Term
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Definition
A mood disorder that is characterized by:
-depressed mood, despair, insomnia
-loss of interest in normal activities
-fatigue, decreased ability to think
-suicidal thoughts |
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Term
| What is the pathophysiology of depression? |
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Definition
| Insufficient amount of monamine neurotransmitters (norepinephrine, serotonin, dopamine) |
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Term
| What are other causes of depression? |
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Definition
Genetic predisposition
Social and environmental factors |
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Term
| What are the 3 types of depression? |
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Definition
1.) Reactive
2.) Major
3.) Bipolar |
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Term
| What is reactive depression? |
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Definition
| Usually sudden onset resulting from precipitating event (e.g., death of a loved one) |
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Term
| What is major depression? |
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Definition
Characterized by loss of interest in work or home
Inability to complete tasks
Deep depression |
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Term
| What is bipolar depression? |
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Definition
| Mood swings between manic (euphoric) and depressive (dysphoria) |
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Term
| What do antidepressant drugs target? |
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Definition
The symptoms of:
Sleep disturbance
Appetite disturbance (decreased or increased)
Fatigue
Decreased sex drive
Psychomotor retardation or agitation
Diurnal variations in mood (often worse in the morning)
Impaired concentration or forgetfulness
Anhedonia |
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Term
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Definition
| Loss of ability to experience joy |
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Term
| What are the major antidepressant agents? |
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Definition
-Tricyclic Antidepressants (TCAs)
-Selective Serotonin Reuptake Inhibitors (SSRI)
-Atypical Antidepressants
-Monoamine Oxidase Inhibitors (MAOIS) |
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Term
| What is an example of a TCA? |
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Definition
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Term
| What is an example of 2 SSRI's? |
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Definition
-Fluxoetine (prozac)
-Sertraline (Zoloft) |
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Term
| What is an example of 2 atypical antidepressants? |
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Definition
-Bupronin (Wellbutrin)
-Venlafaxine (Effexor) |
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Term
| What is an example of a MAOI? |
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Definition
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Term
| Which are the first line in treatment of depression? |
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Definition
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Term
| What is the potential toxic side effect of SSRI's? |
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Definition
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Term
| When is serotonin syndrome a possibility? |
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Definition
| when SSRI is administered in combination with monoamine oxidase inhibitor (MAOI) |
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Term
| What is the treatment of serotonin syndrome? |
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Definition
| MONITOR: ABC’s, IV, O2, monitor (supportive care), Sx, gastric lavage, activated charcoal, hemodialysis, tx symptoms |
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Term
| What are the 4 SSRI's used to treat depression? |
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Definition
-Fluoxetine (Prozac)
-Sertraline (Zoloft)
-Paroxetine (Paxil)
-Escitalopram (Lexapro) |
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Term
| What is the drug action of SSRI's? |
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Definition
| Block uptake of neurotransmitter serotonin |
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Term
| What are SSRI's used in the treatment of? |
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Definition
Major depression
Anxiety disorders
Obsessive-compulsiveness
Panic
Phobias
Prevention of migraine headaches |
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Term
| What are the drug interactions of SSRI's? |
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Definition
| Increased CNS effects with alcohol and other CNS depressants |
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Term
| What are the s/e adverse runs of SSRI's? |
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Definition
Headache, nervousness, restlessness
Insomnia, tremors, seizures
GI distress
Sexual dysfunction
Suicidal ideation
Side effects often decrease over 2 to 4 weeks |
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Term
| How can you avoid neuroleptic malignant syndrome? |
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Definition
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Term
| What is the action of Amitriptyline (Elavil)? TCA |
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Definition
-Blocks uptake of neurotransmitters norepi and serotonin
-Blocks histamine receptors
-Elevates mood, increases interest in ADL's and decreases insomnia |
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Term
| What is Amitriptyline (Elavil) used for? |
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Definition
Major depression
Agitated depression |
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Term
| What are the interactions w/ Amitriptyline (Elavil)? |
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Definition
-Increased CNS effects with alcohol and other CNS depressants
-Increased sedation and anticholinergic effects with phenothiazines, haloperidol |
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Term
| What are the s/e and adverse rxns of amitriptyline (Elavil)? |
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Definition
Sedation, dizziness, blurred vision, dry mouth and eyes, urinary retention, constipation,
weight gain, GI distress, sexual dysfunction
Orthostatic hypotension, dysrhythmias, EPS, blood dyscrasias |
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Term
| What is the drug action of Isocarboxazid (Marplan)/ MAOI's? |
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Definition
| Monamine oxidase enzyme inactivates norepinephrine, dopamine, epinephrine, and serotonin. |
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Term
| When are MAOI's used? (Isocarboxazid [Marplan]) |
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Definition
| For depression not controlled by TCA's |
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Term
| What are the s/e adverse rxns of MAOI's? (Isocarboxazid [Marplan]) |
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Definition
Agitation, restlessness, insomnia
Anticholinergic effects
Orthostatic hypotension
Hypertensive crisis from fatal tyramine interaction (from cheese, coffee, cream, yogurt, bananas, liver, yeast, chocolate, beer, red wine, etc.) |
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Term
| What is the role of MAOI's in the brain? |
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Definition
-Prevent the breakdown of norepinephrine, serotonin and dopamine
-Increased levels means increased mood
-Increased levels of of tyramine lead to HTN, CVA, and possible death
-Inhibit the breakdown of tyramine in the liver
-People taking MAOI's MUST restrict intake of tyramine to decrease chance of HTN |
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Term
| What is unique about bupropion (Wellbutrin, Wellbutrin SR, Wellbutrin XL)? |
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Definition
| Is energizing, few sexual side effects, less weight gain |
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Term
What is unique about mirtazapine (Remeron Remeron SolTab)
? |
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Definition
| Good for severe depression, insomnia, less sexual dysfxn |
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Term
| What is unique about Nefazodone (Serzone)? |
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Definition
| Good at reducing anxiety with fewer sexual se |
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Term
| What are the symptoms of serotonin syndrome? |
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Definition
-hyperactivity
-tachycardia
-fever
-elevated BP
-altered mental status
-seizures
-myoclonus, incoordination, tonic rigidity
-apnea that leads to death |
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Term
| What foods should be avoided when taking MAOI's? |
|
Definition
-Milk products
-Foods w/ yeast
-Beer and Wine
-Some fish
-Fermented sausage
-Fermented, smoked, cured meats
-Figs, bananas
-Avocados, fermented beans, sauerkraut |
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Term
| What is the selegiline transdermal system? |
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Definition
| the transcutaneous delivery of an MAOI with a patch called the selegiline transdermal system (STS). |
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Term
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Definition
| STS inhibits MAO in the central nervous system. |
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Term
| Is there breakdown in the liver or digestive tract with the STS? |
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Definition
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Term
| Is there a low-tyramine diet required with the 6mg patch? |
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Definition
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Term
| Is there a low-tyramine diet required with the 9-12 mg patch? |
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Definition
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Term
| What are the potential safety issues with using SSRI's in older adults? |
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Definition
-Antidepressants might contribute to suicidal behavior.
