Psychotropic Medications
Pharmacology in Nursing III
Cypress College Registered Nursing
Drugs for Emotional and Mood Disorders
Depression
Mechanism of mood disorders associated with imbalance of neurotransmitters
Norepinephrine, serotonin, dopamine
Depression characterized by sad or despondent mood for greater than 2 weeks
Depression
DSM IV diagnostic criteria include:
o lack of energy
o sleep disturbances
o abnormal eating patterns
o social isolation, lack of interest in pleasurable activities
o feelings of despair, guilt, hopelessness
Most common mental health disorder of elderly adults
Drug Therapy for Depression
Tricyclic Antidepressants
Selective Serotonin Reuptake Inhibitors
Monoamine Oxidase Inhibitors
Atypical Antidepressants
Nursing Actions: pre-tx
Obtain careful drug history
Rule out medical and neurologic causes
Ask about alcohol and drug use
Obtain family history of depressive illness
Nursing Actions: during tx
Monitor for resolution or exacerbation of symptoms:
o Appetite
o Sleep-wake cycle
o Mood, suicidal ideation
o Psychosomatic complaints
BLACK BOX WARNING
, Tricyclic Antidepressants
Increase norepinephrine and serotonin by blocking receptors
TCAs (Mainstay of tx 1960’s – 1980’s):
Not for use in patients with heart attack, heart block, or arrhythmia
Concurrent use with alcohol or other CNS depressants should be avoided
Therapeutic Uses of TCA’s
Major Depression
Phobic Disorder
Obsessive-compulsive Disorder
Addictions (cocaine, smoking)
o imipramine (Trofranil) – prototype
o Rare but serious: cardiac dysrhythmias, heart block, extreme hypertension
o Anticholinergic effects
o Amitriptyline (Elavil)
o Amoxapine (Asendin)
o Desipramine (Norpramin)
o Doxepin (Sinequan)
o Imipramine (Tofranil)
o Nortriptyline (Pamelor)
o Protriptyline (Vivactil)
o Trimipramine (Surmontil)
Mnemonic for Anticholinergic Syndrome
Blind as a bat (dilated pupils/visual dist)
Red as a beet (vasodilation)
Hot as a hare (hyperthermia)
Dry as a bone (dry skin)
Mad as a Hatter (hallucinations)
Bloated as a toad (ileus/urinary retention)
And the heart runs alone (tachycardia)
Selective Serotonin Reuptake Inhibitors
SSRIs
o Ex: sertraline (Zoloft)
o Safer than other classes
o Less common sympathomimetic effects (increased heart rate and
hypertension)
o Fewer anticholinergic effects
o Can cause weight gain and sexual dysfunction (up to 70%)
Nursing Actions:
Pharmacology in Nursing III
Cypress College Registered Nursing
Drugs for Emotional and Mood Disorders
Depression
Mechanism of mood disorders associated with imbalance of neurotransmitters
Norepinephrine, serotonin, dopamine
Depression characterized by sad or despondent mood for greater than 2 weeks
Depression
DSM IV diagnostic criteria include:
o lack of energy
o sleep disturbances
o abnormal eating patterns
o social isolation, lack of interest in pleasurable activities
o feelings of despair, guilt, hopelessness
Most common mental health disorder of elderly adults
Drug Therapy for Depression
Tricyclic Antidepressants
Selective Serotonin Reuptake Inhibitors
Monoamine Oxidase Inhibitors
Atypical Antidepressants
Nursing Actions: pre-tx
Obtain careful drug history
Rule out medical and neurologic causes
Ask about alcohol and drug use
Obtain family history of depressive illness
Nursing Actions: during tx
Monitor for resolution or exacerbation of symptoms:
o Appetite
o Sleep-wake cycle
o Mood, suicidal ideation
o Psychosomatic complaints
BLACK BOX WARNING
, Tricyclic Antidepressants
Increase norepinephrine and serotonin by blocking receptors
TCAs (Mainstay of tx 1960’s – 1980’s):
Not for use in patients with heart attack, heart block, or arrhythmia
Concurrent use with alcohol or other CNS depressants should be avoided
Therapeutic Uses of TCA’s
Major Depression
Phobic Disorder
Obsessive-compulsive Disorder
Addictions (cocaine, smoking)
o imipramine (Trofranil) – prototype
o Rare but serious: cardiac dysrhythmias, heart block, extreme hypertension
o Anticholinergic effects
o Amitriptyline (Elavil)
o Amoxapine (Asendin)
o Desipramine (Norpramin)
o Doxepin (Sinequan)
o Imipramine (Tofranil)
o Nortriptyline (Pamelor)
o Protriptyline (Vivactil)
o Trimipramine (Surmontil)
Mnemonic for Anticholinergic Syndrome
Blind as a bat (dilated pupils/visual dist)
Red as a beet (vasodilation)
Hot as a hare (hyperthermia)
Dry as a bone (dry skin)
Mad as a Hatter (hallucinations)
Bloated as a toad (ileus/urinary retention)
And the heart runs alone (tachycardia)
Selective Serotonin Reuptake Inhibitors
SSRIs
o Ex: sertraline (Zoloft)
o Safer than other classes
o Less common sympathomimetic effects (increased heart rate and
hypertension)
o Fewer anticholinergic effects
o Can cause weight gain and sexual dysfunction (up to 70%)
Nursing Actions:
