Podcast
Questions and Answers
What is a significant risk associated with combining TCAs and MAOIs?
What is a significant risk associated with combining TCAs and MAOIs?
Which side effect is often linked with the use of MAOIs?
Which side effect is often linked with the use of MAOIs?
How can TCAs affect patients who smoke tobacco?
How can TCAs affect patients who smoke tobacco?
What type of drug interaction should be avoided while taking TCAs?
What type of drug interaction should be avoided while taking TCAs?
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What is a primary reason for using tricyclic antidepressants (TCAs) in treatment?
What is a primary reason for using tricyclic antidepressants (TCAs) in treatment?
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Which condition should preclude the use of tricyclic antidepressants?
Which condition should preclude the use of tricyclic antidepressants?
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Which of the following could potentially occur if TCAs are combined with an MAOI?
Which of the following could potentially occur if TCAs are combined with an MAOI?
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Which of the following dietary restrictions is essential for a patient on MAOIs?
Which of the following dietary restrictions is essential for a patient on MAOIs?
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What symptom should patients taking MAOIs be cautious of that may indicate an adverse effect?
What symptom should patients taking MAOIs be cautious of that may indicate an adverse effect?
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Why are mood stabilizers primarily prescribed for patients with bipolar illness?
Why are mood stabilizers primarily prescribed for patients with bipolar illness?
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What is the primary use of lithium in medical treatment?
What is the primary use of lithium in medical treatment?
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What is a common symptom associated with elevated lithium levels?
What is a common symptom associated with elevated lithium levels?
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What is a critical factor in ensuring the safety of lithium therapy?
What is a critical factor in ensuring the safety of lithium therapy?
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Which of the following is an expected side effect of lithium therapy?
Which of the following is an expected side effect of lithium therapy?
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What is the therapeutic range for lithium levels initially?
What is the therapeutic range for lithium levels initially?
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What should patients be educated to avoid in relation to lithium therapy?
What should patients be educated to avoid in relation to lithium therapy?
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Which of the following is a sign of severe lithium toxicity?
Which of the following is a sign of severe lithium toxicity?
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What distinguishes acute psychosis from chronic psychosis?
What distinguishes acute psychosis from chronic psychosis?
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Why is it important to distinguish between delirium and chronic psychosis?
Why is it important to distinguish between delirium and chronic psychosis?
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Which laboratory tests are important prior to starting lithium therapy?
Which laboratory tests are important prior to starting lithium therapy?
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What is the desired serum lithium level for treating acute mania?
What is the desired serum lithium level for treating acute mania?
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What symptom indicates the need for immediate contact with a healthcare provider in a patient taking lithium?
What symptom indicates the need for immediate contact with a healthcare provider in a patient taking lithium?
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Why should older adults start with lower doses of lithium?
Why should older adults start with lower doses of lithium?
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Which of the following is a common adverse reaction to lithium?
Which of the following is a common adverse reaction to lithium?
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How often should serum lithium levels be monitored after stabilization of the dosage?
How often should serum lithium levels be monitored after stabilization of the dosage?
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Study Notes
Tricyclic Antidepressants (TCAs)
- Older class of drugs used since the 1950s for depression.
- Mechanism of action unknown, but thought to interfere with norepinephrine and serotonin reuptake.
- Effective for mild to moderate depression, but more side effects than SSRIs or SNRIs.
- Primarily used in severe depression or unresponsive cases.
- Also used for migraine headaches, panic disorder, OCD, and peripheral neuropathy.
Side Effects and Adverse Reactions (TCAs)
- Common side effects: dry mouth, drowsiness, constipation, nausea, orthostatic hypotension.
- Weight gain or loss possible.
- Potential for mild to severe vision problems. Notify healthcare provider.
- Severe adverse reactions: cardiac dysrhythmias, heart failure, seizures, mania triggers in bipolar patients, delirium in older patients with cognitive impairment.
- Increased suicide risk in younger patients.
- Contraindicated in patients with glaucoma.
Drug Interactions (TCAs)
- Avoid with CNS depressants (opioids, sedatives, alcohol). These increase risk of respiratory depression, sedation, and hypotension.
- Interactions with antidysrhythmics can cause serious cardiac issues.
- Avoid with MAOIs, SSRIs, and SNRIs to prevent serotonin syndrome.
- St. John's wort (herbal) and marijuana are also dangerous to combine with TCAs.
- Tobacco reduces TCA effectiveness.
Nursing Implications and Patient Teaching (TCAs)
- Assess patient history, current drug use, and mental status, including suicide risk.
- Monitor vital signs and baseline weight.
- Note drug abuse history.
- Reassess symptoms to evaluate drug response (can take weeks).
- Educate patients on side effects (dry mouth, constipation, orthostatic hypotension), increased blood pressure reports.
- Taper TCAs when switching drugs to reduce withdrawal symptoms.
- Patient and family teaching: do not stop abruptly; avoid alcohol, sedatives, opioids; sugarless items for dry mouth; sun protection; slow position changes; bedtime dosing; report new/troublesome symptoms; wear medical alert bracelet.
Monoamine Oxidase Inhibitors (MAOIs)
- Block monoamine oxidase enzymes, increasing neurotransmitters (dopamine, norepinephrine, serotonin).
- Used as a last resort for severe depression that doesn't respond to other treatments.
- High-Risk Interaction: Hypertensive crisis triggered by foods containing tyramine (aged cheese, cured meats, wine, beer).
Side Effects and Adverse Reactions (MAOIs)
- Common side effects: constipation, headache, dizziness, drowsiness, dry mouth, orthostatic hypotension.
