Antidepressants PDF

PSYCHN Ma’am Lenie Agpalasin | Week 4 3. MAOIs are potentially lethal in overdose Topic Outline: and pose a potential risk for clients with Antidepressant drugs...

PSYCHN Ma’am Lenie Agpalasin | Week 4 3. MAOIs are potentially lethal in overdose Topic Outline: and pose a potential risk for clients with Antidepressant drugs depression who may be considering suicide. ANTIDEPRESSANT DRUGS SELECTIVE SEROTONIN REUPTAKE INHIBITORS - Primarily used in the treatment of: - First available in 1987 with the release of o Major depressive illness fluoxetine (Prozac), have replaced the cyclic o Anxiety disorders drugs as the first choice in treating depression o Depressed phase of bipolar disorder because they are equal in efficacy and produce o Psychotic depression fewer troublesome side effects. - Prozac weekly is the first and only medication - Off label uses of antidepressants include: that can be given once a week as maintenance o Treatment of chronic pain therapy for depression after the client has been o Migraine stabilized on fluoxetine. o Headaches o Peripheral and diabetic neuropathies PREFERRED DRUGS FOR CLIENTS AT HIGH RISK FOR o Dermatologic disorders SUICIDE o Panic disorders - SSRIs, venlafaxine, nefazodone, trazodone, o Eating disorders and bupropion are often a better choice for o Sleep apnea those who are potentially suicidal or highly CLASSIFICATION OF ANTIDEPRESSANTS impulsive because they carry no risk of lethal 1. Tricyclic compounds overdose, in contrast to the cyclic compounds 2. Selective Serotonin Reuptake Inhibitors (SSRI) and the MAOIs. 3. Monoamine Oxidase Inhibitors (MAOIS) - SSRIs are effective only for mild and moderate depression. TRICYCLIC - Effect of antidepressants takes effect for 4 – 6 - The cyclic compounds became available in the weeks. 1950s and for years were the first choice of drugs to treat depression even though they cause MECHANISM OF ACTION varying degrees of sedation, orthostatic - Both of these neurotransmitters are released hypotension and anticholinergic side effects. throughout the brain and help to regulate arousal, vigilance, attention, mood, sensory MONOAMINE OXIDASE INHIBITOR processing, and appetite. - Must be used with extreme caution for several - Norepinephrine, serotonin, and dopamine are reasons: removed from the synapses after release by 1. A life-threatening side effects, hypertensive reuptake into presynaptic neurons. crisis, may occur if the client ingests food - After reuptake, these three neurotransmitters are containing tyramine (an amino acid) while reloaded for subsequent release or metabolized taking MAOIs. by the enzyme MAO. 2. Because of the risk of potential fatal drug interactions, MAOIs cannot be given in MECHANISM OF ACTION combination with other MAOIs, tricyclic - The SSRIs block the reuptake of serotonin, the antidepressants, meperidine (demerol), CNS cyclic antidepressants and venlafaxine block the depressants, many antihypertensives, or reuptake of norepinephrine primarily and general anesthetics. VICTORIA, M.A. SN 2026 | 1  serotonin to some degree; and the MAOIs Ileus, may occur particularly in older adults interfere with enzyme metabolism. Other common side effects: Orthostatic hypotension THERAPEUTIC EFFECTS Sedation 1. Cyclic compounds: 4 – 6 weeks to be effective. Weight gain 2. MAOIs: 2 – 4 weeks for effectiveness. Tachycardia 3. SSRIs: may be effective in 2 – 3 weeks. Sexual dysfunction SIDE EFFECTS OF MAOIs SIDE EFFECTS “PAMANA” Anxiety 1. PArnate Agitation 2. MArplan Akathisia (motor restlessness) 3. NArdil Nausea Insomnia Sweating Sexual dysfunction, specially diminished sexual Tremors drive or difficulty achieving an erection or Elevated temperature orgasm. Bounding heart Weight gain Elevated BP LESS COMMON SIDE EFFECTS NO … Sedation (particularly with paroxetine - paxil) Barbiturates Sweating Meperidine (demerol) Diarrhea Tricyclic and SSRI antidepressants Hand tremor Antihistamines Headaches CNS depressants SSRIs ADVERSE EFFECTS “S-S-S” Antihypertensives S – tomach upset OTC medications (cold remedies, asthma S – exual dysfunction medications, nasal decongestants) FOODS CONTAINING TYRAMINE TO AVOID WHEN S – erotonin syndrome TAKING MAOIs Potential for a