Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Introduction to Clinical
Pharmacology
Chapter 22-
A...
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Tricyclic Antidespressants: Actions
• Increase sens...
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Tricyclic Antidespressants: Uses
• Used to treat:
–...
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Tricyclic Antidespressants: Adverse
Reaction and Co...
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Tricyclic Antidespressants: Precautions
• Used caut...
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Tricyclic Antidespressants: Interactions
Interactan...
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Tricyclic Antidespressants: Interactions
(cont’d)
I...
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Monoamine Oxidase Inhibitors: Actions
and Uses
• Ac...
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Monoamine Oxidase Inhibitors: Adverse
Reaction
– Ne...
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Monoamine Oxidase Inhibitors:
Contraindications and...
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Monoamine Oxidase Inhibitors:
Interactions
Interact...
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Monoamine Oxidase Inhibitors:
Interactions
Interact...
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Selective Serotonin Reuptake Inhibitors
• Actions: ...
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Selective Serotonin Reuptake Inhibitors
(cont’d)
– ...
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Selective Serotonin Reuptake Inhibitors:
Interactio...
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Miscellaneous Antidepressants: Actions
and Uses
• A...
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Miscellaneous Antidepressants: Adverse
Reactions
• ...
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Miscellaneous Antidepressants:
Contraindication and...
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Miscellaneous Antidepressants:
Interactions
Interac...
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Process: Assessment
• Preadministration ass...
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Process: Assessment
• Ongoing assessment:
–...
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Process: Nursing Diagnosis and
Planning
• S...
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Process: Nursing Diagnosis and
Planning
• T...
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Process: Implementation
• Promoting an opti...
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Process: Implementation
• Monitoring and ma...
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Process: Implementation
• Monitoring and ma...
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Process: Implementation
• Monitoring and ma...
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Process: Implementation
• Monitoring and ma...
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Process: Implementation
• Educating the pat...
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Process: Implementation
• Educating the Pat...
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Process: Implementation
• Evaluation (cont’...
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
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Ppt chapter022

  1. 1. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Introduction to Clinical Pharmacology Chapter 22- Antidepressant Drugs
  2. 2. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Tricyclic Antidespressants: Actions • Increase sensitivity in postsynaptic alpha (a)-adrenergic, serotonin receptors • Decreases sensitivity-presynaptic receptor sites • Makes neurotransmission activity more effective • Inhibits reuptake of norepinephrine or serotonin in brain
  3. 3. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. 4. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Tricyclic Antidespressants: Adverse Reaction and Contraindications • Adverse reactions: Sedation, dry mouth, visual disturbances, urinary retention, constipation, photosensitivity • TCS contraindications: Hypersensitivity to drugs, patients on MAOI antidepressants, myocardial infarction, children, lactating mothers; sinequan contraindications- glaucoma, urinary retention
  5. 5. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. 6. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Tricyclic Antidespressants: Interactions Interactant drug Effect of interaction Sedatives, hypnotics, analgesics Increased risk of respiratory, nervous system depression Dicumarol Increased risk for bleeding Cimetidine (tagamet) Increased anticholinergic symptoms (dry mouth, urinary retention, blurred vision)
  7. 7. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Tricyclic Antidespressants: Interactions (cont’d) Interactant drug Effect of interaction MAOIs Increased risk for hypertensive episodes, severe convulsions, and hyperpyretic episodes Adrenergic agents Increased risk for arrhythmias and hypertension
  8. 8. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. 9. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. 10. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. 11. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Monoamine Oxidase Inhibitors: Interactions Interactant drug Effect of interaction sedatives, hypnotics, and analgesics Increased risk for adverse reactions during surgery Thiazide diuretics Increased hypotensive effects of the MAOI Meperidine (demerol) Increased risk for hypertensive episodes, severe convulsions, hyperpyretic episodes Adrenergic agents Increased risk for cardiac arrhythmias, hypertension
  12. 12. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Monoamine Oxidase Inhibitors: Interactions Interactant drug Effect of interaction Tyramine or tryptophan Hypertensive crisis, which may occur up to 2 weeks after the MAOI is discontinued
  13. 13. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. 14. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. 15. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Selective Serotonin Reuptake Inhibitors: Interactions Interactant drug Effect of interaction Other antidepressants Increased risk of toxic effects Cimetidine (Tagamet) Increased anticholinergic symptoms Aspirin or nonsteroidal anti- inflammatory drugs (NSAIDs), e.g., ibuprofen Increased risk for GI bleeding Lithium (interaction with fluoxetine) Increased risk of lithium toxicity
  16. 16. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. 17. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. 18. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. 19. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Miscellaneous Antidepressants: Interactions Interactant drug Effect of interaction Sedatives, hypnotics and analgesics Increased risk for respiratory & nervous system depression Warfarin (Coumadin) and cimetidine (Tagamet) Increased risk for bleeding, increased anticholinergic symptoms Antihypertensive agents Increased risk for hypotension MAOIs Increased risk for hypertensive episodes, severe convulsions, & hyperpyretic episodes
  20. 20. Copyright © 2010 Wolters Kluwer Health | 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
  21. 21. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. 22. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Nursing Diagnosis and Planning • Self-Care Deficit Syndrome • Disturbed sleep pattern • Nutrition, imbalanced less than bodily requirements • Risk for suicide • Pain
  23. 23. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. 24. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 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 – Patients with depression: Develop nursing care plan, antidepressants, keep patient lying down for 30 minutes
  25. 25. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. 26. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 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 patient reorient 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. 27. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Implementation • Monitoring and managing patient’s need (cont’d): •Strict dietary control- foods containing tyramine not be eaten for patients on 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. 28. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. 29. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. 30. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Implementation • Educating the Patient and 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. 31. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. 32. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins End of Presentation
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