sexual dysfunction, increased sweating.

What contraindications exist for Duloxetine?

Concurrent use with MAOIs, uncontrolled narrow-angle glaucoma, and hypersensitivity to the drug.

What nursing considerations are important for a patient taking Venlafaxine?

Monitor blood pressure, especially at higher doses, assess for suicidal ideation, and observe for signs of serotonin syndrome.

What side effects are associated with Imipramine?

Cardiovascular effects (arrhythmias), sedation, anticholinergic effects, and weight gain.

When should a nurse withhold Bupropion?

If the patient has a seizure disorder, eating disorder, or is taking monoamine oxidase inhibitors (MAOIs).