NCM 117 LEC

PSYCHIATRIC NURSING
L E C / PROF. ACUAR
______________________________________________________________________________________________________________
MIDTERMS

OUTLINE TriCyclic Antidepressants (TCA medications)

Antidepressants / Mood Elevators ● Most effective
I. Different Medications under Antidepressants ● MOA: increases serotonin and norepinephrine (epinephrine
A. SSRI may be elevated with norepinephrine)
B. TCA ● thats why its called TRI – it elevates 3 neurotransmitters
C. MAOI (serotonin, norepinephrine, and epinephrine)
● considered as stimulants so MONITOR HEART RATE
ANTIDEPRESSANTS / MOOD ELEVATORS ● may have more side effects
● Normal Mood - balance out the feelings of happiness and
sadness NOTE: uunahin iadminister ang SSRI because safety muna
● MANIA - exaggerated feeling of happiness
● MAJOR DEPRESSION - exaggerated feeling of sadness Medication takes effect after 2 to 4 weeks
→ If not corrected by normal activities, take medications
(antidepressants) PRAMINE/TRIPTYLLINE
● Bipolar Disorder – combination of both mania and major 1. Clomipramine (Anafranil) → for OCPD
depression (alternating) 2. Imipramine (Tofranil) → Bedwetting (enuresis)
3. Desipramine (Norpramine)
A. DIFFERENT MEDICATIONS UNDER 4. Amitriptyline
ANTIDEPRESSANTS 5. Nortriptyline

Selective Serotonin Reuptake Inhibitors (SSRI) MANAGEMENT:

● Not the most effective medication, but the safest type of ● Promote Insomnia or Drowsiness (more evident) → given at
medication hours of sleep
● Effect: Slowly increase serotonin → promotes episodes or ● Monitor the following:
feelings of happiness → (priority) Cardiac function - Cardiotoxic
● Lesser neurotransmitters targeted, lesser side effects → Liver Function - hepatotoxicity
→ Eye function - increases Intraocular pressure(IOP) →
S - Safest – targets only one neurotransmitter (low side effect) glaucoma (Normal IOP level: 10-21 mmHG)
S - Stimulant – promotes elevation of serotonin → Bladder function/Urinary patterns - possibly promote
Common side effect is insomnia; Suppression of urinary retention
appetite → weight loss
Medication is best administered at the morning MonoAmine Oxidase Inhibitor (MAOI)
after meal ● Amines - SNS Neurotransmitters
R - Reproductive Impairment – commonly male individuals → DECREASE
I - Impotence / Delayed Ejaculation → erection problems ▪ S - Serotonin
(erectile dysfunction); decreased libido ▪ E - Epinephrine
▪ N - Norepinephrine
● Serotonin Crisis – adverse effect of the medication ▪ D - Dopamine
→ may be due to exaggerated administration of SSRI ● Oxidase - Enzymes that destroys amines
→ may be due to SSRI was accidentally administered in ● Oxidase destroys amines → all neurotransmitters (SEND)
combination with other antidepressants (such as will elevate
mono-amine oxidase inhibitors)
→ ALWAYS MONITOR FOR HEART RATE Examples of Medications
→ worst possible effect is arrhythmia ● Parnate
▪ check for the the HR first before checking in ECG ● Marplan
● Nardil
COMMON SSRI (ends in -xetine / -xamine) ● Emsam (selegiline) – newest type of MAO
1. Luvox (Fluvoxamine)
2. Paxil (Paroxetine) ● CONTRAINDICATED TO TYRAMINE-CONTAINING
3. Prozac (Fluoxetine) → Priapism - painful contraction of the PRODUCTS
penis which leads to prolonged erection → (monitor increasing blood pressure - hypertensive crisis
4. Zoloft (Sertraline) → can lead to seizure attacks → stroke)
5. Citalopram (Celexa) / Desyrel (Trazodone) - newest SSRI → Examples of tyramine-containing product: processed,
found in the market. fermented, and overripe products (Tyramine)
6. Vestaril (Reboxetine) → MOC antihypertensive: Calcium Channel Blockers

SSRI should not be given together with other Electroconvulsive therapy

antidepressants and alcohol ● Electroconvulsive therapy/shock therapy - last resort for
treating depression
St. John’s wort - herbal remedy for depression