Antidepressant and Anti-Anxiety Medications Flashcards

Antidepressant Medications: Heterocyclics

• Examples:
  • Bupropion
  • Trazodone
• Actions:
  • Does not inhibit MAO.
  • Has some anticholinergic and sedative effects.
  • Alters effects of serotonin on CNS.
• Indications:
  • Treatment of depression.
  • Smoking cessation (Bupropion specifically).
• Adverse effects:
  • Dry mouth
  • Nausea
  • Bupropion: Insomnia and agitation
  • Trazodone: Sedation, orthostatic hypotension
• Nursing considerations:
  • May require gradual reduction before stopping.
  • Avoid use with alcohol and other CNS depressants for up to 1 week after the end of therapy.

Antidepressant Medication: Monoamine Oxidase (MAO) Inhibitors

• Examples:
  • Phenelzine sulfate
  • Isocarboxazid
  • Tranylcypromine
• Actions:
  • Interferes with monoamine oxidase, increasing neurotransmitter concentrations (epinephrine, norepinephrine, serotonin) in the synaptic space, stabilizing mood.
• Indications:
  • Depression
  • Chronic pain syndromes
• Adverse effects:
  • Hypertensive crisis when taken with foods containing tyramine (aged cheese, bologna, pepperoni, salami, figs, bananas, raisins, beer, Chianti red wine) or OTC meds containing ephedrine/pseudoephedrine.
  • Photosensitivity
  • Weight gain
  • Sexual dysfunction
  • Orthostatic hypotension
• Nursing considerations:
  • Not first-line drugs for depression.
  • Should not be taken with SSRIs.
  • Administer antihypertensive medications with caution.
  • Avoid use of other CNS depressants, including alcohol.
  • Discontinue 10 days before general anesthesia.
  • Medications lower seizure threshold.
  • Monitor for urinary retention.

Antidepressant Medication: Selective Serotonin Reuptake Inhibitors (SSRIs) & Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)

• Examples:
  • SSRIs: Fluoxetine, paroxetine, sertraline hydrochloride, citalopram
  • SNRIs: Venlafaxine, duloxetine
• Actions:
  • Inhibits CNS neuronal uptake of serotonin.
  • Acts as stimulant counteracting depression and increasing motivation.
• Indications:
  • Depression
  • Obsessive-compulsive disorders
  • Obesity
  • Bulimia
• Adverse effects:
  • Headache, dizziness
  • Nervousness
  • Insomnia, drowsiness
  • Anxiety
  • Tremor
  • Dry mouth
  • GI upset
  • Taste changes
  • Sweating
  • Rash
  • URI
  • Painful menstruation
  • Sexual dysfunction
  • Weight gain
• Nursing considerations:
  • Take in A.M.
  • Takes 4 weeks for full effect.
  • Monitor weight.
  • Good mouth care.
  • Do not administer with MAOIs - risk of serotonin syndrome.
  • Monitor for thrombocytopenia, leukopenia, and anemia.

Antidepressant Medications: Tricyclics

• Examples:
  • Amitriptyline
  • Imipramine
• Actions:
  • Inhibits presynaptic reuptake of neurotransmitters norepinephrine and serotonin.
  • Anticholinergic action at CNS and peripheral receptors.
• Indications:
  • Depression
  • Obstructive sleep apnea
• Adverse effects:
  • Sedation
  • Anticholinergic effects (dry mouth, blurred vision)
  • Confusion (especially in elderly)
  • Photosensitivity
  • Disturbed concentration
  • Orthostatic hypotension
  • Bone marrow depression
  • Urinary retention
• Nursing considerations:
  • Therapeutic effect in 1-3 weeks; maximum response in 6-9 weeks.
  • May be administered in daily dose at night to promote sleep and decrease adverse effects during the day.
  • Orthostatic hypotension precautions.
  • Instruct client that adverse effects will decrease over time.
  • Sugarless lozenges for dry mouth.
  • Do not abruptly stop taking medication (headache, vertigo, nightmares, malaise, weight change).
  • Avoid alcohol, sleep-inducing drugs, OTC drugs.
  • Avoid exposure to sunlight, wear sunscreen.
  • Older adults: strong anticholinergic and sedation effects.

