ANTIDEPRESSANT DRUGS EENT: nasal congestion, pharyngitis, sinusitis

GI: nausea, diarrhea, dry mouth anorexia, dyspepsia,

MEDICATION constipation, abdominal pain, vomiting, flatulence, increased
appetite
Generic Name: Fluoxetine GU: sexual dysfunction
Meta: weight loss
Brand Name: Prozac Musculo: muscle pain
Respi: upper respiratory tract infection, cough, respiratory
DRUG CLASSIFICATION distress
Skin: rash, pruritus, diaphoresis
Therapeutic Class: Antidepressant Other: flulike syndrome

Pharmacologic Class: SSRI NURSING RESPONSIBILITIES

INDICATION  Use antihistamines or topical corticosteroids to treat

 Depression, obsessive-compulsive disorder (OCD)
 Depression in elderly patients
 Maintenance therapy for depression in stabilized patients
 Depression caused by bipolar disorder
MECHANISM OF ACTION
Unknown. Thought to be linked to drug’s inhibition of CNDS
neuronal uptake of serotonin
CONTRAINDICATIONS AND CAUSES
SIDE EFFECTS/ADVERSE REACTIONS
rashes or pruritus
 Record mood changes. Watch for suicidal tendencies
 Tell patient to avoid taking drug in the afternoon
whenever possible because fluoxetine commonly
causes nervousness and insomnia
 Drug may cause dizziness or drowsiness. Warn patient
to avoid driving and other hazardous activities that
require alertness and good psychomotor coordination
until effects of drug are known

CNS: nervousness, somnolence, anxiety, insomnia, headache,  Contraindicated in patients hypersensitive to drug and in
drowsiness, fatigue, tremor, dizziness, asthenia, fever, those taking MAO inhibitors within 14 days of starting
suicidal behavior therapy
CV: palpitations, hot flashes
  Use cautiously in patients at high risk for suicide and in GI: nausea, diarrhea, constipation, dyspepsia, anorexia,
those with history of diabetes mellitus; seizures; mania; or vomiting, flatulence, dysphagia, dry mouth, taste perversion
hepatic, renal, or CV disease GU: abnormal ejaculation, urinary frequency, impotence,
anorgasmia, urine retention
MEDICATION Respi: upper respiratory tract infection, dyspnea, yawning
Skin: sweating
Generic Name: Fluvoxamine maleate Other: tooth disorder, flulike syndrome, chills, decreased
libido
Brand Name: Luvox
NURSING RESPONSIBILITIES
DRUG CLASSIFICATION
 Record mood changes. Monitor patient for suicidal
Therapeutic Class: Antidepressant tendencies
 Drug isn’t approved for depression in the U.S. Don’t use
Pharmacologic Class: SSRI for the treatment of major depressive disorders in children
younger than age 18
INDICATION
 Patient’s shouldn’t stop drug without first consulting
prescriber; abruptly stopping drug may cause withdrawal
 Obsessive compulsive disorder (OCD)
syndrome, including headache, muscle ache, and flulike
symptoms
MECHANISM OF ACTION
 Warn patient to avoid hazardous activities until CNS
Unknown. Selectively inhibits the presynaptic neuronal uptake of effects of drug are known
serotonin, which may improve OCD  Tell patient to notify prescriber about planned, suspected,
or known pregnancy
SIDE EFFECTS/ADVERSE REACTIONS  Tell patient who develops rash, hives, or a related allergic
reaction to notify prescriber
CNS: headache, asthenia, somnolence, insomnia,  Tell patient drug can be taken with or without food
nervousness, dizziness, tremor, anxiety, hypertonia, agitation,  Inform patient that several weeks of therapy may be
depression, CNS stimulation needed to obtain full therapeutic effect
CV: palpitations, vasodilation
EENT: amblyopia CONTRAINDICATIONS AND CAUSES
  Contraindicated in patients hypersensitive to drug or to Unknown. Thought to be linked to drug’s inhibition of CNS
other phenyl piperazine antidepressants, in those receiving neuronal uptake of serotonin
pimozide or thioridazine therapy, and within 2 weeks of
MAO inhibitor SIDE EFFECTS/ADVERSE REACTIONS
 Use cautiously in patients with hepatic dysfunction, other
conditions that may affect hemodynamic responses or CNS: somnolence, dizziness, insomnia, tremor, nervousness,
metabolism, or history of mania or seizures anxiety, paresthesia, confusion, headache, agitation, asthenia,
suicidal behavior
MEDICATION CV: palpitations, vasodilation, orthostatic hypotension
EENT: lump or tightness in throat
