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The SSRI's are usually the first choice for treatment due to their limited side effects. The TCA's MAOI's are reserved for the more severly depressed clients. General contraindications for all antidepressants are caution in pregnancy, elderly, use with clients with hepatic, renal, or cardiac insufficiency.
The SSRI's are usually the first choice for treatment due to their limited side effects. The TCA's MAOI's are reserved for the more severly depressed clients. General contraindications for all antidepressants are caution in pregnancy, elderly, use with clients with hepatic, renal, or cardiac insufficiency.
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The SSRI's are usually the first choice for treatment due to their limited side effects. The TCA's MAOI's are reserved for the more severly depressed clients. General contraindications for all antidepressants are caution in pregnancy, elderly, use with clients with hepatic, renal, or cardiac insufficiency.
Hak Cipta:
Attribution Non-Commercial (BY-NC)
Format Tersedia
Unduh sebagai DOCX, PDF, TXT atau baca online dari Scribd
All antidepressants function to increase the level of the specific neurotransmitters
to elevate the clients mood. The SSRI's are usually the first choice for treatment due to their limited side effects. The TCA's MAOI's are reserved for the more severly depressed clients. Some other uses for Anti-depressants especially the SSRI's are many other emotional problems, such as anxiety disorders, eating disorders, personality disorders, sleep disorders, phobias and for some medical conditions, such as migraine headaches, chronic pain, peptic ulcer disease, and premenstrual dysphoria.
General contraindications for all Anti-Depressants are caution in pregnancy,
elderly, use with clients with hepatic, renal, or cardiac insufficency. Most antidepressants are metabolized in the liver and excreted via the renal system. Caution use for clients with benign prostatic hypertrophy, Psychotic clients and in children and young adults. Avoid alcohol. Instruct client that it their symptoms may lift in 4 weeks, but overall effectiveness will not be seen until 12 to 13 weeks.
SSRI's MAOI's
Block the reuptake of Inhibit the enzyme
serotonin in the synapse's monoamine oxidase from therefore making more of destroying the nuerotransmitter nuerotransmitters thus available to elevate the increasing their mood concentration in the synapse All not combined with MAOI's
Celexa (citalopram) -Initial dose 20 mg
daily. May be increased to 40 mg daily Nardil (phenelzine) 15 mg PO tid after a minimum of 1 week. Maximum May be increased rapidly to 60 mg dose 40 mg daily. taken once a day, in daily. Maximum dose 90 mg daily which the morning or evening, with or without can then generally be reduced to 15 mg food. daily. Have clients report any signs of a Lexapro (escitalopram) 10 mg once daily hypertensive crisis: dizziness, headach in morning or evening. May be Parnate (tranylcypromine) 10 mg PO increased to 20 mg daily after a tid minimum of one week. Drowsiness, May be increased by 10 mg daily at 1 to the CNS are established. It may cause 3 week intervals. Maximum dose 60 mg sexual dysfunctions, such as ejaculation daily. This is a potent drug which is disorder, impotence, anorgasmia, and capable of producing serious side menstrual cramps. effects. Thhe most dangerous reaction to Parnate is a surge in blood pressure, Luvox (fluvoxamine) 50 mg at bedtime which has sometimes been fatal. For May be increased in 50 mg increments this reason, you should tell clients to every 4 to 7 days. Maximum dose 300 report promptly to their doctor any of mg per day. the following symptoms: constriction or pain in the throat or chest, dizziness, Paxil (paroxetine) Initially 20 mg per day, fever, headache, irregular heartbeat, usually in the morning. light sensitivity, nausea, neck stiffness May be increased in 10 mg/day or soreness, palpitations, pupil dilation, increments at intervals of at least one sweating, or vomiting. week. May cause sexual dysfunction.
Prozac (fluoxetine) Initially 20 mg each
morning. If no improvement is noted after 2 weeks, dosage may be increased to 80 mg per day in 2 divided doses. Tell client to avoid taking drug in the early afternoon. Commonly causes nervousness and insomnia.