Antidepressant Medication Overview: MAOIs

• Examples:
  • Isocarboxazid
  • Tranylcypromine sulfate
  • Phenelzine sulfate
• Actions:
  • Inhibits monoamine oxidase enzyme, preventing destruction of norepinephrine, epinephrine, and serotonin.
  • Increases brain amine levels
• Adverse effects:
  • Postural hypotension
  • Hypertensive crisis if foods with tyramine are ingested: headache, sweating, palpitations, stiff neck, intracranial hemorrhage
  • Potentiates alcohol and other medications
• Nursing Considerations:
  • Avoid foods with tyramine: aged cheese, liver, herring, yeast, beer, wine, sour cream, pickled products
  • Avoid caffeine, antihistamines, amphetamines
  • Takes 3-4 weeks to work
  • Avoid tricyclics until 3 weeks after stopping MAO inhibitors
  • Monitor vital signs
  • Sunblock required
  • Sedation/drowsiness, especially with amitriptyline
  • Suicide risk high after 10-14 days because of increased energy

Antidepressant Medication Overview: Tricyclics

• Examples:
  • Amitriptyline hydrochloride
  • Imipramine
  • Desipramine hydrochloride
  • Doxepin
  • Nortriptyline
• Adverse effects:
  • Blurred vision, dry mouth, diaphoresis
  • Postural hypotension, palpitations
  • Nausea, vomiting
  • Constipation, urinary retention
  • Increased appetite
  • Palpitations, bradycardia
• Nursing considerations:
  • Monitor vital signs
  • Sunblock required
  • Increase fluid intake
  • Take dose at bedtime (sedative effect)
  • Use sugarless candy or gum for dry mouth
  • Delay of 2-6 weeks before noticeable effects

Antidepressant Medication Overview: SSRIs

• Examples:
  • Fluoxetine
  • Paroxetine
  • Sertraline hydrochloride
  • Citalopram
• Actions:
  • Decreases neuronal uptake of serotonin
• Adverse effects:
  • Nausea, vomiting, diarrhea or constipation, increased or decreased appetite
  • Urinary retention
  • Nervousness, insomnia
• Nursing considerations:
  • Take in AM to avoid insomnia
  • Takes at least 4 weeks to work
  • Can potentiate effect of digoxin, warfarin, and diazepam
  • Used for anorexia

Antidepressant Medication Overview: SNRIs

• Examples:
  • Venlafaxine
  • Duloxetine

Antidepressant Medication Overview: Heterocyclics/Atypical

• Examples:
  • Bupropion
  • Trazodone
• Adverse effects:
  • Dry mouth
  • Nausea
• Nursing considerations:
  • May require gradual reduction before stopping
  • Avoid use with alcohol, other CNS depressants for up to 1 week after end of therapy

Antidepressant Medication Overview: Herbals

• Examples:
  • St. John's wort
• Adverse effects:
  • Dizziness, hypertension
  • Allergic skin reaction
  • Phototoxicity
• Nursing Considerations:
  • Avoid use of St. John's wort and MAOI within 2 weeks of each other
  • Do not use alcohol
  • Contraindicated in pregnancy
  • Avoid exposure to sun and use sunscreen
  • Discontinue 1 to 2 weeks before surgery
  • St. John's wort-interacts with SSRIs; do not take within 2 weeks of MAOI
  • Ginseng may potentiate MAOIs
  • Avoid Ma huang or ephedra with MAOIs
  • Kava kava should not be combined with benzodiazepines or opioids due to increased sedation
  • Increased use of Brewer's yeast with MAOIs can increase blood pressure