Generic Name: Paroxetine GI: dry mouth, nausea, constipation, diarrhea, flatulence,
vomiting, dyspepsia, dysgeusia, increased or decreased
Brand Name: Paxil appetite, abdominal pain
GU: ejaculatory disturbances, sexual dysfunction, urinary
DRUG CLASSIFICATION frequency, other urinary disorders
Musculo: myopathy, myalgia, myasthenia
Therapeutic Class: Antidepressant Skin: rash, pruritus, diaphoresis
Other: yawning, decreased libido
Pharmacologic Class: SSRI
NURSING RESPONSIBILITIES
INDICATION
 Patients taking drug may be at increased risk for
 Depression developing suicidal behavior, but this hasn’t been
 Obsessive-compulsive disorder (OCD) definitively attributed to use of the drug
 Panic disorder  if signs and symptoms of psychosis occur or increase,
 Social anxiety disorder expect prescriber to reduce dosage. Record mood
 Generalized anxiety disorder changes. Monitor patient for suicidal tendencies, and
 Posttraumatic stress disorder allow only a minimum supply of drug
 Tell patient that drug may be taken with or without food,
MECHANISM OF ACTION usually in morning
  Tell patient not to break, crush, or chew controlled-release MEDICATION
tablets
 Warn patient to avoid activities that require alertness and Generic Name: Sertralin
good coordination until effects of drug are known
 Instruct patient not to stop taking medication abruptly Brand Name: Zoloft

CONTRAINDICATIONS AND CAUSES DRUG CLASSIFICATION

 Contraindicated in patients hypersensitive to drug, within 14 Therapeutic Class: Antidepressant

days of MAO inhibitor therapy, and in those thioridazine
Pharmacologic Class: SSRI
 Contraindicated in children and adolescents under age 18
with major depressive disorder
INDICATION
 Use cautiously in patients with history of seizure disorders or
mania and in those with other severe, systemic illness  Depression
 If signs or symptoms of psychosis occur or increase, expect  Obsessive-compulsive disorder
prescriber to reduce dosage. Record mood changes. Monitor  Panic disorder
patient for suicidal tendencies, and allow only a minimum  Posttraumatic stress disorder
supply of drug  Social anxiety disorder
 Monitor patient for complaints of sexual dysfunction. In men,
they include anorgasmy, erectile difficulties, delayed MECHANISM OF ACTION
ejaculation or orgasm, or impotence; in women, they include
anorgasmy or difficulty with orgasm Unknown. Thought to be linked to drug’s inhibition of CNS
 Don’t stop drug abruptly. Withdrawal or discontinuation neuronal uptake of serotonin
syndrome may occur if drug is stopped abruptly. Symptoms
include headache, myalgia, lethargy, and general flulike SIDE EFFECTS/ADVERSE REACTIONS
symptoms. Taper drug slowly over 1 to 2 weeks
 Tell patient that drug may be taken with or without food, CNS: headache, suicidal behavior, tremor, dizziness,
usually in morning insomnia, somnolence, paresthesia, hypesthesia, fatigue,
 Warn patient to avoid activities that require alertness and nervousness, anxiety agitation, hypertonia, twitching,
good coordination until effects of drug are known confusion
CV: palpitations, chest pain, hot flashes
 GI: dry mouth, nausea, diarrhea, loose stools, dyspepsia,  Use in third trimester of pregnancy may cause neonatal
vomiting, constipation, thirst, flatulence, anorexia, abdominal complications at birth. Consider the risk versus benefit of
pain, increased appetite treatment during this time
GU: male sexual dysfunction
Musculo: myalgia MEDICATION
Skin: rash, pruritus, diaphoresis
Generic Name: Citaprolam
NURSING RESPONSIBILITIES
Brand Name: Celexa
 Give sertraline once daily, either in morning or evening, with
or without food DRUG CLASSIFICATION
 Make dosage adjustments at intervals of no less than 1 week
 Record mood changes. Monitor patient for suicidal tendencies Therapeutic Class: Antidepressant
and allow only a minimum supply of drug
Pharmacologic Class: SSRI
 Don’t use the oral concentrate dropper, which is made of
rubber, in a patient with latex allergy
INDICATION
 Advise patient to use caution when performing hazardous
tasks that require alertness  Depression
 Instruct patient to avoid stopping the medication abruptly
MECHANISM OF ACTION
CONTRAINDICATIONS AND CAUSES