life-threatening hypertensive Effective for sadness, panic & compulsions crisis if the client ingests food that contain tyramine or take sympathomimetic drugs. Effective – Escitalopram o Mature or aged cheeses or dishes made For – Fluoxetine, Fluvoxamine with cheese (lasagna or pizza) except Sadness – Sertroline cottage cheese, cream cheese, ricotta Panic – Paroxetine cheese, and processed cheese slices. Compulsions – Citalopram o Aged meats (pepperoni, salami, mortadella, summer sausage, beef logs) ANTICHOLINERGIC EFFECTS o Italian broad beans (fava) pods or Dry mouth banana peel. Constipation o All tap beers and microbrewery beer Urinary hesitancy or retention o Sauerkraut, soy sauce, or soybean Dry nasal passages condiments, marmite Blurred near vision o Yogurt, sour cream, peanuts, brewer’s More severe: yeast, and monosodium glutamate (MSG) Agitation Inhibition results in increased serum tyramine Delirium levels. VICTORIA, M.A. SN 2026 |2  ✓ Severe hypertension syndrome can result from taking an MAOI and ✓ Hyperpyrexia an SSRI at the same time. ✓ Tachycardia It can also occur if the client takes one of these ✓ Diaphoresis drugs too close to the end of therapy with the ✓ Tremulousness other. ✓ Cardiac dysrhythmias SYMPTOMS MOST COMMON SIDE EFFECTS OF MAOIs ✓ Agitation Daytime sedation ✓ Sweating Insomnia ✓ Fever Weight gain ✓ Tachycardia Dry mouth ✓ Hypotension Orthostatic hypotension ✓ Rigidity Sexual dysfunction ✓ Hyperreflexia ✓ In extreme reactions even coma and death SIDE EFFECTS OF OTHER ANTIDEPRESSANTS CLIENT TEACHING DRUG SIDE EFFECTS Clients should take SSRIs first thing in the Nefazodone, trazodone, Sedation morning unless sedation is a problem. mirtazapine If the client forgets a dose of SSRI, he or she can take it up to 8 hours after the missed dose. Nefazodone & Trazodone Headaches To minimize side effects, clients generally Nefazodone Dry mouth and nausea should take cyclic compounds at night in a single daily dose when possible. Bupropion, Venlafaxine, Loss of appetite, nausea, If the client forgets a dose of a cyclic compound, Desvenlafaxine agitation, and insomnia he or she should take it within 3 hours of the Venlafaxine Dizziness, sweating, or missed dose or omit the dose for that day. sedation Clients should exercise caution when driving or performing activities requiring sharp, alert Trazodone Priapism (sustained and reflexes until sedative effects can be determined. painful erection that Clients taking MAOIs need to be aware that a necessitates immediate treatment and life-threatening hyperadrenergic crisis can occur discontinuation of the if they do not observe certain dietary drug) may result in restrictions. impotence. They should receive a written list of foods to avoid while taking MAOIs. The nurse should make clients aware of the risk WARNING: Nefazodone of serious or even fatal drug interactions when May cause rare but potentially life-threatening liver damage, which could lead to liver failure. taking MAOIs and instruct them not to take any additional medications, including OTC preparations, without checking with the WARNING: Bupropion physician or pharmacist. Can cause seizure at a rate of four times that of other antidepressants. MOOD STABILIZING DRUGS Used to treat bipolar disorder by: DRUG INTERACTION Stabilizing the client’s mood An uncommon but potentially serious drug Preventing or minimizing the highs and lows interaction called serotonin or serotonergic that characterized bipolar illness VICTORIA, M.A. SN 2026 |3  Treating acute episodes of mania LITHIUM SIDE EFFECTS LITHIUM is the most established mood Leukocytosis stabilizer Increased urination Anticonvulsant drugs, carbamazepine (tegretol) Tremors and valporic acid (depakote, depakene), are Hypothyroidism effective mood stabilizers. Increased thirst Under-active memory OTHER ANTICONVULSANTS Myoclonus ✓ Gabapentin (neurontin) ✓ Topiramate (tropax) LITHIUM THERAPY SIDE EFFECTS ✓ Oxcarbazepine (trileptal) Mild nausea or diarrhea ✓ Lamotrigine (lamictal), are also used for mood Anorexia stabilization Fine hand tremor ✓ Occasionally, clonazepam (klonopin) also used Polydipsia to treat acute mania. Polyuria A metallic taste in the mouth MECHANISM OF ACTION (LITHIUM) Fatigue