NURS 309: ANTIDEPRESSANTS

Amitriptyline – Class & Action

A client is prescribed amitriptyline for IBS-related symptoms. How does this medication work?

It is a tricyclic antidepressant (TCA) that inhibits reuptake of serotonin & norepinephrine, increasing their levels in the synaptic space.

• It also blocks cholinergic & histamine receptors, causing sedative & anticholinergic effects.

Amitriptyline – Therapeutic Use

What is amitriptyline used for?

Primarily used for relief of IBS symptoms, & also used for depression, neuropathic pain, & chronic pain conditions.

Amitriptyline – Nursing Assessment

Before giving amitriptyline, what should the nurse assess?

ECG (especially in cardiac patients), mood & suicidal ideation, BP (orthostatic changes), weight, glucose, cholesterol, & anticholinergic effects (dry mouth, constipation, urinary retention).

Amitriptyline – Administration

How should amitriptyline be administered?

• Give at bedtime due to sedation.

• May give w food if GI upset occurs.

• Start low & titrate slowly over weeks.

Amitriptyline – Common Side Effects

What side effects may occur?

• Orthostatic hypoTN

• dizziness

• sedation

• lethargy

• blurred vision

• dry mouth

• constipation

• weight gain

Amitriptyline – Adverse Effects

Which adverse effects require immediate attention?

• Dysrhythmias

• torsades de pointes

• seizures (high doses)

• glaucoma

• suicidal thoughts/behavior

• bone marrow suppression

Amitriptyline – Drug Interactions

Which medications interact with amitriptyline?

• MAOIs (risk of severe hypotension/tachycardia)

• SSRIs (toxicity/serotonin effects)

• TCAs w phenothiazines, carbamazepine, quinidine, amiodarone, St. John’s wort, & CNS depressants (ETOH, opioids, sedatives, antihistamines)

Amitriptyline – Contraindications

Who should avoid amitriptyline?

Clients with hypersensitivity to TCAs, recent MI, heart failure, QT prolongation, seizures, or closed-angle glaucoma.

Amitriptyline – Precautions

Which clients require caution?

Older adults, children/young adults (<26), suicidal ideation, BPH or urinary retention, hepatic or renal impairment, pregnancy, breastfeeding, and seizure disorders.

Amitriptyline – Client Teaching

What should clients be taught?

Take at bedtime, avoid alcohol and CNS depressants, change positions slowly, do not drive until effects are known, increase fluids and fiber for constipation, use sugarless gum for dry mouth, report mood changes or suicidal thoughts, and notify provider for urinary retention or vision changes.

Fluoxetine – Class & Action

A client is prescribed fluoxetine for depression. How does this medication work?

It is a selective serotonin reuptake inhibitor (SSRI) that blocks serotonin reuptake transporters, increasing serotonin levels in the synaptic gap and improving mood regulation.

Fluoxetine – Therapeutic Use

What is fluoxetine used for?

Treatment of major depressive disorder, PMDD, and DMDD; also used for anxiety, panic disorder, and as adjunct therapy in bipolar depression (with a mood stabilizer).

Fluoxetine – Nursing Assessment

Before giving fluoxetine, what should the nurse assess?

Suicidal ideation (especially in patients <24), mood changes, sleep and appetite patterns, weight changes, sexual dysfunction, and signs of serotonin syndrome or NMS.

Fluoxetine – Administration

How should fluoxetine be administered?

Orally, once daily at the same time each day—preferably in the morning. May take with food if GI upset occurs. Do not discontinue abruptly.

Fluoxetine – Common Side Effects

What side effects may occur?

Nervousness, anxiety, tremor, insomnia or drowsiness, headache, nausea, diarrhea, dry mouth, abdominal pain, weight changes, and sexual dysfunction.

Fluoxetine – Adverse Effects

Which adverse effects require immediate attention?

Suicidal thoughts, serotonin syndrome, manic episodes (especially in bipolar disorder), seizures, bleeding risk, QT prolongation/torsades de pointes, and neuroleptic malignant syndrome.

Fluoxetine – Drug Interactions

Which medications interact with fluoxetine?

MAOIs (must avoid within 14 days), other SSRIs/SNRIs, lithium, linezolid, tramadol, opioids, triptans, St. John’s wort, NSAIDs, aspirin, warfarin, anticoagulants, and other serotonergic or sedating drugs.

Fluoxetine – Contraindications

Who should avoid fluoxetine?

Clients with hypersensitivity, children <7 years old, and those with active suicidal tendencies (use extreme caution).

Fluoxetine – Precautions

Which clients require caution?

Older adults, pregnancy, liver/kidney disease, peptic ulcer disease, seizures, diabetes, glaucoma, cardiac disease (MI, heart failure, QT prolongation), and electrolyte imbalances (low K+ or Mg2+).

Fluoxetine – Client Teaching

What should clients be taught?

Take daily at the same time, preferably morning; do not stop abruptly; report mood changes, agitation, or suicidal thoughts; avoid alcohol and CNS depressants; inform providers of all medications/supplements; expect delayed onset of full effects.

Selegiline – Class & Action

A client is prescribed selegiline for depression or Parkinson’s disease. How does this medication work?

Selegiline – Therapeutic Use

What is selegiline used for?

Major depressive disorder, Parkinson’s disease (low doses), and as an adjunct to carbidopa/levodopa when response decreases.

Selegiline – Nursing Assessment

Before giving selegiline, what should the nurse assess?

Blood pressure, mental status, suicidal ideation, behavioral changes, and Parkinson’s disease manifestations; monitor for orthostatic hypotension.

Selegiline – Administration

How is selegiline administered?

Oral capsules or orally disintegrating tablets (take on empty stomach or as directed), or transdermal patch. Do not take with certain foods or drugs that increase serotonin or sympathetic activity.

Selegiline – Common Side Effects

What side effects may occur?

Dizziness, drowsiness, orthostatic hypotension, headache, dry mouth, nausea, constipation, abdominal pain, insomnia, agitation, vivid dreams.

Selegiline – Adverse Effects

Which adverse effects require immediate attention?

Hypertensive crisis, serotonin syndrome, suicidal thoughts, psychosis, hallucinations, dysrhythmias, severe agitation, compulsive behaviors, extrapyramidal symptoms.

Selegiline – Drug Interactions

Which medications interact with selegiline?

SSRIs/SNRIs, other antidepressants, opioids (especially meperidine and methadone), triptans, dextromethorphan, buspirone, cyclobenzaprine, linezolid, St. John’s wort, and sympathomimetics (risk of hypertensive crisis or serotonin syndrome).

Selegiline – Contraindications

Who should avoid selegiline?

Clients with hypersensitivity, pheochromocytoma, psychotic disorders, or concurrent use of contraindicated serotonergic or sympathomimetic medications.

Selegiline – Precautions

Which clients require caution?

Older adults, history of mania, peptic ulcer disease, phenylketonuria (ODT formulation), and those at risk for orthostatic hypotension or depression worsening. Stop 10 days before surgery.

Selegiline – Client Teaching

What should clients be taught?

Avoid tyramine-rich foods (cheese, cured meats), alcohol, caffeine, and OTC cold meds; report signs of hypertensive crisis or serotonin syndrome; take exactly as prescribed; inform all providers of use; report mood or neurological changes immediately.

It is a monoamine oxidase-B (MAO-B) inhibitor that blocks breakdown of neurotransmitters, increasing dopamine, norepinephrine, and serotonin levels in the brain.