-No conclusive evidence supports this concern.
-All treatments have risks.
-No conclusive evidence supports that either the new or the old antidepressants precipitate suicide.
-FDA provides a “Black box” warning.
-FDA recommends close observation for worsening depression or suicidal thoughts.
-Close observation is especially recommended for children, adolescents, and older adults. |
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Term
| What are the nursing interventions associated w/ antidepressants? |
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Definition
-Monitor vitals
-Monitor mood for drug effect
-Monitor for suicidal thoughts and tendencies
-Seizure risk
-Warn about tyramine high foods w/ MAOIS
-Encourage to take drug as prescribed
-Encourage to avoid alcohol CNS depressants and cold medicines
-Take drug w/ food if GI distress occurs
-Don't drive/operate machinery
-Do not abruptly stop
-Take @ bedtime
-Therapeutic response may take 2-4 weeks
-Inform client that herbs (St. John's Wart/Ginseng) may interact |
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Term
| What is Lithium Carbonate (LiCO3)? |
|
Definition
First-line agent for bipolar disorder
MOOD STABILIZER |
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Term
| What is the drug action of Lithium Carbonate (LiCO3)? |
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Definition
| Alters sodium transport in nerve and muscle cells, and inhibits the release of norepinephrine and dopamine. |
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Term
| Does lithium have an effect on serotonin? |
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Definition
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Term
| What is lithium used to treat? |
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Definition
| -Acute mania and depressive episodes and the prevention of recurrent episodes of both |
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Term
| What is the therapeutic blood level of Lithium? |
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Definition
|
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Term
| What is the maintenance blood level of Lithium? |
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Definition
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Term
| What is the toxic blood level of Lithium? |
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Definition
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Term
| What is the risk associated with life long maintenance therapy of Lithium? |
|
Definition
| Hypothyroidism and impairment of the kidney's to concentrate urine |
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Term
| Who is lithium contraindicated in? |
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Definition
-Cardiovascular disease
-brain damage
-renal disease
-thyroid disease
-myasthenia gravis
-can harm fetus
-breastfeeding |
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Term
| What is the therapeutic blood level of Lithium for older adults? |
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Definition
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Term
| What are the expected rxns of Lithium? |
|
Definition
-fine hand tremor
-polyuria
-mild nausea
-general discomfort
-weight gain |
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Term
| What are the early s/s of toxicity? lithium |
|
Definition
-Nausea
-Vomiting
-Thirst
-Polyuria
-Slurred Speech
-Muscle weakness |
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Term
| What are the advanced s/s of toxicity? lithium |
|
Definition
-Coarse hand tremor
-persistent GI upset
-mental confusion
-muscle hyperirritability
-EEG changes
-Incoordination |
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Term
| What are the s/s of severe toxicity lithium |
|
Definition
-Ataxia
-blurred vision
-clonic movement
-large output of dilute urine
-severe hypotension
-seizures
-stupor
-tinnitus
-coma
-death secondary to pulmonary complications |
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Term
| What is likely to occur when a patient, taking lithium carbonate, has low sodium levels? |
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Definition
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Term
| What are the anticonvulsant drugs? |
|
Definition
-Divalproex (Depakote)
-Carbmazepine (Tegretol)
-Lamotrigine (Lamictal) |
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Term
| What bipolar subtypes respond better to anticovulsants? |
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Definition
-Rapid cycling
-Dysphoric mania |
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Term
| What is Divalproex (Depakote) effective in treating? |
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Definition
| -Rapid cycling/dysphoric mania in lithium non responders |
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Term
| What is Carbmaepine (Tegretol) effective in treating? |
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Definition
| -Rapid cycling in combination with lithium or another antipsychotic |
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Term
| What is Lamotrigrine (Lamictal) effective in treating? |
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Definition
| - First line treatment for bipolar depression and is approved for acute and maintenance therapy. |
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Term
| What are 2 anxiolytics used in treatment-resistance mania and psychomotor agitation? |
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Definition
-Clonazepam (Klonopin)
-Lorazepam (Ativan) |
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Term
| What are the atypical antipsychotics used in the treatment of mania for their sedative properties? |
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Definition
olanzapine (Zyprexa)
risperidone (Risperdal)
aripiprazole (Abilify)
ziprasidone (Geodon)
quetiapine (Seroquel) |
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