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TRICYCLIC ANTIDEPRESSANTS
o ACTION AND INDICATIONS
o Increase the amount of norepinephrine, serotonin, or both through inhibition of reuptake, thus normalizing the hyposensitive receptor site associated with depression o Indicated for:
o the relief of symptoms of depression (anxiety, sleep disturbances oEnuresis in children older than 6
oObsessive-compulsive disorder (Clomipramine) oChronic intractable pain (Investigational) oTCAs are, in addition, anticholinergic
o CONTRAINDICATIONS/ CAUTIONS
TRICYCLIC ANTIDEPRESSANTS
o Allergy o Recent MI o Myelography within the previous 24 hours or in the next 48 hours; concurrent use of an MAOI o Pregnancy and lactation o Cardiovascular disorders o Narrow angle glaucoma, urinary retention, prostate hypertrophy, GI or GU surgery o Psychosis; manic depressive state o History of seizures o Hepatic or renal disease
TRICYCLIC ANTIDEPRESSANTS
o ADVERSE EFFECTS
o CNS: Sedation, sleep disturbances, fatigue, hallucinations, disorientation, visual disturbances, difficulty in concentrating, weakness, ataxia, and tremors o GI anticholinergic effects: dry mouth, constipation, anorexia, increased salivation, cramps, and diarrhea o GU effects: urinary retention and hesitancy, loss of libido, changes in sexual functioning o CV effects: orthostatic hypotension, hypertension, arrhythimias, myocardial infarction, angina, palpitations, stroke o Withdrawal syndrome: nausea, headache, malaise, vertigo, and nightmares
TRICYCLIC ANTIDEPRESSANTS
o Nursing Responsibilities o Limit drug access if patient is suicidal o Maintain initial dosage for 4-8 weeks o Give parenteral forms only if oral forms are not feasible or available o Give the major portion of the dose at bedtime if drowsiness and aticholinergic effects are severe o Reduce dosage if minor side effects occur and gradually discontinue the drug if major or potentially life-threatening effects occur o Provide comfort measures o Provide patient teaching
TRICYCLIC ANTIDEPRESSANTS
o IMPORTANT DRUGS oAmitriptyline (generic) oClomipramine (Anafranil) oDesipramine (Norpramin) oDoxepin (Sinequan) oImipramine (Tofranil) oNortriptyline (Pamelor)
o ACTION AND INDICATION oBlock the reuptake of serotonin into the presynaptic cells, thereby increasing serotonin levels at the synapse oUsed to treat generalized anxiety disorders, depression, obsessivecompulsive disorder, and bulimia nervosa.
o CONTRAINDICATIONS/ CAUTIONS
o Allergy o Impaired renal or hepatic function o Diabetes
o ADVERSE EFFECTS
o CNS effects: headache, drowsiness, dizziness, insomnia, anxiety, tremor, agitation, and seizures o GI effects: n/v, diarrhea, dry mouth, anorexia, constipation, and changes in taste o GU effects: painful menstruation, cystitis, sexual dysfunction, urgency, and impotence o Respiratory changes: cough, dyspnea, URI, pharyngitis
IMPORTANT DRUGS
o Fluoxetine (Prozac) o Sertraline (Zoloft) o Citalopram (Celexa) o Escitalopram (Lexapro) o Paroxetine Hcl (Paxil) o Fluvoxamine (Luvox)
o NURSING RESPONSIBILITIES
o Arrange for lower dosage in elderly patients and in those with renal or hepatic impairment o Monitor for up to 4 weeks to ascertain onset of full therapeutic effect o Suggest that patients use barrier contraceptives o Provide comfort measures o Provide thorough patient teaching
Other Antidepressants
o Bupropion (Wellbutrin)depression, smoking cessation o Mirtazapine (Remeron) o Nefazodone (generic) o Trazodone (Desyrel) o Venlafaxine (Effexor)