N221 Antidepressants (exam 3) Practice Questions and Correct Answers

Antidepressant Medications (general info) = Elevate the mood - *Ind.*= Dysthymia (persistent dep. disorder), MDD, alcoholism, schizophrenia, depressive phase of Bipolar, depression accompanied w/ anxiety, chronic pain, PMDD, panic disorder, social phobia, GAD, OCD, bulimia nervosa - *May take up to 2-6 weeks for pt to see full effects/ symptom relief* - *Action*= Increase concentration of Sero, NE and/or Dopa in the body by- 1) blocking the reuptake so it stays in the synapse; 2) increasing the neurotransmitters when the enzyme MAO is inhibited (MAOI's)- aka, preventing the ntsmer's from being broken down - *Drug Classes*= TCA's, Atypicals/Heterocyclics (SNRIs & NDRIs), SSRI's, and MAOI's - *Nursing Dx's*= Risk for Suicide; Risk for injury; Social Isolation; Risk for constipation; Insomnia ~ *Interventions/Teaching*: - All antidepressants have FDA Black Box warning for ^ risk of suicide in children & adolescents - As meds take effect, mood lifts and pt may have ^ energy which can lead to implementing their suicide plan; nurse should pay close attn to sudden lifts in mood - Do not DC abruptly: SSRI discontinue syndrome- must gradually taper - Rise from sitting/lying SLOWLY: orthostat hypoten - Monitor diet if prescribed MAOI: HTN crisis - Avoid alcohol - Do not double up on missed doses: serotonin syndrome - Wear sunblock/sunglasses bc side effect of photosensitivity Tricyclic Antidepressants (TCAs) = *Blocks Serotonin, NE, ACh, a1, and Histamine* - *S/e*= anticholinergic effects (ACh), sedation & weight gain (H1), orthostatic hypotension, cardiac probs (tachycardia, arrhythmias) (a1), GI upset, sexual dysfunction (5-HT = sero), lowering of seizure threshold (DO NOT give to seizure pt's!), exacerbation of mania (because of lifted depression= ^ risk for mania) - *Contraindicated*= acute recovery phase following MI; pt's w/ angle-closure glaucoma; seizure pt's; concurrent use w/ MAOI's - *DO NOT give to* pt's at risk for suicide! Lethal doses are only 3-5x the therapeutic dose & more than 1g of a TCA is often toxic/ may be fatal - *Off-label uses (non-FDA approved)*= panic disorder, bulimia, chronic pain, phantom limb pain