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Unit 2 - Antidepressants and Mood Stabilizers
Test 1
66
Nursing
Undergraduate 3
06/13/2014

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Term
What is depression?
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
Term
What is the pathophysiology of depression?
Definition
Insufficient amount of monamine neurotransmitters (norepinephrine, serotonin, dopamine)
Term
What are other causes of depression?
Definition
Genetic predisposition
Social and environmental factors
Term
What are the 3 types of depression?
Definition
1.) Reactive
2.) Major
3.) Bipolar
Term
What is reactive depression?
Definition
Usually sudden onset resulting from precipitating event (e.g., death of a loved one)
Term
What is major depression?
Definition
Characterized by loss of interest in work or home
Inability to complete tasks
Deep depression
Term
What is bipolar depression?
Definition
Mood swings between manic (euphoric) and depressive (dysphoria)
Term
What do antidepressant drugs target?
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
Term
What is anhedonia?
Definition
Loss of ability to experience joy
Term
What are the major antidepressant agents?
Definition
-Tricyclic Antidepressants (TCAs)
-Selective Serotonin Reuptake Inhibitors (SSRI)
-Atypical Antidepressants
-Monoamine Oxidase Inhibitors (MAOIS)
Term
What is an example of a TCA?
Definition
Amitrityline (Elavil)
Term
What is an example of 2 SSRI's?
Definition
-Fluxoetine (prozac)
-Sertraline (Zoloft)
Term
What is an example of 2 atypical antidepressants?
Definition
-Bupronin (Wellbutrin)
-Venlafaxine (Effexor)
Term
What is an example of a MAOI?
Definition
Isocarboxazid (Marplan)
Term
Which are the first line in treatment of depression?
Definition
SSRI's
Term
What is the potential toxic side effect of SSRI's?
Definition
Serotonin Syndrome
Term
When is serotonin syndrome a possibility?
Definition
when SSRI is administered in combination with monoamine oxidase inhibitor (MAOI)
Term
What is the treatment of serotonin syndrome?
Definition
MONITOR: ABC’s, IV, O2, monitor (supportive care), Sx, gastric lavage, activated charcoal, hemodialysis, tx symptoms
Term
What are the 4 SSRI's used to treat depression?
Definition
-Fluoxetine (Prozac)
-Sertraline (Zoloft)
-Paroxetine (Paxil)
-Escitalopram (Lexapro)
Term
What is the drug action of SSRI's?
Definition
Block uptake of neurotransmitter serotonin
Term
What are SSRI's used in the treatment of?
Definition
Major depression
Anxiety disorders
Obsessive-compulsiveness
Panic
Phobias
Prevention of migraine headaches
Term
What are the drug interactions of SSRI's?
Definition
Increased CNS effects with alcohol and other CNS depressants
Term
What are the s/e adverse runs of SSRI's?
Definition
Headache, nervousness, restlessness
Insomnia, tremors, seizures
GI distress
Sexual dysfunction
Suicidal ideation
Side effects often decrease over 2 to 4 weeks
Term
How can you avoid neuroleptic malignant syndrome?
Definition
Start LOW go SLOW
Term
What is the action of Amitriptyline (Elavil)? TCA
Definition
-Blocks uptake of neurotransmitters norepi and serotonin
-Blocks histamine receptors
-Elevates mood, increases interest in ADL's and decreases insomnia
Term
What is Amitriptyline (Elavil) used for?
Definition
Major depression
Agitated depression
Term
What are the interactions w/ Amitriptyline (Elavil)?
Definition
-Increased CNS effects with alcohol and other CNS depressants
-Increased sedation and anticholinergic effects with phenothiazines, haloperidol
Term
What are the s/e and adverse rxns of amitriptyline (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 drug action of Isocarboxazid (Marplan)/ MAOI's?
Definition
Monamine oxidase enzyme inactivates norepinephrine, dopamine, epinephrine, and serotonin.
Term
When are MAOI's used? (Isocarboxazid [Marplan])
Definition
For depression not controlled by TCA's
Term
What are the s/e adverse rxns of MAOI's? (Isocarboxazid [Marplan])
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.)
Term
What is the role of MAOI's in the brain?
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
Term
What is unique about bupropion (Wellbutrin, Wellbutrin SR, Wellbutrin XL)?