A selective serotonin reuptake inhibitor whose action is
 Contraindicated in patient with a hypersensitivity to drug or presumed to be linked to potentiation of serotogenic activity
its components in the CNS resulting from inhibition of neuronal reuptake of
 Contraindicated in patients taking pimozide or MAO serotonin
inhibitors or within 14 days of MAO inhibitor therapy
 Use cautiously in patients at risk for suicide and in those with SIDE EFFECTS/ADVERSE REACTIONS
seizure disorders, major affective disorder, or diseases or
conditions that affect metabolism or hemodynamic responses CNS: tremor, somnolence, insomnia, anxiety, agitation,
dizziness, paresthesia, migraine, impaired concentration,
amnesia, depression, apathy, suicide attempt, confusion,
 fatigue, fever
CV: tachycardia, orthostatic hypotension, hypotension
EENT: rhinitis, sinusitis, abnormal accommodation
GI: dry mouth, nausea, diarrhea, anorexia, dyspepsia,
vomiting, abdominal pain, taste perversion, increased saliva,
flatulence, increased appetite
GU: dysmenorrhea, amenorrhea, ejaculation disorder,
impotence, anorgasmia, polyuria
Meta: decreased or increased weight
Musculo: arthralgia, myalgia
Respi: upper respiratory tract infection, coughing
Skin: rash, pruritus, increased sweating
Other: yawning, decreased libido
NURSING RESPONSIBILITIES
 Although drug hasn’t been shown to impair psychomotor
performance, any psychoactive drug has the potential to
impair judgment, thinking, or motor skills
 The possibility of a suicide attempt is inherent in
depression and may persist until significant remission
occurs. Closely supervise high-risk patients at start of
drug therapy. Reduce risk of overdose by limiting amount
of drug available per refill
 At least 14 days should elapse between MAO inhibitor
therapy and citalopram
 Tell patient that drug may be taken in the morning or
evening without regard to meals. If drowsiness occurs, he
should take drug in evening
 Advise patient not to stop medication abruptly
 Instruct patient to exercise caution when driving or
operating hazardous machinery; drug may impair
judgment, thinking, and motor skills
CONTRAINDICATIONS AND CAUSES
 Contraindicated in patients hypersensitive to drug or
its inactive components, within 14 days of MAO
inhibitor therapy, and in patients taking pimozide
 Use cautiously in patients with history of mania,
seizures, suicidal thoughts, or hepatic or renal
impairment
 Safety and effectiveness of drug haven’t been
established in children
MEDICATION
Generic Name: Escitalopram
Brand Name: Lexapro
DRUG CLASSIFICATION
Therapeutic Class: Antidepressant
Pharmacologic Class: SSRI
INDICATION
 Treatment and maintenance therapy for patients
with major depressive disorder
MECHANISM OF ACTION
Antidepressant action thought to be linked to potentiation of
serotogenic activity in the CNS resulting from inhibition of neuronal
reuptake of serotonin. Drug is the S-enantiomer of the racemic
compound citalopram and is thought to be the active component
SIDE EFFECTS/ADVERSE REACTIONS
CNS: fever, insomnia, dizziness, somnolence, paresthesia, light-
headedness, migraine, tremor, vertigo, abnormal dreams, irritability,
impaired concentration, fatigue, lethargy, suicidal behavior
CV: palpitations, hypertension, flushing, chest pain
EENT: rhinitis, sinusitis, blurred vision, tinnitus, earache
GI: nausea, diarrhea, constipation, indigestion, abdominal pain,
vomiting, increased or decreased appetite, dry mouth, flatulence,
heartburn, cramps, gastroesophageal reflux
GU: ejaculation disorder, impotence, anorgasmia, menstrual cramps,
UTI, urinary frequency
Meta: weight gain or loss
Musculo: arthralgia, myalgia, muscle cramps, pain in arms or legs
Respi: bronchitis, cough
Skin: rash, increased sweating
Other: decreased libido, yawning, flulike symptoms
NURSING RESPONSIBILITIES
 Closely monitor patients at high risk of suicide
 Evaluate patient for history of drug abuse and observe for
sign of misuse or abuse
 Periodically reassess patient to determine need for
maintenance treatment and appropriate dosing
 Inform patient that symptoms should improve gradually
over several weeks, rather than immediately