or lethargy Lithium normalizes the reuptake of certain neurotransmitters such as serotonin, TOXIC EFFECTS OF LITHIUM norepinephrine, acetylcholine, and dopamine. Severe diarrhea It also reduces the release of norepinephrine Vomiting through competition with calcium and produces Drowsiness its effects intracellularly rather than within Muscle weakness neuronal synapses Lack of coordination It acts directly on G proteins and certain enzyme Untreated, these symptoms worsen and can lead subsystems such as cyclic adenosine to renal failure, coma, and death. monophosphate and phosphatidylinositol. Lithium is considered a first-line agent in the CARBAMAZEPINE treatment of bipolar disorder. Available in liquid, tablet, and chewable tablet forms. DOSAGE Dosage usually ranges from 800 to 1200 Lithium is available in tablet, capsule, liquid, mg/day; the extreme dosage range is 200 to and sustained-released forms; no parenteral 2000 mg/day. forms are available. Daily dosages generally range from 900 to VALPROIC ACID 3600mg; more importantly, the serum lithium Available in liquid, tablet, and capsule forms level should be about 1 mEq/L. and as sprinkles with dosages ranging from 1000 Serum lithium levels of less than 0.5 mEq/L are to 1500mg/day; extreme dosage range is 750 to rarely therapeutic and levels of more than 1.5 3000mg/day. mEq/L are usually considered toxic. May cause weight gain, alopecia, and hand tremor. WARNING: Lithium WARNING: Valproic acid and its derivatives Toxicity is closely related to serum lithium Can cause hepatic failure resulting in fatality. levels and can occur at therapeutic doses. Liver function tests should be performed prior Facilities for serum lithium determinations are to therapy and at frequent intervals thereafter, required to monitor therapy. especially for the first 6 months. Can produce teratogenic effects such as neural tube defects (spina bifida). Can cause life-threatening VICTORIA, M.A. SN 2026 |4  pancreatitis in both children and adults. Can Anticonvulsant occur shortly after initiation or after years of Muscle relaxant effects therapy. BUSPIRONE Nonbenzodiazepine Often used for the relief of anxiety WARNING: Carbamazepine Can cause aplastic anemia and agranulocytosis at a rate 5 to 8 times greater than the general Other drugs such as propanolol, clonidine (catapres), population. Pretreatment hematologic baseline and hydroxyzine (vistraril) that may be used to relive data should be obtained and monitored anxiety are much less effective. periodically throughout therapy to discover lowered WBC or platelet counts. MECHANISM OF ACTION Benzodiazepines mediate the actions of the SIDE EFFECTS OF CARBAMAZEPINE & VALPROIC ACID amino acid GABA, the major inhibitory Drowsiness neurotransmitter in the brain. Sedation Because GABA-receptor channels selectively Dry mouth admit the anion chloride into neurons, activation Blurred vision of GABA receptors hyper polarizes neurons and Rashes thus is inhibitory. Orthostatic hypotension Benzodiazepines produce their effects by binding to a specific site on the GABA receptor. TOPIRAMATE Causes dizziness, sedation, weight loss, and CNS DEPRESSION increased incidence of renal calculi. Drowsiness Sedation CLIENT TEACHING Poor coordination For clients taking lithium and the Impaired memory or clouded sensorium anticonvulsants, monitoring blood levels periodically is important. When used for sleep: The time of the last dose must be accurate so Clients may complain of next-day sedation or a that plasma levels can be checked 12 hours after hangover effect. the last done has been taken. The client should not attempt to drive until Physical dependence dizziness, lethargy, fatigue, or blurred vision has subsided. Significant discontinuation symptoms occur when the drug is stopped. Psychological dependence ANTI ANXIETY DRUGS - Also called as anxiolytic drugs. Used to treat: COMMON SIDE EFFECTS FROM BUSPIRONE o Anxiety and anxiety disorders Dizziness o Insomnia Sedation o OCD Nausea o Depression Headache o Post-traumatic stress disorder o Alcohol withdrawal CLIENT TEACHING Client should be aware of decreased response BENZODIAZEPINES time, slower reflexes, and possible sedative Most effective in relieving anxiety Drug most frequently prescribed VICTORIA, M.A. SN 2026 |5  effects of these drugs when attempting activities DISULFIRAM such as driving or going to work. Sensitizing agent that causes an adverse reaction BENZODIAZEPINE withdrawal can be fatal. when mixed with alcohol in the body. Used as deterrent to drinking alcohol in persons STIMULANTS DRUGS receiving treatment for alcoholism. AMPHETAMINES Useful for persons who are motivated to abstain To treat psychiatric disorders in the 1930s for from drinking and who are not impulsive. their pronounced effects of CNS stimulation. 