Introductory Clinical Pharmacology Chapter 24 Antidepressant Drugs Copyright

Depression • Clinical Depression is treated with anti-depressants and/or psychotherapy. • Clinical Depression can

Medications to Recognize: Anti-depressants • Tricyclic Anti-depressants (TCAs) – imipramine (Tofranil) – nortriptyline (Pamelor)

• Misc – bupropion (Wellbutrin) – duloxetine (Cymbalta) Copyright © 2008 Lippincott Williams

Tricyclic Antidespressants: Actions • Increase sensitivity of serotonin receptors • Make neurotransmission activity more

Tricyclic Antidespressants: Uses • Used to treat: – Depressive episodes – Bipolar disorder; obsessive-compulsive

Tricyclic Antidespressants: Adverse Reactions and Contraindications • Adverse reactions: Sedation • TC contraindications: Hypersensitivity

Monoamine Oxidase Inhibitors: Actions and Uses • Actions: Increase in endogenous epinephrine, norepinephrine, dopamine,

Monoamine Oxidase Inhibitors: Adverse Reactions – Neuromuscular reactions: Orthostatic hypotension, dizziness, vertigo, headache, blurred

Selective Serotonin Reuptake Inhibitors • Actions: Inhibit CNS uptake of serotonin • Uses: Depressive

Selective Serotonin Reuptake Inhibitors (cont’d) – Gastrointestinal, genitourinary system reactions: Constipation, dry mouth, nausea,

Nursing Process: Assessment • Preadministration assessment – Obtain medical history – Assess mental status,

Nursing Process: Assessment • Ongoing assessment – Monitor vital signs, report change to primary

End of Presentation Copyright © 2008 Lippincott Williams & Wilkins.

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Depression • Clinical Depression is treated with anti-depressants and/or psychotherapy. • Clinical Depression can be caused by an imbalance of neurotransmitters (ex. Seratonin) • S & Sx’s of Depression – Feelings of Hopelessness – Diminished interests in activities of life – Insomnia / Hypersomnia – Fatigue – Recurrent thoughts of death or suicide Copyright © 2008 Lippincott Williams & Wilkins.

Medications to Recognize: Anti-depressants • Tricyclic Anti-depressants (TCAs) – imipramine (Tofranil) – nortriptyline (Pamelor) • Monoamine Oxidase Inhibitors (MAOIs) – phenelzine (Nardil) • Selective Serotonin Reuptake Inhibitors (SSRIs) – fluoxetine (Prozac) – citalopram (Celexa) – paroxetine (Paxil) – sertraline (Zoloft) Copyright © 2008 Lippincott Williams & Wilkins.

Tricyclic Antidespressants: Actions • Increase sensitivity of serotonin receptors • Make neurotransmission activity more effective • Inhibit reuptake of norepinephrine or serotonin in brain Copyright © 2008 Lippincott Williams & Wilkins.

Tricyclic Antidespressants: Uses • Used to treat: – Depressive episodes – Bipolar disorder; obsessive-compulsive disorders; chronic neuropathic pain – Depression-anxiety disorders; – Bulimia nervosa Copyright © 2008 Lippincott Williams & Wilkins.

Tricyclic Antidespressants: Adverse Reactions and Contraindications • Adverse reactions: Sedation • TC contraindications: Hypersensitivity to drugs, patients on MAOI antidepressants Copyright © 2008 Lippincott Williams & Wilkins.

Monoamine Oxidase Inhibitors: Actions and Uses • Actions: Increase in endogenous epinephrine, norepinephrine, dopamine, serotonin in nervous system • Uses: Depressive episodes, psychotherapy, bulimia, night terrors, migraine headaches, seasonal affective disorder, multiple sclerosis Copyright © 2008 Lippincott Williams & Wilkins.

Monoamine Oxidase Inhibitors: Adverse Reactions – Neuromuscular reactions: Orthostatic hypotension, dizziness, vertigo, headache, blurred vision – Gastrointestinal (GI) and genitourinary (GU) system reactions: Constipation, dry mouth, nausea, diarrhea, impotence Copyright © 2008 Lippincott Williams & Wilkins.

Selective Serotonin Reuptake Inhibitors • Actions: Inhibit CNS uptake of serotonin • Uses: Depressive episodes, bulimia nervosa, panic, post-traumatic stress disorders, anxiety and social phobias, Adverse reactions – Neuromuscular reactions: dizziness, headache, insomnia, tremor, weakness Copyright © 2008 Lippincott Williams & Wilkins.

Selective Serotonin Reuptake Inhibitors (cont’d) – Gastrointestinal, genitourinary system reactions: Constipation, dry mouth, nausea, abnormal ejaculation Copyright © 2008 Lippincott Williams & Wilkins.

Nursing Process: Assessment • Preadministration assessment – Obtain medical history – Assess mental status, subjective feelings, slowness to answer questions, monotone speech pattern, sadness or crying – Physical assessment, including blood pressure, pulse, respiratory rate, weight, suicidal thoughts – Ask about intent using simple, straightforward questions Copyright © 2008 Lippincott Williams & Wilkins.

Nursing Process: Assessment • Ongoing assessment – Monitor vital signs, report change to primary health care provider – Observe response to therapy – Document general summary – outward behavior, complaints, problems, compare previous notations, observations Copyright © 2008 Lippincott Williams & Wilkins.