 Tell patient that although improvement may occur within
1-4 weeks, he should continue drug as prescribed
 Advise patient to consult health care provider before
taking other prescription or OTC drugs
 Tell patient that drug may be taken in the morning or
evening without regard to meals
 Encourage patient to avoid alcohol while taking drug
 Tell patient to notify health care provider if she’s pregnant
or breast-feeding
CONTRAINDICATIONS AND CAUSES
 Contraindicated in patients taking MAO inhibitors or
within 14 days of MAO inhibitor therapy and in those
hypersensitive to escitalopram, citalopram, or any of its
inactive ingredients
 Use cautiously in patients with a history of mania, seizure
disorders, suicidal thoughts, or renal or hepatic
impairment
 Use cautiously in patients with diseases that produce
altered metabolism or hemodynamic responses
 Use with caution in elderly patients because they may
have a greater sensitivity to drug
 Drug appears in breastmilk. Patient should either stop
breastfeeding or stop taking drug
CYCLIC COMPOUNDS hypertension, MI, arrhythmias, heart block, precipitation of
heart failure
MEDICATION EENT: blurred vision, tinnitus, mydriasis
GI: dry mouth, constipation, nausea, vomiting, anorexia,
Generic Name: Imipramine paralytic ileus, abdominal cramps
GU: urine retention
Brand Name: Tofranil Meta: hypoglycemia, hyperglycemia
Skin: rash, urticaria, photosensitivity reactions, pruritus,
DRUG CLASSIFICATION diaphoresis
Other: hypersensitivity reactions
Therapeutic Class: Antidepressant
NURSING RESPONSIBILITIES
Pharmacologic Class: Trcicylic antidepressant
 Monitor patient for nausea, headache, and malaise after
INDICATION abrupt withdrawal of long-term therapy; these symptoms
don’t indicate addiction
 Depression
 Don’t withdraw drug abruptly
 Childhood enuresis
 Because of hypertensive episodes during surgery in
MECHANISM OF ACTION patients receiving tricyclic antidepressants, stop drug
gradually several days before surgery
Unknown, a tricyclic antidepressant that increases norepinephrine,  If signs and symptoms f psychosis occur or increase,
serotonin, or both in the CNS by blocking their reuptake by the expect prescriber to reduce dosage. Record mood
presynaptic neurons changes. Monitor patient for suicidal tendencies, and
allow only a minimum supply of drug
SIDE EFFECTS/ADVERSE REACTIONS  To prevent relapse in children receiving drug for enuresis,
withdraw drug gradually
CNS: CVA, drowsiness, dizziness, excitation, tremor,  Tell patient to take full dose at bedtime whenever
confusion, hallucinations, anxiety, ataxia, paresthesia, possible, but earn him of possible morning dizziness upon
nervousness, EEG changes, seizures, extrapyramidal standing up quickly
reactions  Tell patient to avoid alcohol while taking this drug
CV: orthostatic hypotension, tachycardia, ECG changes,
  Warn patient to avoid hazardous activities that require
alertness and good coordination until effects of the drug are
known. Drowsiness and dizziness usually subside after a few
weeks
 Warn patient not to stop drug suddenly
CONTRAINDICATIONS AND CAUSES
 Contraindicated in patients hypersensitive to drug and in
those receiving MAO inhibitors; also contraindicated during
acute recovery phase of MI
 Use with extreme caution in patients at risk for suicide; in
patients with history of urine retention, angle-closure
glaucoma, or seizure disorders; in patients with increased
intraocular pressure, CV disease, impaired hepatic function,
hyperthyroidism, or impaired renal function; and in patients
receiving thyroid drugs. Injectable form contains sulfites,
which may cause allergic reactions in hypersensitive patients
MEDICATION
Generic Name: Desipramine
Brand Name: Norpramin
DRUG CLASSIFICATION
Therapeutic Class: Antidepressant
Pharmacologic Class: Tricyclic antidepressant
INDICATION
 Depression
MECHANISM OF ACTION
Unknown. A tricyclic antidepressant that increases amount of
norepinephrine, serotonin or both in the CNS by blocking
their uptake by the presynaptic neurons
SIDE EFFECTS/ADVERSE REACTIONS
CNS: drowsiness, dizziness, excitation, tremor, weakness,
confusion, anxiety, restlessness, agitation, headache,
nervousness, EEG changes, seizures, extrapyramidal
reactions
CV: orthostatic hypotension, tachycardia, ECG changes,
hypertension
EENT: blurred vision, tinnitus, mydriasis
GI: dry mouth, constipation, nausea, vomiting, anorexia,
paralytic ileus
GU: urine retention
Meta: hypoglycemia, hyperglycemia
Skin: rash, urticaria, photosensitivity reactions, diaphoresis
Other: hypersensitivity reactions, sudden death in children
NURSING RESPONSIBILITIES
 Monitor patient for nausea, headache, and malaise after
abrupt withdrawal of long-term therapy; these symptoms
don’t indicate addiction
  Don’t withdraw drug abruptly
 If signs and symptoms of psychosis occur or increase,
expect prescriber to reduce dosage. Record mood
changes. Monitor patient for suicidal tendencies, and
allow only a minimum supply of drug
 Advise patient to take full dose at bedtime, whenever
possible
 Warn patient to avoid hazardous activities that require
alertness and good coordination until effects of drug are
known. Drowsiness and dizziness usually subside after a
few weeks
 Tell patient to call prescriber if ever sore throat occurs.
Blood counts may need to be avoided
 Tell patient to avoid alcohol during drug therapy because
it may antagonize effects of desipramine
 Warn patient to not stop drug abruptly
CONTRAINDICATIONS AND CAUSES
 Contraindicated in patients hypersensitive to drug, in
those who have taken MAO inhibitors within 14 days
 Contraindicated in patients during acute recovery phase
after MI
 Use with extreme caution in patients with CV disease; on
those with history of urine retention, glaucoma, seizure
disorders, or thyroid disease; and in those taking thyroid
drug
 Avoid use in children
MEDICATION
Generic Name: Amitriptyline
Brand Name: Elavil
DRUG CLASSIFICATION
Therapeutic Class: Antidepressant
Pharmacologic Class: Tricyclic antidepressant
INDICATION
 Depression (outpatients)
 Depression (hospitalized patients)
 Postherpetic neuralgia
 Prevention of chronic headache
 Prevention of chronic headache
 Prevention of migraine
 Fibromyalgia
MECHANISM OF ACTION
Unknown. A tricyclic antidepressant that increases the
amount of norepinephrine, serotonin, or both in the CNS by
blocking their reuptake by the presynaptic neurons
SIDE EFFECTS/ADVERSE REACTIONS
CNS: stroke, seizures, coma, ataxia, tremor, peripheral
neuropathy, anxiety, insomnia, restlessness, drowsiness,
dizziness, weakness, fatigue, headache, extrapyramidal
reactions, hallucinations, delusions, disorientation
 CV: orthostatic hypotension, tachycardia, heart block,
arrhythmias, MI, ECG changes, hypertension, edema
EENT: blurred vision, tinnitus, mydriasis, increased
intraocular pressure
GI: dry mouth, nausea, vomiting, anorexia, epigastric pain,
diarrhea, constipation, paralytic ileus
GU: urine retention, altered libido, impotence
Hema: agranulocytosis, thrombocytopenia, leukopenia,
eosinophilia
Meta: hypoglycemia, hyperglycemia
Skin: rash, urticaria, photosensitivity reactions, diaphoresis
Other: hypersensitivity reactions
NURSING RESPONSIBILITIES
 Drug may increase the risk of suicidal thoughts and
behavior in children, adolescents, and young adults with
major depressive disorder. Don’t use in children younger
than age 12
 If signs and symptoms of psychosis occur or increase,
expect prescriber to reduce dosage. Record mood
changes. Monitor patient for suicidal tendencies and allow
only minimum supply of drug
 Watch for nausea, headache, and malaise after abrupt
withdrawal of long-term therapy; these symptoms don’t
indicate addiction
 Advise families and caregivers to closely observe patient
for increased suicidal thinking and behavior
 Warn patient to avoid activities that require alertness and
good psychomotor coordination until CNS effects of drug
re known. Drowsiness and dizziness usually subside after
a few weeks
 Inform patient that dry mouth may be relieved with
sugarless hard candy or gum. Saliva substitutes may be
useful
CONTRAINDICATIONS AND CAUSES
 Contraindicated in patients hypersensitive to drug and in
those who have received a MAO inhibitor within the past
14 days
 Contraindicated during acute recovery phase of MI
 Use cautiously in patients with history of seizures, urine
