pharm

felling sad, unhappy, or down

Dysphoric- major depressive episode (exagerated sadness, anxiety, unhappiness) that interferes w/ daily functioning

• S/S:
• feeling hopelessness & helplessness, worthlessness
• decreased intrest in activities of life
• significant wt loss or gain (w/o diet)
• insomnia or hypersomnia
• agitation, restlessness, irritability
• fatigue
• guilt
• inability to think, concentrate, indecisiveness
• thoughts of death or suicide even attempted

• slow adaptive changes in norepinephrine & serotonin receptor system
• tx thought to increase sensitivity of postsynaptic receptors, & decrease sensitivity of presynaptic

• Use:
• bipolar disorder
• OCD
• chronic neuropathic pain
• enuresis
• unlabeled uses: peptic ulcer, sleep apnea, panic disorder, bulimia, premenstrual symptons, & dermatologic problems, psychotherapy in severe cases

• AR:
• anticholinergic effect(sedation, dry mouth, visual disturbance, urinary retention)
• constipation & photosensitivity
• tachycardia
• heart block
• ortho hypotension

• Cont:
• not given w/i 14 days of the MAOI antidepressants
• pt w/ myocardial infarction
• children
• lactating, preg.

• pre:
• pt w/ cardiac disease, hepatic & renal impairment, thyroid disease, hx seizure, narrow glucoma, increasesd intraocular pressure, suidical thought/behavior, urinary retention

• Inter:
• sedatives, hypnotics, analgesics- increased risk 4 resp. & NS depression
• dicumarol(blood thinner)- increase risk 4 bleeding
• cimetidine(tx gastric upset)- increased anticholinergic symptoms
• MAOIs- increased risk 4 hypertensive episodes, convulsions, hyperpyretic
• adrengic agent(neuromuscular agent)- increased risk 4 arrhythmias & hypertension

• amitriptyline
• use: depression,bipolar, OCD, peptic ulcer, sleep apnea, neuropathic pain, bulimia
• AR: sedation, anticholinergic effect, constipation

• amoxapine
• use: depression w/ anxiety
• AR: tardive dyskinesia, sedation, constipation, anticholinergic

increase in serotonin levels thought to act as stimulant to reverse depression

• use:
• depression, anxiety,OCD, bulimia, panic disorders, prementrual symptoms, migraines
• raynauds disease
• DM neuropathy

• prec:
• pt w/ DM, impaired liver & kidney, cardiac disease, risk 4 suicide thought/behaviors
• pt shouldnt be switched to SSRI w/i 2wk of stopping MAOI

• Inter:
• other antidepressant- increases risk 4 toxicity
• cimenidine(gastric upset)- increased anticholinergenic symptoms
• NSAID- increase risk 4 GI bleeding
• lithium(bipolar)- increased rosk 4 lithium toxicity

herbal alert- st john wort shouldnt be given w/ SSRI increases sedation

• citalopram (celexa)
• use:
• depression, panic disorder, PTSD, premenstrual disorder
• AR:
• nausea, dry mouth, sweating, somnolance, insomnia, anorexia, diarrhea

• fluoxtine (prozac)
• use:
• depression, bulimia, OCD, panic disorder
• AR:
• anxiety, nervouseness, somnolance, insomnia, drowsiness, asthenia, headache, nausea, diarrhea, constipation, dry mouth, anorexia

• paroxetine(paxil)
• use:
• depression, OCD, panic disorder, anxiety, social anxiety, PTSD
• AR:
• headache, tremors, somnolance, nervouseness, dizzieness, insomnia, nausea, diarrhea, constipation, dry mouth, sweating, weakness, sexual dysfunction

• sertraline (zoloft)
• use:
• depression, OCD, panic disorder, PTSD
• AR:
• headache, drowsiness, anxiety, fatique, dizzieness, insomnia, nausea, diarrhea, dry mouth, sweating, weakness, ejaculatory disturbance

• complex enzyme system responsible 4 inactivaton of certain neurotransmitters
• blocking MAOIs increases endogenous epinephrine, norpinephrine, dopamin & serotonin in NS

• use:
• depressive episodes, phsycotherapy in severe cases
• unlabeled use: bulimia, night terrors, migraine, seasonal affective disorders, multiple sclerosis

