N481 unit 1 drugs

What drugs are the SSRIs

1. Citalpram

2. Escitalopram

3. Fluoxetine

4. Fluvoxamine

5. Paroxetine

6. Sertraline

MOA of SSRIs

block reuptake of serotonin, increasing levels in the brain

Uses of SSRIs

GAD, panic, agoraphobia, social anxiety, OCD

potential side effects of SSRIs

jitteriness, nausea, restlessness, headache, fatigue, changes in appetie, changes in weight, tremor, sweating, QTC prolongation, sexual dysfunction, diarrhea, constipation, hyponatreamia, increased risk of bleeding

BBW: serotonin syndrome

BBW: Antidepressants increase the risk of suicidal thinking and behaviors in children, adolescents and young adults

signs of serotonin syndrome

SHIVERS

-shivering

-hyperreflexia

-increased temperature

-vital sign changes

-encephalopathy

-restlessness

- sweating

What are the emergency measures for serotonin syndrome?

Discontinue use of the offending medication immediately. Initiate symptomatic treatment per order (muscle relaxants, serotonin production blocking agents, oxygen, IV fluid, drugs that control heart rate and BP, Esmolol, nitroprusside, phenylephrine or epi, cooling blankets, breathing tube and machine and meds to paralyze muscles).

patient and family teaching for SSRIs

SSRIs may cause sexual dysfunction (impotence; difficulty achieving orgasm, especially in women) or lack of sex drive. Inform the health care provider. This can be treated.

• SSRIs may cause insomnia, anxiety, and nervousness. Some people also experience headache, fatigue, nausea, diarrhea, dry mouth, dizziness, or tremor. Symptoms tend to subside within a few weeks. Inform nurse or physician if they persist.

• SSRIs may cause a serious interaction with other medications and make other medications less effective. Be sure the physician knows all other medications the patient is taking. SSRIs should not be taken within 14 days of the last dose of a monoamine oxidase inhibitor (MAOI).

• No over-the-counter drugs should be taken, especially cold medications and herbal supplements, without first notifying the physician.

• Because of the potential for drowsiness and dizziness, do not drive or operate machinery until these side effects are ruled out.

• Alcohol should be avoided. People report increased effects of alcohol while taking an SSRI. Alcohol is also a central nervous system (CNS) depressant that may work against the desired effect of the SSRI.

• Liver and renal function tests should be performed, and blood counts checked periodically.

• Medication should not be discontinued abruptly to prevent a discontinuation syndrome: dizziness, nausea, diarrhea, muscle jerkiness, tremors, and rebound depression. If side effects from the SSRIs become bothersome, the patient should ask the health care professional about changing to a different drug. The drug will be slowly tapered before starting a new antidepressant.

• SSRIs should be used with caution in the elderly and in pregnant women. The benefits versus the risk must be considered in this population.

contraindications for SSRIs

Fluoxetine and Paroxetine-->Increased risk of birth defects

Contraindicated for those taking MAOIs and TCAs

Use cautiously in liver and renal dysfunction, cardiac disease

What drugs are the SNRIs

Venlafaxine

Desvenlafaxine

Duloxetine

Levomilnacipran

MOA of SNRIs

blocks reuptake of serotonin and norepinephrine, increasing levels in the brain

Uses of SNRIs

Depression and anxiety, OCD

side effects of SNRIs

(very similar to SSRIs) jitteriness, nausea, restlessness, headache, fatigue, changes in appetie, changes in weights, tremors, sweating, sexual dysfunction, diarrhea, constipation, hyponatreamia

BBW: Serotonin syndrome

BBW: Antidepressants increase the risk of suicidal thinking and behaviors in children, adolescents and young adults

teaching with SNRIs

follow teaching of SSRIs

What drugs are the benzodiazepines

1. alprazolam

2. oxazepam

3. triazolam

4. lorazepam

5. diazepam

6. clonazepam

7. chlordiazepoxide

MOA of benzodiazepines

enhances the actions of GABA, slows neuronal transmission

uses of benzodiazepines

- short term anxiety

- anti seizure

adverse effects of benzodiazepines

- high risk for developing tolerance, dependence and abuse.

- sedation, dizziness, fatigue, impaired driving, impaired cognitive function, CNS depression

patient and family teaching with benzodiazepines

. Caution the patient and family:

• Drug is indicated for short-term use only.

• Drug may lose its effectiveness over time related to tolerance.

• Do not increase dose or frequency of use without prior approval of the health care provider.

• Medications may cause sedation and reduce the ability to handle mechanical equipment and increase fall risk.

• Avoid alcohol or other central nervous system depressant drugs such as opioid pain medications, because the sedative effect can be compounded and can be fatal.

• Drug can have an opposite effect in selected individuals—increased anxiety/agitation rather than calming effect—and may cause rebound anxiety.

• Avoid caffeine to avoid decreasing the desired effects of the drug.

• Long-term use can increase mortality and the development of dementia.

• Avoid for people with a history of substance use disorder; increases risk of developing addiction.

2. Avoid becoming pregnant because these drugs increase the risk of congenital anomalies, especially in the first trimester.

3. Avoid breast-feeding because these drugs are excreted in the milk and would have adverse effects on the infant.

4. Teach the patient the following:

• Abrupt cessation of benzodiazepine use after 3 to 4 months of daily use may cause withdrawal symptoms such as insomnia, irritability, nervousness, dry mouth, tremors, convulsions, confusion, and even psychosis.

• Take with meals or snacks to reduce gastrointestinal discomfort.

• Drug interactions

• Antacids may delay absorption.

• Cimetidine interferes with the metabolism of benzodiazepines, causing increased sedation.

• Central nervous system depressants cause increased sedation.

contraindications for benzodiazepines

allergy, pregnancy, narrow-angle glaucoma

what drug is the non-benzodiazapine anoxiolytic

Buspirone

MOA of buspirone

binds to serotonin and dopamine receptors

uses of buspirone

generalized anxiety disorder

adverse effects of buspirone

less sedating than benzos

no dependence

dizziness, nausea, headache, nervousness, insomnia, lightheadedness, excitability

patient teaching with buspirone

may take 3 weeks or longer to feel effects

What drug is in the class peripherally acting antiadrenergic

prazosin

moa of prazosin

blocks excessive responsiveness to norepinephrine at postsynpatic adrenergic receptors

uses of prazosin

PTSD (nightmares)

adverse effects of prazosin

first dose orthostatic hypotension, dizziness, headache