Antidepressans.docx

Al-Warith University Nursing Faculty Pharmacology II // Prepared by Dr. Nassim Samir Ali Saker 2022 Antidepressant drugs Introduction: Scientists believe that patients with depression may have an imbalance in neurotransmitters, chemicals that nerves make and use to communicate with other nerves. Gro...

Al-Warith University Nursing Faculty Pharmacology II // Prepared by Dr. Nassim Samir Ali Saker 2022 Antidepressant drugs Introduction: Scientists believe that patients with depression may have an imbalance in neurotransmitters, chemicals that nerves make and use to communicate with other nerves. Groups: Group Examples TCA/ Tricyclic Antidepressants Amitriptyline, Nortriptyline, Imipramine, Desipramine, Clomipramine, Doxepin, (SSRIs)Selective Serotonin Reuptake Inhibitors Citalopram, Sertraline, Fluoxetine, Paroxetine Mood-Stabilizing Agent Lithium carbonate MOAs Monoamine Oxidase Inhibitor Phenelzine, Isocarboxazid Uses: Depression Treatment of anxiety Enuresis (imipramine); Chronic pain syndromes Smoking cessation Obsessive-compulsive disorder Social anxiety disorder Bulimia / SSRI  / General Action and Information Antidepressant activity is most likely due to preventing the reuptake of dopamine, norepinephrine, and serotonin by presynaptic neurons, resulting in accumulation of these neurotransmitters. The two major classes of antidepressants are the tricyclic antidepressants and the SSRIs. Most tricyclic agents possess significant anticholinergic and sedative properties, which explains many of their side effects The SSRIs are more likely to cause insomnia I- Tricyclic Antidepressants Tricyclic antidepressants increase levels of norepinephrine and serotonin, two neurotransmitters, and block the action of acetylcholine, another neurotransmitter. Scientists believe that by restoring the balance in these neurotransmitters in the brain that tricyclic antidepressants alleviate depression. Adverse effects sedation, orthostatic hypotension, cardiac dysrhythmias, anticholinergic effects (eg, blurred vision, dry mouth, constipation, urinary retention), weight gain. They are well absorbed after oral administration, II- Selective Serotonin Reuptake Inhibitors (SSRIs) Action: Selective serotonin reuptake inhibitors (SSRIs), produce fewer serious adverse effects than the TCAs. They are well absorbed with oral administration, undergo extensive first-pass metabolism in the liver, are highly protein Adverse effects Gastrointestinal symptoms (eg, nausea, diarrhea, weight loss) and Sexual dysfunction (eg, delayed ejaculation in men and impaired orgasmic ability in women). Most also cause some degree of CNS stimulation (eg, anxiety, nervousness, insomnia), III- Monoamine Oxidase Inhibitors Action: MAOIs are infrequently used, mainly because they may interact with some foods and drugs to produce severe hypertension and possible heart attack or stroke. Foods that interact contain tyramine, Normally when deactivation of tyramine is blocked by MAOIs, tyramine is absorbed systemically and transported to adrenergic nerve terminals, where it causes a sudden release of large amounts of norepinephrine. Foods that should be avoided include aged cheeses and meats, and fava beans. Mood-Stabilizing Agents Lithium carbonate is a naturally occurring metallic salt that is used in bipolar disorder, mainly to treat and prevent manic episodes. It is well absorbed after oral administration, Before lithium therapy is begun, baseline studies of renal, cardiac, and thyroid status should be obtained because adverse drug effects involve these organ systems. Baseline electrolyte studies are also necessary. Patient/Family Teaching A Caution patient to avoid alcohol and other CNS depressants. Health care professional should be contacted immediately if symptoms of hypertensive crisis develop. Inform patient that dizziness or drowsiness may occur. Caution patient to avoid driving and other activities requiring alertness until response to the drug is known. Caution patient to make position changes slowly to minimize orthostatic hypotension. Advise patient to notify health care professional if dry mouth, urinary retention, or constipation occurs. Frequent rinses, good oral hygiene, and sugarless candy or gum may diminish dry mouth. An increase in fluid intake, fiber, and exercise may prevent constipation. Advise patient to notify health team of medication regimen and any herbal alternative therapies before treatment or surgery. Patients receiving MAO inhibitors should also avoid OTC drugs and foods or beverages containing tyramine during and for at least 2 wk after therapy has been discontinued