retention, angle-closure glaucoma, or increased
intraocular pressure; diabetes, or impaired liver function;
and in those receiving thyroid drugs
 Use cautiously in elderly patients and in patients with
suicidal ideation
MEDICATION
Generic Name: Nortriptyline
Brand Name: Pamelor
DRUG CLASSIFICATION
Therapeutic Class: Antidepressant
Pharmacologic Class: Tricyclic antidepressant
 INDICATION  Monitor patient for nausea, headache, and malaise after
abrupt withdrawal of long-term therapy; these symptoms
 Depression don’t indicate addiction
 Postherpetic neuralgia  If signs and symptoms of psychosis occur or increase,
expect to reduce dosage. Record mood changes. Monitor
MECHANISM OF ACTION patient for suicidal tendencies and allow him only a
minimum supply of drug
Unknown. Increases the amount of norepinephrine, serotonin, or both  Drug may increase the risk of suicidal thinking and
in the CNS by blocking reuptake by the presynaptic neurons behavior in children, adolescents, and young adults with
major depressive disorder or other psychiatric disorder
SIDE EFFECTS/ADVERSE REACTIONS
 advise
CNS: drowsiness, dizziness, seizures, stroke, tremor, weakness,
CONTRAINDICATIONS AND CAUSES
confusion, headache, nervousness, EEG changes, extrapyramidal
syndrome, insomnia, nightmares, hallucinations, paresthesia, ataxia,
 Contraindicated in patients hypersensitive to drug and
agitation
during acute recovery phase of MI; also contraindicated
CV: tachycardia, heart block, MI, ECG changes, hypotension,
within 14 days of MAO inhibitor
EENT: blurred vision, tinnitus, mydriasis,
 Use with extreme caution in patients with glaucoma,
GI: constipation, dry mouth, nausea, vomiting, anorexia, paralytic
suicidal tendency, history of urine retention or seizures,
ileus
CV disease, or hyperthyroidism and in those receiving
GU: urine retention
thyroid drugs
Hema: agranulocytosis, thrombocytopenia, bone marrow
depression, eosinophilia
MEDICATION
Meta: hypoglycemia, hyperglycemia,
Skin: rash, urticaria, photosensitivity reactions, diaphoresis
Generic Name: Doxepin
Other: hypersensitivity reactions
Brand Name: Silenor
NURSING RESPONSIBILITIES
DRUG CLASSIFICATION

Therapeutic Class: Antidepressant

 Pharmacologic Class: Tricyclic antidepressant  If signs and symptoms of psychosis occur or increase,
expect prescriber to reduce dosage. Record mood
INDICATION changes. Monitor patient for suicidal tendencies and
allow a minimum supply of drug
 Depression; anxiety  Drug may increase risk of suicidal thoughts and
behavior in children, adolescents, and young adults
MECHANISM OF ACTION ages 18-2, especially during the first few months of
treatment, especially in those with major depressive
Unknown. Increases amount of norepinephrine, serotonin, or both in disorder
the CNS by blocking their reuptake by the presynaptic neurons  Recommend use of sugarless hard candy or gum to
relieve dry mouth
SIDE EFFECTS/ADVERSE REACTIONS
CONTRAINDICATIONS AND CAUSES
CNS: drowsiness, dizziness, seizures, confusion, numbness,
hallucinations, paresthesia, ataxia, weakness, headache,
 Contraindicated in patients hypersensitive to drug and
extrapyramidal reactions
in those with glaucoma or tendency toward urine
CV: orthostatic hypotension, tachycardia, ECG changes
retention; also contraindicated in those who have
EENT: blurred vision, tinnitus
received a MAO inhibitor within past 14 days and
GI: dry mouth, constipation, nausea, vomiting, anorexia
during acute recovery phase of an MI
GU: urine retention
 Doxepin isn’t approved for use in children younger
Meta: hypoglycemia, hyperglycemia
than age 12
Skin: diaphoresis, rash, urticaria, photosensitivity reactions
Other: hypersensitivity reactions
MEDICATION
NURSING RESPONSIBILITIES
Generic Name: Trimipramine
 Don’t withdraw drug abruptly Brand Name: Surmontil
 Monitor patient for nausea, headache, and malaise after
abrupt withdrawal of long-term therapy; these symptoms DRUG CLASSIFICATION
don’t indicate addiction
Therapeutic Class: Antidepressant
 Pharmacologic Class: Tricyclic antidepressants
INDICATION
 Treatment of depression, often in conjunction with
psychotherapy
MECHANISM OF ACTION
Potentiates the effect of serotonin and norepinephrine in the CNS.