• AR:
• vertigo, othro hypotension, blurred vision, constipation, dry mouth, impotance, nausea, diarrhea
• severe case hypertensive crises(very high B/P), occurs w/ food high in tyramine(amino acid), followed by headache, stiff/sore neck, nausea, vomiting, sweating, fever, chest pain, dilated pupils, brady/tachy cardia

• cont:
• elders, phechromocytoma, liver &kidney disease, cerebralvascular disease, HTN, hx of headache, CHF, preg. younger then 16y, hx seizures, hyperthyroidism, rick 4 suicide
• pt shoudnt take decongestion w/o Dr approving

• Inter:
• sedative/hypnotic/analgesic- increase risk AR during surgery
• thiazide(diuretic)- increases hypotension effect MAOI
• meperidine(pain)- increase risk 4 hypertension, severe convulsion, hyperpyretic episodes
• adrenergic(neuromuscular)-increase risk 4 arrhythmias & hypertension
• tyramine/tryptophan(amino acid)- hypertensive crisis, 2wk after MAOI d/c
• antitussive(cough)- hypotension, fever, nausea, jerkinh, legs, coma

Ex. phenelzine (nardil)- atypical depression

thought that affect neurotramsmission of serotonin, norepinephrine, & dopamine

• use:
• Depression, anxiety, neripheral neuropathic pain, wt loss, fibromylagia, alcohol & cocain withdrawal, stop smoking

• AR:
• hypotension, lightheadedness, blurred vision, bitter taste

• Prec:
• pt w/ cardiac disease, renal & hepatic impairment, hypothyriod disease, risk 4 suicide

• inter:
• Sedative/hypnotic/anagesic- increase risk 4 resp. & nervous depression
• warfarin(blood thinner)- increases risk 4 bleeding
• cimetidine(GI upset)- increased anticholinergic symptoms
• antihypertensive(B/P)- increase risk 4 hypotension
• MAOIs- increase risk 4 hypertensive, convulsion, hyperpyrtic

• Bupropion (welbutrin)
• use:
• depression, neuropathis pain, ADHD, stop smoking
• AR:
• agitation, dizziness, dry mouth, sedation, headache, GI problems, tremors, wt loss, sweating

• duloxetine(cymbalta)
• use:
• depression, diabetic peripheral neuropathy, fibromylagia, stress, incontinance
• AR:
• insomnia, dry mouth, nausea, constipation

• venlafaxine(effexor)
• use:
• depression, anxiety, premenstrual disorder
• AR:
• headache, insomnia, dizziness, nervousness, weakness anorexia, constipation, dry mouth, somnolance, sweating

• aged cheese(blue, camembert, chedder, mozzorella, parmesan)
• sour cream
• yogurt
• beef/chicken live
• pickeled herring
• fermanted meats(salami, bolongna, pepperoni, dried fish)
• undistilled alcoholic beverages
• caffeinated drinks
• chocolate
• certain fruits & veggie (avocado, bananas, fava beans, raisins)
• yeast extracts
• soy sauce

• slow therapuetic respons
• w/ fluoxetine AR sometime seen before therapeutic resopnse
• 2 AR why pt stop taking meds are somnolance & dry mouth
• when given IM give in gluteus, keep pt laying down 4 30 min

• often pt dont have physical/emotional energy 4 ADL
• assist when ambulation/ADL
• possible othro hypotension
• provide positive feed back
• when somnolance give med @ night, except SSRIs
• asses enviroment to promote sleep
• foods high in fiber & increase of fluids b/c nausea & constipation
• check wt daily
• pt on MAOI no foods containg tyramine, list foods to pt/family, & importance/reason why not to take
• well supervised b/c risk 4 suicide, b/c therapeutic effect take 10days-14wks pt gains energy to carry out suicide
• report expressions of hopelessness, helplessness, guilt, insomnia, wt loss, direct/indirect threats of suicide
• always inspect that pt did take med b/c they could use it 4 suicide, if pt doesnt allow then give med parenterally

• explain reason 4 drug therapy & how to take
• ask family to help make sure pt taking meds
• instruct to take med as RX
• advise that therapeutic effect might take several wks to be seen
• advise about S/S whether drug is working or not
• review measures 2 reduce suicide
• advise about AR
• reinforce safety measures of taking drugs
• advice no alcohol or nonRX drugs
• instruct measures to reduce dry mouth
• emphysizes on not taking food high in tyramine, give list of foods
• reassurence that labs will be done on follow-up appt
• assist with arrangements of follow-up appt.