Sleepiness faintness lightheadedness GI Bleeding Bruxism wear mouth guard may

Sleepiness faintness lightheadedness gi bleeding

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Sleepiness, faintness, lightheadedness GI Bleeding Bruxism – wear mouth guard; may add low dose of Buspirone to treat Contraindications
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Fluoxetine preg risk C Fluoxetine and paroxetine increase risk of birth defects Don’t take with MAOIs or TCAs Caution w/ liver/renal dysfunction, cardiac disease, sz disorder, DM, ulcers, and hx of GI bleed Interactions: Risk for serotonin syndrome increased w/ MAOIs or St. john’s wort (dc MAOIs for 14 day before taking SSRI; dc Fluoxetine for 5 wks before starting MAOIs) Increases warfarin levels (monitor PT and INR) May cause toxicity w/ tricyclic antidepressant or lithium Don’t use with NSAIDS or anticoagulants MONOAMINE OXIDASE INHIBITORS (MAOIs) – ( Phenelzine , Isobarboxazid, Tranylcypromine, Selegiline transdermal patch) Expected Action: blocks MAO to increase norepinephrine, dopamine, and serotonin available for transmission of impulses; relieves depression Uses: depression, bulimia nervosa, FIRST LINE TREATMENT FOR ATYPICAL DEPRESSION Complications: CNS stimulation: anxiety, agitation, hypomania, mania (notify provider if any of this occurs) Orthostatic hypotension Hypertensive Crisis: results with intake of tyramine; causes HA, N/V, increased HR, increased BP, diaphoresis, change in LOC o Tx with phentolamine IV or nifedipine and apply continuous cardiac monitoring Local rash may occur w/ patch; tx w/ topical glucocorticoid if rash occurs Contraindications: Phenelzine pregnancy risk C Contraindicated w/ SSRIs No with pheochromocytoma, heart failure, cardiovascular and cerebral vascular disease, or severe renal insufficiency Caution w/ diabetes, sz disorders and w/ TCAs No transdermal w/ carbamazepine or oxcarbazepine (increase blood levels of MAOIs) Interactions: Use with ephedrine, amphetamine (indirect-acting sympathomimetic meds) promote release or norepinephrine and lead to hypertensive crisis Use with TCAs can lead to hypertensive crisis Use w/ SSRIs can cause serotonin syndrome Use w/ meperidine can lead to hyperpyrexia w/ tyramine causes hypertensive crisis o tyramine containing food: aged cheese, pepperoni, salami, avocado, figs, bananas, smoked fish, protein, beers and red wine
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use w/ vasopressors can cause hypertension ATYPICAL ANTIDEPRESSANTS ( Bupropion) Expected Action: inhibits dopamine uptake Uses: tx depression, alternative for SSRIs, aid to quit smoking, prevention of seasonal pattern depression Complications: HA, dry mouth, GI distress, constipation, increased HR, nausea, restlessness, and insomnia o Treat HA w/ mild analgesia Suppression of appetite resulting in weight loss o Monitor food intake and weight Seizures, especially at higher dose ranges o Don’t give with head injuries Contraindications: Pregnancy Risk B No w/ sz disorders No w/ MAOIs No w/ anorexia nervosa or bulimia nervosa Interactions: DC MAOI 2 weeks prior to beginning tx Increased risk of sz w/ concurrent use of SSRIs OTHER ATYPICAL ANTIDEPRESSANTS Vanlafazine, duloxetine, desvenlafazine, levomilnacipran (SNRIs) Considerations: o
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  • Winter '16
  • Selective serotonin reuptake inhibitor, Major depressive disorder, Antidepressant, Tricyclic antidepressant, W/, Caution w/

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