11- ANTIDEPRESSANTS Overview (SSRIs, MAOIs, TCAs) | Nursing Pharmacology (NurseInTheMaking)

Source: https://www.youtube.com/watch?v=MMF5o_9xQ4g&list=PLsrJ2GPZGwJ-31cGPC_6hJD_7cvF2wvur&index=1&t=2s

Correct Answer: C. Antidepressants increase energy before mood improves

Explanation:
When antidepressants are initiated, energy and motivation improve before mood, which may allow a patient with suicidal ideation to act on a preexisting plan.

Which statement best explains why antidepressants increase the risk for suicide when first started?

A. Antidepressants worsen depression initially
B. Antidepressants increase serotonin too quickly
C. Antidepressants increase energy before mood improves
D. Antidepressants cause impulsive behavior

Correct Answer: C. Monitor for suicidal thoughts

Explanation:
All antidepressants carry an increased suicide risk, especially early in treatment, making monitoring for suicidal ideation critical.

Which nursing action is most important when a patient first starts an antidepressant?

A. Monitor blood glucose
B. Monitor liver enzymes
C. Monitor for suicidal thoughts
D. Encourage high-protein intake

Correct Answer: D. Taper the medication gradually

Explanation:
Antidepressants must not be stopped abruptly due to withdrawal symptoms and relapse risk; they must be tapered.

Which instruction should the nurse give regarding stopping antidepressants?

A. Stop once symptoms improve
B. Stop if side effects occur
C. Stop abruptly if feeling better
D. Taper the medication gradually

Correct Answer: C. Inhibiting serotonin reuptake

Explanation:
SSRIs inhibit the reuptake of serotonin, increasing serotonin levels in the brain.

SSRIs work by which mechanism of action?

A. Blocking monoamine oxidase
B. Increasing dopamine release
C. Inhibiting serotonin reuptake
D. Blocking norepinephrine receptors

Correct Answer: C. –pram

Explanation:
Common SSRI suffixes include –pram (citalopram, escitalopram) and –etine.
⚠ –zodone (e.g., trazodone) is NOT an SSRI.

Which medication suffix is correctly associated with SSRIs?

A. –zodone
B. –pramine
C. –pram
D. –zine

Correct Answer: D. Serotonin antagonist and reuptake inhibitor (SARI)

Explanation:
Trazodone is a SARI, not an SSRI, despite often being grouped with antidepressants in simplified teaching.

Trazodone belongs to which antidepressant class?

A. SSRI
B. TCA
C. MAOI
D. Serotonin antagonist and reuptake inhibitor (SARI)

Correct Answer: C. Sexual dysfunction

Explanation:
SSRIs commonly cause sexual dysfunction, along with GI upset and possible weight changes.

Which side effect is commonly associated with SSRIs?

A. Hypertensive crisis
B. Anticholinergic effects
C. Sexual dysfunction
D. Severe hypotension

Correct Answer: C. Too much serotonin

Explanation:
Serotonin syndrome results from excess serotonin, often due to drug interactions or overdose.

Serotonin syndrome occurs due to:

A. Too little serotonin
B. Excess dopamine
C. Too much serotonin
D. Blocking serotonin receptors

Correct Answer: B. Muscle rigidity and restlessness

Explanation:
Serotonin syndrome presents with muscle rigidity, restlessness, hypertension, tachycardia, and mental status changes.

Which symptom is most indicative of serotonin syndrome?

A. Bradycardia
B. Muscle rigidity and restlessness
C. Hypoglycemia
D. Dry mouth

Correct Answer: C. St. John’s wort

Explanation:
St. John’s wort increases serotonin, raising the risk of serotonin syndrome when combined with SSRIs.

Which substance should NOT be taken with SSRIs?

A. Vitamin C
B. Calcium
C. St. John’s wort
D. Iron supplements

Correct Answer: C. Norepinephrine

Explanation:
TCAs block reuptake of both serotonin and norepinephrine.

TCAs differ from SSRIs because they also block the reuptake of:

A. Dopamine
B. Acetylcholine
C. Norepinephrine
D. GABA

Correct Answer: B. Anticholinergic effects

Explanation:
TCAs cause anticholinergic effects: urinary retention, blurred vision, dry mouth, and constipation.

Which side effect is characteristic of TCAs?

A. Sexual dysfunction
B. Anticholinergic effects
C. Hypertensive crisis
D. Insomnia only

Correct Answer: C. Rise slowly from sitting or lying positions

Explanation:
TCAs cause orthostatic hypotension, so patients should rise slowly to prevent falls.

A patient taking TCAs reports dizziness when standing. What is the nurse’s best instruction?

A. Increase sodium intake
B. Take medication at night
C. Rise slowly from sitting or lying positions
D. Stop the medication

Correct Answer: C. 14 days

Explanation:
A 14-day washout period is required to prevent dangerous drug interactions.

How long should a patient wait after stopping an MAOI before starting an SSRI or TCA?

A. 7 days
B. 10 days
C. 14 days
D. 30 days

Correct Answer: B. Preventing monoamine breakdown

Explanation:
MAOIs inhibit monoamine oxidase, preventing the breakdown of serotonin, dopamine, norepinephrine, and epinephrine.

