!
!
!
! ACTIVE LEARNING TEMPLATE: Medication
!
!
STUDENT NAME _ _____________
!
! Duloxetine (Cymbalta)
MEDICATION __________________________________________________________________________ REVIEW MODULE CHAPTER ___________ Ch. 21
Serotonin/Norepinephrine Reuptake Inhibitors (SNRI’s)
CATEGORY CLASS ______________________________________________________________________
!
!
PURPOSE OF MEDICATION
!
! Expected Pharmacological Action Therapeutic Use
!
• Increase the levels of both serotonin and NE in the synaptic • Treatment of major depression disorder
cleft! ****THERAPEUTIC EFFECT USUALLY TAKES 4- 6
• Some may weakly inhibit dopamine reuptake ! WEEKS****!
• Do NOT inhibit MAO ! • Diabetic Peripheral Neuropathy !
!
!
! Complications Medication Administration
• Related to effects on 5HT (Serotonin) and NE levels ! • PO!
• Nausea! • Vomiting! • Abnormal bleeding ! • Metabolized in the Liver !
• Constipation! • Excreted in the Urine
• Palpitations ! • Angle Closure
• Higher Heart rates!
• RISK FOR SEROTONIN glaucoma !
• ED! SYNDROME! • Urinary Retention
• Tachycardia • HTN !
!
!
! Contraindications/Precautions
• Allergy ! • Anorexia! !
• Avoid use with MAOIs ! • Hx of Mania! !
• Pregancy • Suicidal Ideation ! Nursing Interventions
• Cardiac or hepatic disease!
!
• Assess Suicidal tendencies,!
• Renal imparimetn ! • Increase in psychiatric symptoms!
!
! • HTN
• Hepatic Studies: AST, ALT. Bilirubin !
! • Sexual Dysfunction !
• Monitor for tinntus
!
! Interactions
! • Increased risk of serotonin syndrome — MAOI’s, any substance that is
! serotonergic (Triptans, tricyclics, fentanyl, lithium, tramadol, tryptophan,
buspirone, amphetamines, St. John’s Wort) !
! • Increases risk of side effects - SSRIs, TCAs!
! • Increased risk of bleeding - ASA, NSAID’s, antiplatelets, or drugs that
! affect coagulation
Client Education
• Take Drug w/ food !
• Report headache !
Evaluation of Medication Effectiveness • Take OTC analgesics as needed !
• Have the BP checked regularly !
• Improvement in mood - Increased Hopefulness and will to live ! • Take the drug in the morning to avoid
• Ability to perform ADLs ! interference w/ sleep !
• DO NOT STOP TAKING ABRUPTLY; taper off
• Improved sleeping and eating habits !
gradually. !
• Increases interaction with peers ! • Report any worsening of depression or
! thoughts of suicide!
• Suggest pt use barrier contraceptive
ACTIVE LEARNING TEMPLATES THERAPEUTIC PROCEDURE A7
!
!
! ACTIVE LEARNING TEMPLATE: Medication
!
!
STUDENT NAME _ _____________
!
! Duloxetine (Cymbalta)
MEDICATION __________________________________________________________________________ REVIEW MODULE CHAPTER ___________ Ch. 21
Serotonin/Norepinephrine Reuptake Inhibitors (SNRI’s)
CATEGORY CLASS ______________________________________________________________________
!
!
PURPOSE OF MEDICATION
!
! Expected Pharmacological Action Therapeutic Use
!
• Increase the levels of both serotonin and NE in the synaptic • Treatment of major depression disorder
cleft! ****THERAPEUTIC EFFECT USUALLY TAKES 4- 6
• Some may weakly inhibit dopamine reuptake ! WEEKS****!
• Do NOT inhibit MAO ! • Diabetic Peripheral Neuropathy !
!
!
! Complications Medication Administration
• Related to effects on 5HT (Serotonin) and NE levels ! • PO!
• Nausea! • Vomiting! • Abnormal bleeding ! • Metabolized in the Liver !
• Constipation! • Excreted in the Urine
• Palpitations ! • Angle Closure
• Higher Heart rates!
• RISK FOR SEROTONIN glaucoma !
• ED! SYNDROME! • Urinary Retention
• Tachycardia • HTN !
!
!
! Contraindications/Precautions
• Allergy ! • Anorexia! !
• Avoid use with MAOIs ! • Hx of Mania! !
• Pregancy • Suicidal Ideation ! Nursing Interventions
• Cardiac or hepatic disease!
!
• Assess Suicidal tendencies,!
• Renal imparimetn ! • Increase in psychiatric symptoms!
!
! • HTN
• Hepatic Studies: AST, ALT. Bilirubin !
! • Sexual Dysfunction !
• Monitor for tinntus
!
! Interactions
! • Increased risk of serotonin syndrome — MAOI’s, any substance that is
! serotonergic (Triptans, tricyclics, fentanyl, lithium, tramadol, tryptophan,
buspirone, amphetamines, St. John’s Wort) !
! • Increases risk of side effects - SSRIs, TCAs!
! • Increased risk of bleeding - ASA, NSAID’s, antiplatelets, or drugs that
! affect coagulation
Client Education
• Take Drug w/ food !
• Report headache !
Evaluation of Medication Effectiveness • Take OTC analgesics as needed !
• Have the BP checked regularly !
• Improvement in mood - Increased Hopefulness and will to live ! • Take the drug in the morning to avoid
• Ability to perform ADLs ! interference w/ sleep !
• DO NOT STOP TAKING ABRUPTLY; taper off
• Improved sleeping and eating habits !
gradually. !
• Increases interaction with peers ! • Report any worsening of depression or
! thoughts of suicide!
• Suggest pt use barrier contraceptive
ACTIVE LEARNING TEMPLATES THERAPEUTIC PROCEDURE A7
