Flashcards in CH 8 DEPRESSIVE DISORDERS Deck (38)
What 4 groups are antidepressants classified into?
Selective serotonin inhibitors ( SSRI)
Tricyclic antidepressants (TCA)
Monoamine oxidase inhibitors ( MAOI's)
What does SSRI mean?
Selective serotonin reuptake inhibitors
What is the prototype drug of SSRI's?
What are other medications in the SSRI class of drugs?
escitalopram ( Lexapro)
sertraline ( Zoloft)
vilazodone ( viibryd)
What is the pharmalogical action of SSRI's?
SSRI's selectively block reuptake of the monoamine neurotransmitter serotonin in the synaptic space, thereby intensifying the effects of serotonin.
What are the therapeutic uses of SSRI's?
Major depression, OCD
Premenstrual dysphoric disorders
What are the adverse effects of SSRI's?
CNS stimulation....inability to sleep, agitation, anxiety
Weight loss early in therapy followed by wt gain with long term tx.
What are manifestations of serotonin syndrome?
May begin 2-72 hr after treatment.
Mental confusion, difficulty concentrating, fever, agitation
Anxiety, hallucinations, in coordination, hyperreflexia,
What are some facts about SSRI's?
Pregnancy category C
fluoxetine & paroxetine increase the risk of birth defects
It is contraindicated in clients taking MAOI's?
Use cautiously in clients who have liver or kidney failure, cardiac disease, seizure disorders, diabetes, ulcers and a hx of GI bleeding.
What increases the risk of serotonin syndrome?
St. John's wart
What med can displace warfarin?
fluoxetine can displace warfarin from bound protein and result in increased warfarin levels.
What can fluoxetine increase?
Fluoxetine can increase the levels of Tricyclic antidepressants and lithium.
What flouxetine suppress?
fluoxetine suppresses platelet aggregation and this increases the risk of bleeding when used concurrently with NSAID's and anticoagulants.
What is the protype drug for ATYPICAL ANTIDEPRESSANTS?
bupropion HCL ( Wellbutrin)
What is the pharmacological action of ATYPICAL ANTIDEPRESSANTS?
The action is not fully understood. However, it likely acts by inhibiting dopamine uptake.
What are the therapeutic uses of ATYPICAL ANTIDEPRESSANTS?
Treatment of depression
Alternative to SSRI clients unable tolerate sexual dysfunction side effects of SSRI's.
Aid to quit smoking
Prevention of seasonal pattern depression.
What are adverse effects of ATYPICAL ANTIDEPRESSANTS?
Headache, dry mouth, GI distress, constipation, increased heart rate
Nausea, restlessness, insomnia
Suppresses appetite and often causes wt. loss
What is true of bupropion?
Pregnancy category B
contraindicated in clients taking MAOI's
Contraindicated in clients with seizure disorders
what is the prototype drug of TRYCYCLIC ANTIDEPRESSANTS (TCA)?
Name some TCA medications.
imipramine ( Tofranil)
doxepin ( Sinequan)
nortiptyline ( Aventyl)
amoxapine ( Asendin)
trimipramine ( Surmontil)
What are the pharmalogical actions of TCA's?
These meds block reuptake of norepinephrine & serotonin in the synaptic space, thereby intensifying the effects of these neurotransmitters.
What are the therapeutic uses of TCA's?
Depressive episodes of bipolar disorders
Neuropathic pain, fibromyalgia
What are complications of TCA medications?
Anticholinergic effects....dry mouth, blurred vision, photophobia,constipation, tachycardia, urinary hesitancy
Sedation, diaphoresis, decreased seizure threshold.
What are some facts about TCA.
Pregnancy category C
contraindicated in clients with seizure disorders
Use cautiously in clients with CAD, diabetes, liver & kidney, and respiratory disorders, urinary retention and obstruction,
Angle- closure glaucoma, benign prostatic hyperplasia, and hypothyroidism
What do TCA's decrease?
TCA's decrease the effects of ephedrine, amphetamine because uptake into the nerve terminals is blocked, and they are unable to reach their site of action.
What drug- drug interactions are their with TCA's?
Concurrent use with MAOI's or St. John's wart may lead to serotonin syndrome.
What is the prototype drug of MONOAMINE OXIDASE INHIBITORS?
phenelzine ( Nardil)
Name some MAOI medications.
selegiline (emsam)- transdermal MAOI
What is the purpose of MAOI medications?
These medications block MAO in the brain, thereby increasing the amt of norepinephrine, dopamine, and serotonin available for transmission of impulses.man increased amt of these neurotransmitters at nerve endings intensifies responses and relieves depression.