chapter 16

side effects of SSRI

insomnia- dont sexual dysfunction Anxiety, restlessness, agitation weight gain

signs of hypertension crisis caused by MAOI

Stiff neck Headache Flushing Palpitations Nausea Can ultimately cause Myocardial infarction & Cerebral bleeding Stroke

when tapering off SNRI/discontinuening

Symptoms of depression may improve (e.g., increased appetite, sleep, and psychomotor activity) within a few days. However, the depression still exists, and it usually takes several weeks of the patient receiving therapeutic dosing before improvement is noted. Suicide precautions should be maintained during this time

Drug interactions of SSRI

lithium=lithium toxicity warfarin-enhances anti-coagulation effect-check INR Smoking-enhances metaboilism of FLUXOTINE & may require high dose Tricyclic depressent-cause seizure, dysrthmia, CNS depression

Serotonin Withdrawal Syndrome/symptoms

A=Agitation, anxiety B=balance problem C=concentration problem D=Dizziness E=Electric shock sensation F= flue like symptoms ( muscle aches, fatigue, headache. G=GI symptoms (N/V/D)

Names of SSRI medications

sertaLINE citaloPRAM EscitaloPRAM fluxotINE- ONLY SSRI for children &adolescent parxotINE

Never mix SSRI with....

st.john wort MAOI tramedol SNRI

Common adverse effects of SNRI

dizziness, drowsiness, restlessness anxiety, agitation, insomnia, suicidal anorexia

MAOI with insulin

can increase hypoglycemic effect- low dose of insulin to produce desired effect

serious adverse effects of TCA

cardiac arthymias parkisonian syndrome, tremors, sezuire

Selective Serotonin Reuptake Inhibitors (SSRIs)

a group of second-generation antidepressant drugs that increase serotonin activity specifically, without affecting other neurotransmitters

Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)

used for depression, anxiety, pain( Fibromayalgia, chronic muscoloteal pain, diabeties neuropathy)

Tyramine-containing foods and wines should be avoided if a patient is taking which of the following drug classifications? a. Cephalosporins b. COX-2 inhibitors c. Monoamine oxidase inhibitors-ANswer d. NSAIDs

(aged cheese, Saurkeret, pickles, cured meats, cream, yogurt, coffee, CHOCOLATE, bananas, raisins, Italian green beans, liver, pickled foods, sausage, soy sauce, yeast, beer, and red wines

Premedication Assessment for SSRI

1. Obtain the patient's baseline blood pressures in the supine, sitting, and standing positions; record and report significant lowering to the healthcare provider before administering the drug. 2. Obtain the patient's baseline weight and schedule weekly weight measurements. 3. Note any gastrointestinal (GI) symptoms present before the start of therapy. 4. Monitor any CNS symptoms present, such as insomnia or nervousness. 5. Check the patient's hepatic studies before initiating the medication and periodically throughout the course of administration

MOA requires 2 weeks

2 weeks of washout period

how many weeks does it take to obtain full therapy of SSRI

2-4 weeks

therapeutic management of MAOI

Administration When given with anti-hypertensive medications increased risk of hypotension Can increase effectiveness of insulin causing hypoglycemiaPatients may need lower doses of insulin Inform patient it will take 2-3 weeks for med to show its effect. If stopping one antidepressant wait 2-3 weeks to start a new one to prevent toxicity

Monoamine Oxidase Inhibitors (MAOIs)

Inhibits the enzyme MAO that breaks down norepinephrine and serotonin. Used as a second or third line for depression (last resort). MOST DANGEROUS! Nmenonics-TIPS isocarboxazid (Marplan) phenelzine sulfate (Nardil) tranylcypromine sulfate (Parnate) selegiline HCl (Emsam, Eldepryl) Side effects: orthostatic hypotension, hypertensive crisis if food containing TYRAMINE is eaten, agitation, headaches, anticholinergic effects, photosensitivity, insomnia Teaching: AVOID TYRAMINE FOODS!!! (cheese, cream, yogurt, coffee, CHOCOLATE, bananas, raisins, Italian green beans, liver, pickled foods, sausage, soy sauce, yeast, beer, and red wines). Avoid Any drugs that are CNS stimulants or sympathomimetics (e.g., vasoconstrictors and cold medications containing phenylephrine and pseudoephedrine). Take no later than 6pm at night to avoid insomnia.

Serotonin Syndrome

SHIVERS S=shivering H=hyperflexia/myocolonus I=increased temp-fever V=vital sign instability E=ecelophalopathy-confusion R=restlessness S=sweeting, shitting-Gi

uses of tricyclic antidepressants

depression phantom limb pain chronic pain peripheral neuropathy postherpetic neuralgia

advantage of SSRI over TCA?

fewer side effects, less risk of overdose DOES NOT HAVE ANTI-CHOLINERGIC EFFECT

tricyclic antidepressants

prevents presynaptic reuptake of norepinephrine & serotonin

Common adverse effects of TCA

sedation orthostatic hypotension-cz it blocks alpha 1 4-CAN'T- cant see(blurred vision) cant pee(urinary retension) cant poop(constipation) cant drink-dry mouth, throat, nose