Definition
Is energizing, few sexual side effects, less weight gain
Term
What is unique about mirtazapine (Remeron Remeron SolTab)
?
Definition
Good for severe depression, insomnia, less sexual dysfxn
Term
What is unique about Nefazodone (Serzone)?
Definition
Good at reducing anxiety with fewer sexual se
Term
What are the symptoms of serotonin syndrome?
Definition
-hyperactivity
-tachycardia
-fever
-elevated BP
-altered mental status
-seizures
-myoclonus, incoordination, tonic rigidity
-apnea that leads to death
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
Term
What is the selegiline transdermal system?
Definition
the transcutaneous delivery of an MAOI with a patch called the selegiline transdermal system (STS).
Term
Where do STS act?
Definition
STS inhibits MAO in the central nervous system.
Term
Is there breakdown in the liver or digestive tract with the STS?
Definition
No
Term
Is there a low-tyramine diet required with the 6mg patch?
Definition
no
Term
Is there a low-tyramine diet required with the 9-12 mg patch?
Definition
Yes
Term
What are the potential safety issues with using SSRI's in older adults?
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.
Term
What are the nursing interventions associated w/ antidepressants?
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
Term
What is Lithium Carbonate (LiCO3)?
Definition
First-line agent for bipolar disorder
MOOD STABILIZER
Term
What is the drug action of Lithium Carbonate (LiCO3)?
Definition
Alters sodium transport in nerve and muscle cells, and inhibits the release of norepinephrine and dopamine.
Term
Does lithium have an effect on serotonin?
Definition
NO
Term
What is lithium used to treat?
Definition
-Acute mania and depressive episodes and the prevention of recurrent episodes of both
Term
What is the therapeutic blood level of Lithium?
Definition
0.8 to 1.4 mEq/L
Term
What is the maintenance blood level of Lithium?
Definition
0.4 to 1.3 mEq/L
Term
What is the toxic blood level of Lithium?
Definition
1.5 to 2.0 mEq/L
Term
What is the risk associated with life long maintenance therapy of Lithium?
Definition
Hypothyroidism and impairment of the kidney's to concentrate urine
Term
Who is lithium contraindicated in?
Definition
-Cardiovascular disease
-brain damage
-renal disease
-thyroid disease
-myasthenia gravis
-can harm fetus
-breastfeeding
Term
What is the therapeutic blood level of Lithium for older adults?
Definition
0.3-0.4
Term
What are the expected rxns of Lithium?
Definition
-fine hand tremor
-polyuria
-mild nausea
-general discomfort
-weight gain
Term
What are the early s/s of toxicity? lithium
Definition
-Nausea
-Vomiting
-Thirst
-Polyuria
-Slurred Speech
-Muscle weakness
Term
What are the advanced s/s of toxicity? lithium
Definition
-Coarse hand tremor
-persistent GI upset
-mental confusion
-muscle hyperirritability
-EEG changes
-Incoordination
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
Term
What is likely to occur when a patient, taking lithium carbonate, has low sodium levels?
Definition
Lithium toxicity
Term
What are the anticonvulsant drugs?
Definition
-Divalproex (Depakote)
-Carbmazepine (Tegretol)
-Lamotrigine (Lamictal)
Term
What bipolar subtypes respond better to anticovulsants?
Definition
-Rapid cycling
-Dysphoric mania
Term
What is Divalproex (Depakote) effective in treating?
Definition
-Rapid cycling/dysphoric mania in lithium non responders
Term
What is Carbmaepine (Tegretol) effective in treating?
Definition
-Rapid cycling in combination with lithium or another antipsychotic
Term
What is Lamotrigrine (Lamictal) effective in treating?
Definition
- First line treatment for bipolar depression and is approved for acute and maintenance therapy.
Term
What are 2 anxiolytics used in treatment-resistance mania and psychomotor agitation?
Definition
-Clonazepam (Klonopin)
-Lorazepam (Ativan)
Term
What are the atypical antipsychotics used in the treatment of mania for their sedative properties?
Definition
olanzapine (Zyprexa)
risperidone (Risperdal)
aripiprazole (Abilify)
ziprasidone (Geodon)
quetiapine (Seroquel)
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