Medications - Antidepressants and SSRIs

Medications - Antidepressants

• Amitriptyline: Used for angle-closure glaucoma, recent MI, heart failure; may increase suicide risk
• Monitoring: Obtain weight/BMI, assess fasting glucose, regularly monitor ECG, assess for suicidal thoughts, especially initially
• Adverse Reactions: Arrhythmias, Torsade de pointes, hypotension, ECG changes, suicidal thoughts, lethargy, sedation
• Patient Instructions: Take as directed; may cause drowsiness, orthostatic hypotension

Medications - Selective Serotonin Reuptake Inhibitors

• Escitalopram: Used for concurrent pimozide, concurrent use of MAO inhibitors, concurrent use of citalopram, angle-closure glaucoma, or a family history of bipolar disorder
• Monitoring: Monitor mood, assess for suicidal tendencies, and assess sexual function
• Adverse Reactions: Torsades de Pointes, chest pain, palpitations, QT interval prolongation, increased sweating, erythema nodosum, flushing, rashes, mydriasis, stuffy nose, hyponatremia, diarrhea, abdominal pain, decreased libido, delayed/absent orgasm, ejaculatory delay, tremors

Medications - Fluoxetine

• Use: Concurrent use of pimozide, MAO inhibitors, thioridazine
• Monitoring: Assess for bipolar/manic episode, monitor mood changes, suicidal tendencies, and sexual function. Monitor for serotonin syndrome.
• Adverse Reactions: Sweating, hyponatremia, diarrhea, nausea, abdominal pain, constipation, decreased libido. Includes neuroleptic malignant syndrome, suicidal thoughts, and insomnia.

Medications - Antipsychotics/Mood Stabilizers

• Aripiprazole: Used for hypersensitivity, CYP2D6/CYP3A4 inhibitors/inducers, cardiovascular disease, hypotension, and diabetes.
• Monitoring: Assess mental status, weight/BMI, and monitor blood pressure.
• Adverse Reactions: Bradycardia, chest pain, edema, hypertension, orthostatic hypotension, tachycardia; skin lesions, dry skin, ecchymosis, skin ulcers, conjunctivitis, constipation, anorexia, salivation, and abnormal gait. Cardiac, metabolic, movement disorders, and neurologic symptoms.

Medications - Anti-Anxiety Agents

• Buspirone: Used for significant impairment/renal impairment, concurrent use of MAO inhibitors, and ingestion of large amounts of grapefruit.
• Monitoring: Assess anxiety level before and during therapy, assess substance abuse
• Adverse Reactions: Visual disturbances, nasal congestion, sore throat, tinnitus, taste/smell alterations, dysuria, rashes, myalgia, incoordination, numbness, paresthesia, tremor, dizziness, drowsiness.

Medications - Anticonvulsants/Mood Stabilizers

• Carbamazepine: Used for bone marrow suppression, increased risk of suicidal thoughts, or patients with cardiac or hepatic disease.
• Monitoring: Monitor skin, patient behavior, vital signs.
• Adverse Reactions: Heart failure, edema, heart block, hypertension, visual disturbances, corneal opacities, nystagmus, hyponatremia, hepatotoxicity, pancreatitis, weight gain, hesitancy, agranulocytosis, anemia, thrombocytopenia; a host of neurologic symptoms.

Medications - Anti-emetics/Antipsychotics

• Chlorpromazine: Used for angle-closure glaucoma, bone marrow depression, severe liver/cardiovascular disease, concurrent use of pimozide.
• Monitoring: Assess weight and BMI, fluid and bowel function, and schizophrenia positive/negative symptoms.
• Adverse Reactions: Neuroleptic malignant syndrome, sedation, extrapyramidal reactions, tardive dyskinesia. Cardiovascular, endocrine, gastrointestinal, hematologic, and metabolic symptoms.

Medications - Anti-anxiety agents

• Diazepam: Used to treat hypersensitivity, comorbidities (coma, severe pulmonary impairment, sleep apnea; severe hepatic/renal/pulmonary impairment,pre-existing CNS depression, and uncontrolled severe pain).
• Monitoring: Assess weight and BMI, schizophrenia positive/negative symptoms, fluid/bowel function.
• Adverse Reactions: Extrapyramidal, symptoms, and tardive dyskinesia. Cardiovascular and respiratory issues.

Medications - Anti-alzheimer's agents

• Donepezil: Used for hypersensitivity; piperidine derivatives
• Monitoring: Evaluate cognitive function, heartrate throughout treatment.
• Adverse Reactions: Arrhythmias, ecchymoses, diarrhea, nausea, frequent urination, metabolic issues, muscle cramps, and headaches.

Medications - Mood Stabilizers

• Lithium Carbonate: Used for hypersensitivity, brugada syndrome, alcohol/tartrazine use is contraindicated.
• Monitoring: Mental status, output ratios, fluid intake, renal and thyroid function, and serum lithium levels.
• Adverse Reactions: Cardiac issues, skin issues, diminished sensation, aphasia, blurred vision, dysarthria, tinnitus, hypothyroidism, hyperglycemia, hyperparathyroidism, hyperglycemia, hypercalcemia, hyponatremia, abdominal pain, anorexia. Significant neurologic and hematologic symptoms.

Medications - Antidepressants

• Phenelzine: hypersensitivity, liver/kidney disease, pheochromocytoma, heart failure
• Monitoring: Assess mental status, mood changes, and anxiety, BP and pulse rate. Assess patient for suicidal thoughts, assess for peripheral edema and urinary retention.
• Adverse Reactions: Seizures, dizziness, drowsiness, fatigue, headaches, insomnia, tremor. Additional issues like CV, GI, renal, endocrine/metabolic, hematologic, and neurologic abnormalities.

Medications - Antipsychotics

• Clozapine: Schizophrenia (unresponsive or intolerant to other antipsychotics), reduced suicidal behaviors
• Monitoring: Monitor mental status, vital signs (pulse rate, BP, etc.), monitor for signs of myocarditis, and tardive dyskinesia.
• Adverse Reactions: Increased risk of cardiac arrest, deep vein thrombosis, heart failure, mitral valve incompetence, hypotension, tachycardia, bradycardia; rash, sweating, visual disturbances, gi issues, neuro issues, metabolic problems, and hematologic issues.

Medications - Opioid Analgesics

• Methadone: Respiratory depression, acute/severe bronchial asthma, paralytic ileus; acute, mild, intermittent, or postoperative pain; a variety of other issues.
• Monitoring: Assess pain, BP, pulse, and respirations; assess bowel function.Assess patient for signs/symptoms of adrenal insufficiency.
• Adverse Reactions: Torsades de Pointes, hypotension, bradycardia; GI distress (vomiting, constipation, nausea), dizziness, dysphoria, tachycardia, muscle tightness, unusual dreams. Other cardiovascular, skin, neurologic, respiratory, and endocrine symptoms.

Medications - Antidotes (Opioids)

• Naloxone: Hypersensitivity.
• Monitoring: Monitor respiratory rate, rhythm, depth of breathing, pulse rate, ECG, blood pressure, and level of consciousness.
• Adverse Reactions: Ventricular arrhythmias, hypertension, hypotension, and gastrointestinal issues (nausea, vomiting).

This quiz covers key information about antidepressants, specifically focusing on Amitriptyline and Escitalopram. It includes details on uses, monitoring protocols, adverse reactions, and patient instructions. Test your knowledge on these commonly prescribed medications and their impact on patient care.