Introduction to Clinical Pharmacology Chapter 22- Antidepressant Drugs

1. Introduction to Clinical PharmacologyChapter 22-Antidepressant Drugs

2. Tricyclic Antidespressants: Actions • Increase sensitivity in postsynaptic alpha (a)-adrenergic, serotonin receptors • Decreases sensitivity-presynaptic receptor sites • Makes neurotransmission activity more effective • Inhibits reuptake ofnorepinephrine or serotonin in brain

3. Tricyclic Antidespressants: Uses • Used to treat: • Depressive episodes • Bipolar disorder; Obsessive-compulsive disorders; Chronic neuropathic pain • Depression-anxiety disorders; Enuresis; Peptic ulcer disease; Sleep apnea; Panic disorder • Bulimia nervosa; Premenstrual symptoms; Dermatological problems; Psychotherapy- severe cases

4. Tricyclic Antidespressants: Adverse Reaction and Contraindications • Adverse reactions: Sedation, dry mouth, visual disturbances, urinary retention, constipation, photosensitivity • TCS contraindications: Hypersensitivity to drugs, patientson MAOI antidepressants, myocardial infarction, children, lactating mothers; sinequan contraindications- glaucoma, urinary retention

5. Tricyclic Antidespressants: Precautions • Used cautiously in patients: • Cardiac disease, hepatic and/or renal impairment, hyperthyroid disease • History of seizure activity, narrow angle glaucoma or increased intraocular pressure • Urinary retention, and risk of suicide ideation or behavior

6. Tricyclic Antidespressants: Interactions

7. Tricyclic Antidespressants: Interactions (cont’d)

8. Monoamine Oxidase Inhibitors: Actions and Uses • Actions: Increase in endogenous epinephrine, norepinephrine, dopamine, serotonin in nervous system, increase in neurohormones • Uses: Depressive episodes, psychotherapy, bulimia, night terrors, migraine headaches, seasonal affective disorder, multiple sclerosis

9. Monoamine Oxidase Inhibitors: Adverse Reaction • Neuromuscular reactions: Orthostatic hypotension, dizziness, vertigo, headache, blurred vision • Gastrointestinal (GI) and genitourinary (GU) system reactions: Constipation, dry mouth, nausea, diarrhea, impotence • Serious adverse reaction: Hypertensive crisis foods containing tyramine

10. Monoamine Oxidase Inhibitors: Contraindications and Precautions • Contraindications: Elderly patients; hypersensitivity to drugs; pheochromocytoma; liver, kidney or cerebrovascular disease; hypertension; history of headaches; congestive heart failure • Caution: Patients with impaired liver function; history of seizures; parkinsonian symptoms; diabetes; hyperthyroidism; risk of suicidal ideation or behavior

11. Monoamine Oxidase Inhibitors: Interactions

12. Monoamine Oxidase Inhibitors: Interactions

13. Selective Serotonin Reuptake Inhibitors • Actions: Stimulant to reverse depression • Uses: Depressive episodes, bulimia nervosa, panic, premenstrual, post-traumatic stress disorders, anxiety and social phobias, Raynaud’s disease, migraine headaches, diabetic neuropathy, hot flashes • Adverse Reactions • Neuromuscular Reactions: Somnolence, dizziness, headache, insomnia, tremor, weakness

14. Selective Serotonin Reuptake Inhibitors (cont’d) • Gastrointestinal, genitourinary system reactions: Constipation, dry mouth, nausea, pharyngitis, runny nose, abnormal ejaculation • Contraindications: Hypersensitivity to drugs; pregnancy category C, patients taking cisapride, pimozide or carbamazepine should not take fluvoxamine (prozac) • Precautions: Diabetes mellitus; cardiac disease; impaired liver, or kidney function; risk of suicidal ideation or behavior

15. Selective Serotonin Reuptake Inhibitors: Interactions

16. Miscellaneous Antidepressants: Actions and Uses • Affects: Neurotransmission of serotonin, norepinephrine, dopamine • Uses: Depressive episodes, anxiety disorders, neuropathic pain, enhancing weight loss, treating aggressive behaviors, menstrual disorders, cocaine withdrawal, alcohol cravings, fibromyalgia, stress incontinence