- Weight gain (in some).
- Severe adverse reactions: liver damage, blood disorders, suicidal thoughts, severe hyponatremia.
- Serotonin Syndrome Risk: Do not combine MAOIs with SSRIs within 2 weeks.
Drug Interactions (MAOIs)
- Hypertensive Crisis Risk: Avoid MAOIs with SSRIs, SNRIs, St. John's Wort, stimulants, drugs that lower blood pressure, CNS depressants (opioids, alcohol, benzodiazepines).
- Risk of hypoglycemia in patients taking insulin or oral hypoglycemics.
- Hypertensive crisis from high-tyramine foods.
- Caffeine and tyramine-rich foods should be avoided for 2 weeks after stopping MAOI.
Nursing Implications and Patient Teaching (MAOIs)
- Obtain detailed drug and diet history, including herbal drugs (St. John's wort).
- Monitor vital signs, weight, labs, and suicidal thoughts.
- Educate on dietary restrictions (avoid high-tyramine foods, caffeine, and alcohol).
- Educate on side effects (dry mouth). Monitor for hypotension.
- Teach about importance of monitoring blood sugar closely for patients on insulin or other antidiabetic drugs.
- Educate patients: take as prescribed, avoid alcohol and CNS depressants, avoid caffeine and high-tyramine food; slowly change positions; avoid driving, operating machinery; report symptoms (fever, severe headache, nausea, chest pain) immediately; wear medical ID
Mood Stabilizers (e.g., Lithium, Anticonvulsants)
- Primarily for bipolar disorder to manage mania and depression.
- Long-term treatment is common.
Lithium - Action and Uses
- Used primarily for bipolar illness (acute mania, maintenance).
- Thought to inhibit neurotransmitter synthesis, storage, release, and reuptake.
- Non-sedative effects.
- Onset of action is roughly 1 week, full benefit in 2-3 weeks.
Lithium - Therapeutic Range
- Very narrow therapeutic range.
- Careful monitoring of lithium blood levels (initial level ~3 days into therapy).
- Regular serum measurements are essential to avoid toxicity.
- Therapeutic level 0.8-1.2 mEq/L initially, then 0.8-1mEq/L for maintenance.
- Toxicity risks: older age, kidney disease, low sodium levels, dehydration, heart disease, or taking certain drugs (ACE inhibitors, diuretics, NSAIDs).
Lithium - Side Effects and Adverse Reactions
- Mild weight gain, thirst, urine output increase, dry skin, mild drowsiness.
- Hand tremors (often decrease with continued use).
- Initial nausea, vomiting, or diarrhea.
- Toxicity symptoms worsen with elevated lithium levels.
Lithium - Drug Interactions
- Interactions with diuretics, NSAIDs, antidepressants, and antipsychotics.
Nursing Implications and Patient Teaching (Lithium)
- Baseline labs (CBC, BUN/creatinine, electrolytes, thyroid function).
- Assess mental status (acute symptoms, hyperactivity, irritability), dietary history and sodium, fluid intake.
- Monitor for signs of toxicity (nausea, vomiting, drowsiness, tremors, incoordination).
- Report symptoms needing immediate intervention by RN or physician.
- Frequent lithium level monitoring. Desired level for acute mania is 0.8-1.2 mEq/L, while maintenance level is ~0.8 -1 mEq/L. Levels over 1.5 are toxic.
- Teach about avoiding significant changes in salt/fluid intake; reporting thirst / urination changes; avoiding alcohol/sedatives; seeking help for suicidal thoughts; wearing a medical alert bracelet/card; frequent blood level checks.
Antipsychotics (Typical & Atypical)
- Treat psychosis (loss of reality contact) in schizophrenia and other conditions.
- Atypical antipsychotics often better for long-term use due to lower risk of EPS.
- Typical antipsychotics primarily treat positive symptoms (hallucinations, delusions)
Typical Antipsychotics
- Block dopamine receptors, impacting positive symptoms.
- Cause extrapyramidal side effects (EPSs) - movement disorders.
- Includes phenothiazines and nonphenothiazines.
- Potential for neuroleptic malignant syndrome (NMS): High fever, confusion, blood pressure changes, severe EPSs
Atypical Antipsychotics
- Work via various mechanisms, often blocking both dopamine and serotonin receptors.
- Reduced risk of EPSs compared to typical.
- Often used alone for long-term.
- Risk of weight gain, hypertriglyceridemia, insulin resistance, and diabetes.
- Increased risk of cardiac dysrhythmias (prolonged QT interval), more frequent in clozapine (agranulocytosis - lower white blood cells)
- Drug interactions with other psych meds and alcohol.
Nursing Implications and Patient Teaching (Antipsychotics)
- Assess level of consciousness, agitation, hallucinations, and delusions (mental status exam, if applicable).
- Monitor vital signs closely (especially temperature).
- Recognize and report EPSs.
- Monitor for NMS (high fever, confusion, blood pressure change, EPSs).
- Closely monitor vital signs in patients with other health issues.
- Teach patients about side effects, medication adherence, avoiding alcohol/sedatives, and reporting symptoms.
- Encourage good oral hygiene.
- Teach about temperature changes ( avoid extremes, recognize dehydration as a concern).
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Description
Explore the key aspects of Tricyclic Antidepressants (TCAs), including their history, mechanism of action, and various medical uses. This quiz also covers common side effects, adverse reactions, and important drug interactions. Test your understanding of this older class of antidepressants and their clinical implications.