5 – 10 minutes after a person taking disulfiram For attention deficit/hyperactivity disorder ingests alcohol, symptoms begin to appear: (ADHD) in children and adolescents o Facial and body flushing from Residual attention deficit disorder in adults vasodilation Narcolepsy (attacks of unwanted but irresistible o Throbbing headache daytime sleepiness that disrupt the person’s life) o Sweating o Dry mouth CNS STIMULANTS o Nausea Methylphenidate (Ritalin) o Vomiting Amphetamine (Adderall) o Dizziness Dextroamphetamine (Dexedrine) o Weakness PEMOLINE (CYLERT) Is frequently used for ADHD because of the ELECTRO CONVULSIVE THERAPY potential for liver problems. (ECT) Artificial induction of a grandmal seizure by MOST COMMON SIDE EFFECTS passing a controlled electrical current through Anorexia electrodes applied to or both temples. Weight loss Nausea Irritability INDICATION 1. Depression (clients who do not respond to LESS COMMON SIDE EFFECTS antidepressants or those who experience intolerable side effects at therapeutic doses) Dizziness 2. Bipolar disorder Dry mouth 3. Catatonic schizophrenia Blurred vision 4. Actively suicidal Palpitations Pregnant women can safely have ECT while many The most common long-term problem with stimulants medications are not safe for use during pregnancy. is the growth and weight suppression that occurs in some children. CONTRAINDICATIONS 1. Severe respiratory depression Taking doses of stimulants after meals may 2. Glaucoma minimize anorexia and nausea 3. Increased intracranial pressure Caffeine-free beverages are suggested 4. Recent myocardial infarction Avoid chocolates and excessive sugar 5. Cardiac dysrhythmias Keep the medication out of the child’s reach 6. Recent stroke because as little as a 10-day supply can be fatal. 7. Recent fracture 8. Retinal detachment 9. Pregnancy with complication VICTORIA, M.A. SN 2026 |6  NURSING INTERVENTIONS COMMON COMPLICATIONS PRE ECT 1. Loss of memory 1. Client must be given informed consent 2. Headache 2. NPO after midnight 3. Apnea 3. Take vital signs 4. Fracture 4. Ask the patient to remove jewelry, hairpins, 5. Respiratory depression eyeglasses, & hearing aids, dentures 5. Dress patient in loose, comfortable clothing, 6. Have the patient empty bladder, administer pretreatment medications. 7. Let the patient feel comfortable in bed & let him go to sleep. 8. Monitor respiratory problem 9. Re-orient the patient when he wakes-up 10. Document all treatments 11. After the patient is oriented & has rested, let him have a shower & start his usual activities 12. Make pt. lie simply, with the back resting on a pillow. 13. Let the pt. bite mouth 14. Bag. 15. Apply electrode jelly on the temple to ensure complete contact. 16. Terminal plugs are inserted into electrodes 17. Two assistants support shoulders & wrist joints & another one to support the knee. 18. Treatment switch is pressed after adjusting the dosage & patient goes into grand mal seizure. 19. When convulsion subsides & breathing is resumed, turn the patient on his side to prevent swallowing of saliva. 20. Ventilation & monitoring continues until the patient is recovered. Atropine sulfate Anectine (succinylcholine) Brevital (Methohexital sodium) POST ECT 1. Vital Signs every 15 minutes 2. Maintain patent airway 3. Side lying position-to prevent aspiration 4. Provide ORIENTATION to time, place and Situation 5. Advised the patient that memory will return 6. Vital Signs every 15 minutes 7. Maintain patent airway 8. Provide ORIENTATION to time, place and situation 9. Side lying position-to prevent aspiration 10. Advised the patient that memory will return VICTORIA, M.A. SN 2026 |7