-complications: headache, nausea, agitation, anxiety, dry mouth, sleep disturbances. Hyponatremia older adults taking diuretics, monitor for htn, sexual dysfunction, monitor weight. Caution: pregnancy risk, MAOI use. Avoid use: w/clients who have hepatic disease or use large amts of alcohol MAOIs, TCAs, and St. Johns Wart serotonin syndrome NSAIDs/anticoagulants increased risk of bleeding 3. Other anti-depressants that can be used: TCAs, MAOIs 4. Antihistamines, beta blockers, Trazodone, Prazosin, gabapentin Trauma/Stress related disorders 1. SSRIs 2. SNRIs 3. TCAs: amitriptyline, imipramine 4. alpha-blockers: Prazosin Effective tx is shown by: the client being able to verbalized feeling of less anxiety, improved mood, maintaining a normal sleep pattern, improved social/work interactions, improvement of overall self of being and coping mechanisms.
Chapter 22 Medications for depressive disorders -leading cause of disability can take several weeks or longer to reach therapeutic goal 4 main groups 1.TCAs Purpose: block reupdate of norepinephrine and serotonin intensifying the effects of these neurotransmitters. Complications: orthostatic hypotension or increase in the heart rate. Advise client avoid dehydration (increases the risk of hypotension) -anticholinergic effects; dry mouth, blurred vision, tachycardia, constipation(sip on water, sugarless gum, high fiber foods, wear sunglasses outside, etc.), sedation(adverse effect reduces over time). -Toxicity: s/s dysrhythmias, mental confusion, agitation seizures, coma, possible death Interactions: use with MAOI = severe htn, w/antihistamines/anticholinergic’s = additive anticholinergic effects. Concurrent use w/direct-acting sympathomimetics. Nurse considerations: -supply one week of meds at a time, prevent pt from having lethal overdose. -obtain baseline ECG, monitor vitals frequently and signs of toxicity, monitor those w/seizure disorders, weigh weekly, advise of possible excessive sweating. 2. SSRIs- Fluoxetine first line tx for depression Tx: major depression, ocd, bulimia, PM dysphoric, panic, ptsd, bipolar disorders Complications: sexual dysfunction, CNS stimulation; insomnia, agitation, anxiety, flux in weight. Serotonin syndrome: can begin 2 -72 hrs after start of tx, can be lethal. Observe for rash. s/s: mental confusion difficulty concentrating, abdominal pain, diarrhea, agitation, fever, anxiety, hallucination, tremors, diaphoresis. advise client to withhold meds is symptoms occur and contact provider. -withdrawal syndrome: taper dose -hyponatremia: likely in older clients taking diuretics. Obtain baseline serum sodium levels. -sleepiness, gi bleeding, bruxism. -caution: pregnancy risk/breastfeeding, liver/renal dysfunction (older adults), concurrent use w/MAOIs/TCAs( and lithium), alcohol. Warfarin may increase levels Avoid use of: MAOIs, TCAs, and St. Johns Wart serotonin syndrome NSAIDs/anticoagulants increased risk of bleeding 3. MAOI: Phenelzine first line tx for atypical depression blocks MAO in the brain which increases norepinephrine, dopamine, serotonin levels = intensified response which relieves depression.
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- Fall '19
- Selective serotonin reuptake inhibitor, Antidepressant