Zoloft (sertraline) Initial dose 50 mg
daily as a morning or evening dose. May be increased by 50 mg daily at weekly intervals. Maximum dose: 200 mg daily. Monitored for suicidal tendencies
TCA's SNRI's
Inhibit the reuptake of serotonin The SNRIs increase the levels of
and norepinephrine making them both serotonin and norepinephrine more available at the synapse's. by inhibiting their reabsorption Most taken at night due to into the cells of the brain. The sedation resultant higher levels of these Non-concurrent with MAOI hormones enhance Anti-cholinergic side effects neurotransmission - the sending of nerve impulses - and thus improve and elevate mood. Anafranil (clomipramine) initially 25 mg PO daily with meals, gradually Cymbalta (duloxetine) Initially 20 mg increased to 100 mg daily in divided P.O. bid, then 60 mg P.O. once daily or doses during the first 2 weeks. divided into two equal doses. Maximum Maximum dose 250 mg daily in divided dose: 60 mg daily. Teach clients and doses. After dosage is adjusted, daily family to observe for worsening of dose is totally given at bedtime. depression, to consult physician if taking any OTC's, swallow capsule Sinequan (doxepin) Max dose300 mg whole.
Effexor (venlafaxine) 75 mg daily in 2 or
Elavil (amitriptyline) Initially 50 to 3 divided doses with food. May be 100 mg PO at bedtime. Parenterally: 20 increased in increments of 75 mg per to 30 mg IM qid day at no less than 4 day intervals. Maximum dose: 300 mg daily. available Maximum dose: Usually 225 mg daily. in parenteral form For severely depressed 375 mg per day. Surmontil (trimipramine) Max Should be taken with food. Used with dose300 mg caution in clients with high blood pressure, glaucoma, heart, liver, or Norpramin (desipramine) especially kidney disease, or in clients with useful for depressed elderly clients who histories of seizure or mania. are sensitive to anticholinergic effect and for individuals with open-angle Prestique (desvenlafaxine) NEW !! With glaucoma or prostatic hypertrophy. It is Prestiq, the starting dose is the frequently prescribed for cardiac recommended dose. The recommended clients. dose for Prestique is 50 mg once daily. When stopping Pristiq, the patient's Tofranil (imipramine) Max dose300 health care professional may gradually mg reduce the dose. It should not be Pamelor (nortriptyline) initially 25 stopped without first consulting with the mg tid or qid gradually increasing to health care professional. Should be 150 mg daily. Entire dose may also be taken at the same time each day. It given at bedtime. Serum levels should may be taken with or without food. be monitored when dose is over 100 mg daily.
Vivactil (protriptyline) The usual
adult dosage is 15 to 40 milligrams in 3 or 4 doses per day. The maximum dosage is 60 milligrams daily. Increases are made in the morning dos
Client care considerations:
Clients with an initial depressive episode may receive treatment for six months to a year. However for clients with recurrent episodes, clients may require treatment for up to 2 years. Special attention is given to the elderly, the chronically ill, the debilitated, and the very young. Nurses play a major role in client assessment, evaluation, monitoring, and teaching. Clients are different and medications and doses may need to be adjusted several times to reach the desired effect. A thorough drug histories should be performed to determine all other medications the client is taking to minimize drug interactions. The nurse should be knowledgable and watch for evidence of any adverse drug effects. Continual assessment of the client's appearance, behavior, speech pattern, level of interest, and mood should be monitored by the Nurse. In addition the client's eating, sleeping, elimination patterns should be carefully assessed. Clients who are experiencing dizziness should be help to ambulate if needed. Nurse also should monitor clients for serotonin syndrome: those who may take too much medications and have impaired hepatic and renal function are at risk. S/S of this syndrome are fever, dilated pupils, hyperactive bowel sounds and diarrhea and/or presence or absence of diaphoresis.
Treatment of Serotonin Syndrome involves:
• Airway maintenance and oxygen therapy if needed • Immediate treatment with activated charcoal in case of an overdose • treatment of hypertension or hypotension • Keeping the client safe while he/she is delirious and agitated • Treatment for hyperthermia with benzodiazepines or aggressive cooling • Stop all serotonergic medications immediately • Administration of a serotonin antagonist, such as Cyproheptadine (Periactin) 1 All Sources taken from http://www.edgt.com/EDGTOnline/tutorials/PsychdrugsV2/pdrugsopenframes.cfm