What is a major concern with the use of meds for emotional and mood disorders (FDA black box warning)?
Suicidal ideation (esp in children), evaluations should occur at initiation of therapy and be ongoing
What are PE points for antidepressants in regards to therapeutic effect?
Effects may sometimes take a month or more, strict adherence is crucial; Depression is due to neurotransmitter dysfunction, meds do not completely restore balance
What is the action of Tricyclic Antidepressants (prototype- imipramine/Tofranil)?
Inhibition of NE and serotonin uptake
Side effects of imipramine include orthostatic hypotension and sedation, what PE points would the nurse give?
Change positions slowly, use at bedtime if sedation occurs, abstain from driving until effects are known (other SE include sweating and anticholingeric effects)
TCAs are contraindicated in what conditions?
history of cardiovascular disease and seizure disorders
Although Selective serotonin reuptake inhibitors (prototype- sertaline/Zoloft) have fewer SE than many types of antidepressants what SE may still occur?
N&V, diarrhea, sexual dysfunction, weight gain, insomnia/fatigue
What PE points may the nurse give when patient is prescribed sertaline?
Take in AM with food to avoid GI upset and insomnia, use calorie restriction and exercise to avoid weight gain, do not stop med abruptly, do not use ETOH/CNS depressants
Serotonin syndrome (SES) is associated with the use of SSRIs, when can this occur?
As little as 2 hours after first dose or several weeks after *CAN BE FATAL* (s/s: mental status change, HTN, tremors, sweating, hyperpyrexia, ataxia)
Why are Monoamine oxidase inhibitors (prototype- phenelzine/Nardil) often the last choice in antidepressant therapy?
Many drug-drug and drug-food (tyramine, caffeine) interactions, can also be hepatotoxic
What can occur when a patient taking an MAOI ingests foods with tyramine?
Hypertensive crisis, patients on MAOIs should monitor for signs of CVA/MI and wear a medic alert bracelet
What are Atypical antidepressants?
Antidepressants with unique chemical structures, can include SNRIs which inhibit resorption of serotonin & NE (duloxetine, venlafaxine), drugs with similar action (bupropion, mirtazapine), or herbals (St. John's Wort)
Because St. John's Wort is available OTC, what is a PE point for a patient who has been prescribed an antidepressant?
SES can occur if used with TCAs, SSRIs, MAOIs; If using only St. John's Wort let them know therapeutic effect can take up to 2 months
Why is diligent assessment & evaluation of pharmocotherapy for treatment of neurodegenerative disorders so important?
Drug therapy outcomes are related to progression of disease process, SE are often similar to s/s of the disease
What is the goal of drug therapy for Parkinson's?
Increase the client's ability to perform ADLs, restore balance between neurotransmitters dopamine and Ach in the corpus striatum
How do drugs like levodopa/Larodopa (prototype- Dopaminergic) work?
By restoring dopamine synthesis or by stimulating receptors via dopamine agonists (CONTRAINDICATED in narrow-angle glaucoma)
What is a NC of levodopa that can be very frustrating for patient's and may lead to non-adherence?
Full therapeutic effect may take form weeks to 6 months, increased s/s may require dose adjustments, abrupt withdrawal may cause acute Parkinsonism
Why is it important for patients to report new blepharospasm (eye twitches), tremors, & symptoms?
This may signal an "on-off" syndrome which may require hospitalization to determine reason for exacerbation
SE of levodopa include orthostatic hypotension, dyskinesias, and psychosis, what is less dangerous SE that the patient may find embarrassing?
Darkening of perspiration and urine which can stain clothing (consider use of dress shields)
How do drugs like benztropine/Cogentin (prototype- Anticholinergic) work?
By inhibiting the over-activity of Ach, often used in early treatment (or in those who do not tolerate levodopa) for CNS effects rather than autonomic actions
Because of the anticholinergic effects of benztropine what PE points would the nurse discuss?
Avoid overheating in hot weather (risk for heat stroke), Wear sunglasses in bright light, Increase fiber & fluids, Sugarless gum/candy for dry mouth, Be aware of s/s of anticholinergic crisis (fever, visual changes, difficulty swallowing, agitation)
What is it especially important for older patients to report mental status changes, agitation, and drowsiness?
Those over age 60 have more risk for SE d/t cognition and mental alertness