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antidepressants and mood stabilizers
chapter 27
37
Pharmacology
Undergraduate 4
10/01/2009

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Term
what are the three types of depression?
Definition
reactive, major and bipolar
Term
what is a mood disorder characterized by?
Definition
Characterized primarily by mood changes
Characterized by loss of interest in normal activities
Term
what is the pathophysiology of a mood disorder?
Definition
nsufficient amount of monamine neurotransmitters (norepinephrine, serotonin, dopamine)
Term
Can social and enviornmental factors that effect mood disorders?
Definition
yes
Term
whar are characteristics of a reactive mood disorder?
Definition
called the “blues”)
Usually sudden onset resulting from precipitating event
Term
what are the characteristics of a major mood disorder?
Definition
Characterized by loss of interest in work, home, inability to complete tasks, and deep depression
Term
what are characteristics of bipolar mood disorders?
Definition
Mood swings between manic (euphoric) and depressive (dysphoria)
Term
What types of antidepressants agents  are used for mood disorders?
Definition
tricyclic antidepressants, atypical antidepressants and monoamine oxidase inhibitors
Term

what is an example of a tricyclic antidepressant (TCA)?

 

Definition
amitriptyline (elavil)
Term
what are some examples of seotonin reuptake inhibitors (SSRIs)?
Definition
Fluoxetine (Prozac), sertraline (Zoloft)
Term
what are some examples of atypical antidepressants?
Definition
Bupropion (Wellbutrin)
Venlafaxine (Effexor)
Term
what is an examples of MAOI inhibitors?
Definition
Isocarboxazid (Marplan)
Term
what is an example of tricyclic antidepressant?
Definition
Amitriptyline (Elavil)
Term
what is the action of elavil?
Definition
Block uptake of neurotransmitters norepinephrine and serotonin in brain
Blocks histamine receptors
Elevates mood, increases interest in ADLs, decreases insomnia
Term
what is elavil used for?
Definition
Major depression and agitated depression
Term
what is the interactions of elavil?
Definition
Increased CNS effects with alcohol and other
    CNS depressants
Increased sedation and anticholinergic effects with phenothiazines, haloperidol
Term
what are the side effects/adverse reactions with elavil?
Definition
Sedation, dizziness, blurred vision, dry mouth and eyes, urinary retention, constipation,
    weight gain, GI distress, sexual dysfunction
Orthostatic hypotension, dysrhythmias, EPS, blood dyscrasias
Term
what is the the action of selective serotonin reuptake inhibitors?
Definition
Block uptake of neurotransmitter serotonin
Term
what are some examples of selective serotonin reuptake inhibitors?
Definition
Fluoxetine (Prozac), sertraline (Zoloft),
    paroxetine (Paxil), escitalopram (Lexapro)
Term
what are selective serotonin reuptake inhibitors used for?
Definition
Major depression, anxiety disorders
    (obsessive- compulsiveness, panic, phobias) prevention of migraine headaches
Term
what are interactions with selective serotonin reuptake inhibitors?
Definition
Increased CNS effects with alcohol and other CNS depressants
Term
what are side effects/ adverse reactions with welective serotonin reuptake inhibitors?
Definition
Headache, nervousness, restlessness, insomnia, tremors, GI distress, sexual
    dysfunction
Seizures, suicidal ideation
Side effects often decrease over 2-4 weeks
Term
what is and example of an MOAI inhibitor?
Definition
socarboxazid (Marplan)
Term
what is the action of MAOIs?
Definition
Monamine oxidase enzyme inactivates
    norepinephrine, dopamine, epinephrine, and serotonin
Term
what is the use of MAOI inhibitors?
Definition
depression not controlled by TCAs
Term
what are side effect/ adverse reactions of MAOIs?
Definition
Agitation, restlessness, insomnia, orthostatic hypotension, anticholinergic effects
Hypertensive crisis from fatal tyramine
Term
what are the interactions with MAOIs?
Definition
cheese, coffee, cream, yogurt, bananas, liver, yeast, chocolate, beer, red wine)
Term
what are some nursing interventions?
Definition
Monitor vital signs
Monitor mood for drug effectiveness
Monitor for suicidal tendencies, seizures
Warn about foods that contain tyramine can
    cause a hypertensive crisis with MAOIs
Encourage client to take drug as prescribed
Avoid CNS stimulants (including alcohol), CNS depressants, cold medicines
Term
what are some other nursing interventions?
Definition
Warn client against driving or using dangerous mechanical equipment until drug effect is known
Warn client against abruptly stopping drug
Instruct client to take drug at bedtime
Advise client that a therapeutic response usually occurs in 2-4 weeks
Inform client that herbs (St. John’s wort,
    ginseng, etc) may interact with antidepressants
Term
what is lithium (eskalith) do?
Definition
Alteration of ion transport in muscle and nerve cells
Increased receptor sensitivity to serotonin
Term
what is lithium used for?
Definition
Treat manic episodes in bipolar psychosis
Term
what are some interactions  with lithium?
Definition
Increase lithium level with thiazides, methyldopa, haloperidol, NSAIDs,
    antidepressants, theophylline, phenothiazines
Term
what are side effects/ adverse reactions of lithium?
Definition
Headache, drowsiness, dizziness,
    hypotension, restlessness, slurred speech, dry mouth, metallic taste, tremors, muscle
    weakness, GI distress, edema of hands and ankles, increased urination, dysrhythmias,
    blood dyscrasias, nephrotoxicity
Term
what are some nursing interventions with lituium?
Definition
Monitor vital signs, sodium levels
Monitor for drug effectiveness, suicidal
    tendencies
Monitor urine output, renal function tests
Encourage adequate fluid intake (1-2 L daily)
Take with food to decrease GI irritation
Monitor lithium levels every 1-2 months (0.5 to 1.5 mEq/L); toxic range greater than 2 mEq/L
Term
what are the toxic side effects of lithium?
Definition
persistent nausea, vomiting, severe diarrhea, blurred vision, tinnitus, ataxia, increasing tremors, confusion, dysrhythmias, seizures
Term
what are some other nursing interventions with lithium?
Definition
Nursing Interventions
Teach client to wear medic-alert bracelet
Teach client to take drug as prescribed and keep medical appointments
Warn against driving motor vehicles or
    operating dangerous equipment until drug effect is known
Advise client that drug effect may take 1-2
    weeks
Encourage client to avoid caffeine, crash diets, NSAIDs, diuretics
Should not get pregnant due to teratogenic effects
Term
what are some other bipolar managment drugs?
Definition
Carbamazepine (Tegretol)
Valproic acid (Depakote)
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