17. Miscellaneous Antidepressants: Adverse Reactions • Neuromuscular reactions: Somnolence, migraine headache, hypotension, dizziness, lightheadedness, vertigo, blurred vision, photosensitivity, insomnia, nervousness or agitation, tremor • Gastrointestinal reactions: Nausea, dry mouth, anorexia, thirst, diarrhea, constipation, bitter taste • Generalized body system reactions

18. Miscellaneous Antidepressants: Contraindication and Precautions • Contraindications: Hypersensitivity-drugs, maprotiline- seizure disorder, patients on cisapride, pimozide, carbamazepine • Precautions: Cardiac disease; renal and/or hepatic impairment; hyperthyroid disease; risk of suicidal ideation or behavior

19. Miscellaneous Antidepressants: Interactions

20. 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

21. Nursing Process: Assessment • Ongoing assessment: • Monitor vital signs, report change to primary healthcare provider • Observe response to therapy • Document general summary- outward behavior, complaints, problems, compare previous notations, observations

22. Nursing Process: Nursing Diagnosis and Planning • Self-Care Deficit Syndrome • Disturbed sleep pattern • Nutrition, imbalanced less than bodily requirements • Risk for suicide • Pain

23. Nursing Process: Nursing Diagnosis and Planning • The expected outcome includes an optimal response to therapy: • Reason for administration of antidepressant • Optimal response to drug therapy • Support patient for adverse drug reactions • Understanding, compliance: Prescribed therapeutic regimen

24. Nursing Process: Implementation • Promoting an optimal response therapy: • Observe patient for adverse reactions: Notify primary health care provider • Observe: Behavioral changes during initial therapy when dosage increased, decreased • Patientswith depression: Develop nursing care plan, antidepressants, keep patient lying down for 30 minutes

25. Nursing Process: Implementation • Monitoring and managing patient’s need: • Self-care deficit syndrome • Assist when depression- no physical, or emotional energy to perform self-care activities • Minimize injury risk: Safe environment, assist in changing positions, Assist-activities of daily living, encourage self care, give positive feedback, write behavioral records-periodic intervals, frequency depends– hospital, unit guidelines

26. Nursing Process: Implementation • Monitoring and managing patient’s need (cont’d): • Disturbed sleep pattern: Promote sleep, wakefulness during day, shut drape at night, opened in day, help patientreorient to day, night time • Imbalanced nutrition, less than bodily requirements: • Monitor fluid dietary intake, monitor weight loss, gain, good oral hygiene, frequent sips of fluids, sugarless gum

27. Nursing Process: Implementation • Monitoring and managing patient’sneed (cont’d): • Strict dietary control- foods containing tyramine not be eaten for patientson MAOIs, no food from outside • Risk for suicide: Well-supervised environment, wait for therauptic effect; report for: expressions of guilt, hopelessness, helplessness, insomnia, weight loss, direct/indirect threats of suicide, care while swallowing

28. Nursing Process: Implementation • Monitoring and managing patient’s need (cont’d): • Pain, Acute: • Drugs: Trazodone, priapism-impotence, prolonged, inappropriate penile erection, injection of alpha-adrenergic stimulants, surgical intervention

29. Nursing Process: Implementation • Educating the patient and family • Managing reactions; patients- continue proper drug regimen, evaluate ability to take responsibility of drugs, explain adverse reactions • Teaching plan: Inform primary health care provider, dentist; dizziness: rise slowly of bed, chair; help changing positions; relieve dry mouth: frequent sips-water, sucking hard candy, chewing gum

30. Nursing Process: Implementation • Educating the Patientand Family (cont’d) • Teaching plan: Report: Unusual changes, physical effects; avoid prolonged: exposure to sunlight or sunlamps; male patients: Experience prolonged, inappropriate, painful erections-stop drug, notify primary care provider • Evaluation • Therapeutic effect: Achieved • No evidence of injury apparent

31. Nursing Process: Implementation • Evaluation (cont’d): • Patient: Perform self-care • Adverse reactions: Identified, reported primary health care provider, managed successfully- appropriate nursing interventions • Patient verbalizes: Treatment modalities, importance continued follow-up care • Patient and family demonstrate: Drug regimen

32. End of Presentation