Anti-Anxiety Medications: Benzodiazepine Derivatives

• Examples:
  • Chlordiazepoxide
  • Diazepam
  • Alprazolam
  • Lorazepam
  • Oxazepam
  • Midazolam
• Use: anxiety, sedation, alcohol withdrawal, seizures
• Adverse effects:
  • Lethargy, hangover
  • Respiratory depression
  • Hypotension
  • Drowsiness, light-headedness, hypotension, hepatic dysfunction
  • Increased salivation
  • Orthostatic hypotension
  • Memory impairment and confusion
  • Retrograde amnesia
  • Euphoria
  • Hypotension
  • Dysrhythmia
  • Cardiac arrest
• Nursing Considerations:
  • CNS depressant
  • May result in toxic build-up in the elderly
  • Potential for physiological addiction/overdose
  • Can develop tolerance and cross-tolerance
  • Cigarette smoking increases clearance of drug
  • Alcohol increases CNS depression
  • Safer for elderly (Oxazepam)
  • Don't combine with alcohol or other depressants
  • Check renal and hepatic function
  • Don't discontinue abruptly (true for all anti-anxiety medications)
  • Teach addictive potential
  • Use-preoperative sedation, conscious sedation for endoscopic procedures and diagnostic tests (Midazolam)

Anti-Anxiety Medications: Anxiolytics: Nonbenzodiazepine

• Examples:
  • Buspirone
  • Hydroxyzine
• Adverse effects:
  • Light-headedness
  • Confusion
  • Hypotension, palpitations
  • Drowsiness, ataxia
  • Leukopenia, hypotension
• Nursing Considerations:
  • Little sedation (Buspirone)
  • Requires approximately 3 weeks to be effective (Buspirone)
  • Cannot be given as a PRN medication (Buspirone)
  • Particularly useful for generalized anxiety disorder (GAD) (Buspirone)
  • No abuse potential (Buspirone)
  • Used for clients with previous addiction (Buspirone)
  • Avoid alcohol and grapefruit juice (Buspirone)
  • Monitor for worsening depression or suicidal tendencies (Buspirone)
  • Produces no dependence, tolerance, or intoxication (Buspirone)
  • Can be used for anxiety relief for indefinite periods (Buspirone)

Anti-Anxiety Medications: Herbals

• Examples:
  • Kava
  • Melatonin
• Adverse effects:
  • Impaired thinking, judgment, motor reflexes, vision, decreased plasma proteins, thrombocytopenia, leukocytopenia, dyspnea, and pulmonary hypertension (Kava)
  • Sedation, confusion, headache, and tachycardia (Melatonin)
• Nursing considerations:
  • Similar activity to benzodiazepines (Kava)
  • Suppresses emotional excitability and produces mild euphoria (Kava)
  • Do not take with CNS depressants (Kava)
  • Should not be taken by women who are pregnant or lactating or by children under the age of 12 (Kava)
  • Influences sleep-wake cycles (levels are high during sleep) (Melatonin)
  • Used for prevention and treatment of "jet lag" and insomnia (Melatonin)
  • Use cautiously if given with benzodiazepines and CNS depressants (Melatonin)
  • Contraindicated in hepatic insufficiency, history of cerebrovascular disease, depression, and neurologic disorders (Melatonin)

Anti-Anxiety Medications: General Information

• Action:
  • Affects neurotransmitters
• Indications:
  • Anxiety disorders, insomnia, seizures, panic attacks, acute manic episodes
• Adverse effects:
  • Sedation
  • Depression, confusion
  • Anger, hostility
  • Headache
  • Dry mouth, constipation
  • Bradycardia
  • Elevations in LDH, AST, ALT
  • Urinary retention
• Nursing considerations:
  • Monitor liver function
  • Monitor for therapeutic blood levels
  • Avoid alcohol
  • Caution when performing tasks requiring alertness (e.g., driving car)
  • Benzodiazepines are also used as muscle relaxants, sedatives, hypnotics, anticonvulsants