1. Copyright © 2008 Lippincott Williams & Wilkins. Introductory Clinical Pharmacology Chapter 24 Antidepressant Drugs

2. Copyright © 2008 Lippincott Williams & Wilkins. 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

3. 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)

4. Copyright © 2008 Lippincott Williams & Wilkins. Misc – bupropion (Wellbutrin) – duloxetine (Cymbalta)

5. 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

6. 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

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

8. 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

9. 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

10. 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

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

12. 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, straight- forward questions

13. 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

14. Copyright © 2008 Lippincott Williams & Wilkins. End of Presentation