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Antidepressants
Depression Drugs
| Question | Answer |
|---|---|
| What are the 3 drug classes of antidepressant medications? | 1) TCA 2) SSRI 3)MAOI |
| What are TCAs? | Tricyclic Antidepressants - they are known as the "older drugs" used to treat depression. They prevent to reuptake of norepinephrine or serotonin, which results in increased concentrations of these neurotransmitters |
| What are the 4 TCA medications? | 1)amitriptyline (Elavil) - route(s): PO,IM 2) nortriptyline (Aventyl) - route(s): P O 3) imipramine (Tofranil) - route(s): PO & IM 4) doxepin (Sinequan) route(s): PO |
| When are TCA medications used? | They are still used to treat OCD and some depressed clients. It is no longer the first choice medication in treating depression. |
| If a client is having suicidal thoughts, how long can the client take TCA medication for? Why? | Give only 1 week's worth of medication if client has suicidal thoughts - RISK OF OVERDOSE! |
| When & how many times a day should TCA medications be given? | Usually given ONCE daily at BEDTIME. We give it at bedtime because it causes sedation & the client should avoid activities that require mental alertness. Instruct client to move slowly from lying to sitting position to prevent POSTURAL HYPOTENSION |
| TCA medications are contraindicated in clients with: | EPILEPSY, GLAUCOMA & CARDIOVASCULAR DISEASE |
| Of the 4 TCA medications, which one is tolerated the best by the elderly? How should this medication be given to the elderly client? | SINEQUAN is tolerated better by the elderly; has less effect on cardiac status; dilute the concentrate with ORANGE JUICE. |
| TCA medication should not be taken at the same time as which other anntidepressant medication? A time lag of ______ days is necessary when changing from one drug group to another. | Should not be given at the same time as an MAOI; a time lag of 14 days is necessary when changing from one drug group to another |
| What are the side effects of TCA medications? | Dry mouth, drowsiness/sedation, dizziness, blurred vision, decreased tears, urinary retention, constipation & weight gain |
| What is the drug of choice for depression? Why? | SSRIs - SSRIs are overtaking TCAs as drugs of choice for depression. SSRIs have a less incidence of side effects & they don't have a great risk for overdose. |
| What are SSRIs? | Selective Serotonin Reuptake Inhibitors - they are the first-line drugs to treat depression. They cause selective inhibition of serotonin uptake and produce CNS excitation rather than sedation. They have NO EFFECT on dopamine or norepinephrine |
| What are the 4 SSRI medications? | 1)fluoxetine (Prozac) 2)sertaline (Zoloft) 3)paroxetine (Paxil) 4)fluvoxamine (Luvox) 5)citalopram (Celexa) 6)venlafaxine (Effexor) |
| When are SSRI medications used? | Used to treat depression, OCD, bulimia & appetite suppression in obese clients |
| What time of the day should SSRI medication be taken? | Take SSRI medications in the morning - all are given PO |
| What are the side effects of SSRI medications? | Headache, nausea, increased sweating, blurred vision, nervousness, anxiety, insomnia, sexual side effects/dysfunction, skin rash |
| What are MAOIs? | Monoamine Oxidase Inhibitors - the second-line drugs for the treatment of depression. They inhibit enzyme monoamine oxidase, which breaks down norepinephrine & serotonin, increasing the concentration of these neurotransmitters. |
| Why is it the second-line drugs for the treatment of depression? | Because of the potential interactions with other drugs and certian foods; they also potentiate many drug actions. If client takes MAOIs, they must be willing to abide by restricitons. |
| What are the 3 MAOI medications used? | 1) isocarboxazid (Marplan)- PO 2) phenelzine sulfate (Nardil) - PO 3) tranylcypromine (Parnate) - PO |
| MAOI medications potentiate many drug actions such as: | Narcotics, barbiturates, and atropine-like medications |
| MAOI medications have a LONG duration of action; therefore ________ weeks must go by before another drug is administered while a client is taking an MAOI. | 2-3 WEEKS |
| What foods and drugs can cause a potential interaction with MAOI medications? What happens if these foods or drugs are ingested? | Foods or drugs containing TYRAMINE or EPINEPHRINE-LIKE SUBSTANCES should be restricted. Ingestion of these substances may cause a SEVERE HYPERTENSIVE CRISIS |
| What is a severe hypertensive crises characterized by? | Characterized by marked elevation of blood pressure, increased temperature, tremors & tachycardia. Monoamine oxidase is needed to breakdown tyramine & epinephrine. If it is inhibited, then tyramine remains high and increased blood pressure occurs. |
| Foods to avoid when taking MAOI medications include: | Coffee, tea, cola beverages, beer, red wines, aged cheese, pickled foods, avocados, raisins & figs. |
| Drugs to avoid when taking MAOI medications include: | Over-the-counter cough & cold preperations containing ephedrine or ephedrine-like substances (Warnings are on labels); hay fever medications; nasal decongestants |
| What are the side effects of MAOI medications (besides food/drug interactions)? | Dry mouth, drowsiness, insomnia, urinary retention, hypotension |
| How long does it take for all antidepressant medications to take therapeutic effect? | Therapeutic effect has a delayed onset of 7-21 days; however, SSRIs may take as long as 6 weeks to become effective. Clients may feel calmer right away, and worry less. |
| Why are antidepressants usually discontinued before surgery? | Because of adverse interactions with anesthetic agents (10 days for MAOIs; 2-3 days for TCAs). |
| SEROTONIN SYNDROME: What is Serotonin Syndome? | a potentially life-threatening condition in which there is an excess of serotonin in the central nervous system. SEROTONIN LEVELS ARE TOO HIGH! |
| What may cause Serotonin Syndrome? | occurs when you take medications that cause high levels of the chemical serotonin to accumulate in your body. It can occur when you increase the dose of such a drug or add a new drug or dietary supplement to the ones you take already. |
| A client is at increased risk for developing Serotonin Syndrome when taking... | Increased risk when taking more than one antidepressant or use of ST. JOHN'S WORT with meds. Among antidepressants, MAOIs are of particular concern. |
| There is no test for Serotonin Syndrome so it must be diagnosed based upon symptoms. Symptoms include: | Tachycardia, hypertension, fever, sweating, shivering, confusion, anxiety, restlessness, disorientation, tremors, muscle spasms & muscle rigidity. |
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