MAOIs increase neurotransmitters by:

A. Blocking serotonin receptors
B. Preventing monoamine breakdown
C. Increasing neurotransmitter excretion
D. Enhancing reuptake

Correct Answer: C. Aged cheese

Explanation:
Aged and fermented foods high in tyramine can cause a hypertensive crisis when combined with MAOIs.

Which food should a patient on MAOIs avoid?

A. Fresh apples
B. White rice
C. Aged cheese
D. Boiled eggs

Correct Answer: C. Hypertensive crisis

Explanation:
Tyramine + MAOIs can lead to a life-threatening hypertensive crisis.

What is the most serious complication of consuming tyramine while on MAOIs?

A. Serotonin syndrome
B. Orthostatic hypotension
C. Hypertensive crisis
D. Respiratory depression

Correct Answer: C. In the morning

Explanation:
MAOIs can cause sleep disturbances, so they are taken in the morning.

When should MAOIs be taken?

A. At bedtime
B. With meals only
C. In the morning
D. Every other day

Correct Answer: D. 4 weeks

Explanation:
MAOIs take approximately 4 weeks to reach therapeutic levels.

How long do MAOIs typically take to reach therapeutic effect?

A. 1 week
B. 2 weeks
C. 3 weeks
D. 4 weeks

Correct Answer: B. Eating disorders

Explanation:
SSRIs are used to treat depression, anxiety, OCD, and eating disorders, as stated in the content.

Which condition is an approved use of SSRIs that the nurse should recognize?

A. Neuropathic pain
B. Eating disorders
C. Hypertensive crisis
D. Parkinson’s disease

Correct Answer: B. Bipolar disorder

Explanation:
TCAs may be used in depressive episodes, bipolar disorder, OCD, and neuropathy.

Which disorder is a clinical use of tricyclic antidepressants (TCAs)?

A. Schizophrenia
B. Bipolar disorder
C. Alzheimer’s disease
D. Acute psychosis

Correct Answer: C. TCAs

Explanation:
TCAs are commonly prescribed for neuropathic pain, in addition to mood disorders.

A patient with diabetic neuropathy is prescribed an antidepressant. Which class is most appropriate?

A. SSRIs
B. MAOIs
C. TCAs
D. SARIs

Correct Answer: B. Weight gain

Explanation:
SSRIs may cause weight gain, though it is variable and not universal.

Which side effect related to SSRIs should the nurse educate the patient about, even though it is not experienced by all patients?

A. Hypertensive crisis
B. Weight gain
C. Anticholinergic effects
D. Respiratory depression

Correct Answer: B. Muscle rigidity and confusion

Explanation:
Serotonin syndrome includes muscle rigidity, restlessness, autonomic instability, and mental status changes such as confusion or agitation.

Which finding supports a diagnosis of serotonin syndrome?

A. Bradycardia and hypotension
B. Muscle rigidity and confusion
C. Dry mouth and constipation
D. Hypoglycemia and diaphoresis

Correct Answer: B. High heart rate and high blood pressure

Explanation:
Serotonin syndrome causes tachycardia and hypertension due to excess serotonin.

Which vital sign changes are most concerning in serotonin syndrome?

A. Low heart rate and low blood pressure
B. High heart rate and high blood pressure
C. Low oxygen saturation
D. Slow respiratory rate

Correct Answer: B. Suck on sugar-free hard candies

Explanation:
TCAs cause anticholinergic effects, including dry mouth. Sugar-free candies and increased fluids help relieve symptoms.

Which nursing intervention helps relieve dry mouth caused by TCAs?

A. Limit oral intake
B. Suck on sugar-free hard candies
C. Avoid fluids
D. Take the medication at night

Correct Answer: C. Increase fluids, fiber, and exercise

Explanation:
Constipation from TCAs is managed with fluids, fiber, and regular exercise.

Which nursing education helps prevent constipation in patients taking TCAs?

A. Increase protein intake
B. Reduce physical activity
C. Increase fluids, fiber, and exercise
D. Take stool softeners daily

Correct Answer: B. Overripe fermented fruits

Explanation:
Fermented or overripe fruits contain tyramine and may trigger a hypertensive crisis in patients on MAOIs.

Which food should a patient taking MAOIs avoid due to high tyramine content?

A. Fresh vegetables
B. Overripe fermented fruits
C. White bread
D. Boiled potatoes

Correct Answer: B. Yogurt and sour cream

Explanation:
Yogurt and sour cream are moderate-to-high tyramine foods and should be avoided to prevent hypertensive crisis.

Which additional food is high in tyramine and must be avoided with MAOIs?

A. Low-fat milk
B. Yogurt and sour cream
C. Fresh chicken
D. Steamed rice

Correct Answer: C. Liver

Explanation:
Liver and other organ meats are high in tyramine and are contraindicated with MAOIs.

Which organ meat is unsafe for a patient taking MAOIs?

A. Chicken breast
B. Fish fillet
C. Liver
D. Eggs