Has significant anticholinergic properties, including sedation.
Therapeutic Effects: Antidepressant action
SIDE EFFECTS/ADVERSE REACTIONS
CNS: lethargy, sedation.
EENT: blurred vision, dry eyes, dry mouth.
CV: arrhythmias, hypotension, ECG changes.
GI: constipation, hepatitis, paralytic ileus, increased appetite, weight
gain.
GU: urinary retention, ↓ libido.
Meta: changes in blood glucose, gynecomastia.
Hema: blood dyscrasias.
Skin: photosensitivity
NURSING RESPONSIBILITIES
 Monitor BP and pulse before and during initial therapy.
Notify health care professional of decreases in BP (10–20
mmHg) or sudden increase in pulse rate. Patients taking high
doses or with a history of cardiovascular disease should have
ECG monitored before and periodically during therapy.
 Geriatric patients started on trimipramine may be at an
increased risk for falls; start with low dose and monitor
closely.
 Monitor mental status and affect. Assess for suicidal
tendencies, especially during early therapy. Restrict
amount of drug available to patient. Risk may be
increased in children, adolescents, and adults ≤24 yrs.
After starting therapy, children, adolescents, and young
adults should be seen by health care professional at least
weekly for 4 wks, every 3 wks for next 4 wks, and on
advice of health care professional thereafter. Assess for
bipolar disorder; onset may mimic depression and
trimipramine is not approved for treatment of bipolar
disorder.
 Assess for serotonin syndrome (mental changes [agitation,
hallucinations, coma], autonomic instability [tachycardia,
labile BP, hyperthermia], neuromuscular aberrations
[hyperreflexia, incoordination], and/or GI symptoms
[nausea, vomiting, diarrhea]), especially in patients taking
other serotonergic drugs (SSRIs, SNRIs, triptans).
CONTRAINDICATIONS AND CAUSES
 Tricyclic antidepressants; Recovery phase following MI;
Concurrent use of MAO inhibitors or MAO-like drugs
(linezolid or methylene blue); Angle-closure glaucoma.
 Instruct patient to take medication as directed. Take
missed doses as soon as possible unless almost time for
next dose. Advise patient that drug effects may not be
 noticed for at least 2 wk. Do not discontinue without mouth, and an increase in fluid intake or bulk may prevent
consulting health care professional. Abrupt constipation.
discontinuation may cause nausea, vomiting, diarrhea,  Therapy for depression is usually prolonged and should
headache, trouble sleeping with vivid dreams, and be continued for at least 3 mo to prevent relapse.
irritability. Instruct patient to read medication guide, Emphasize the importance of follow-up exams to monitor
Antidepressant Medicines, Depression and other Serious effectiveness and side effects
Mental Illness, and Suicidal Thoughts or Actions prior to
starting therapy and with each Rx refill. MEDICATION
 May cause drowsiness and blurred vision. Caution patient
to avoid driving and other activities requiring alertness Generic Name: Mirtazapine
until response to drug is known.
 Orthostatic hypotension, and sedation are common during Brand Name: Remeron
early therapy, especially in geriatric patients. Protect
patient from falls and advise patient to make position DRUG CLASSIFICATION
changes slowly.
Therapeutic Class: Antidepressant
 Advise patient to avoid alcohol or other CNS depressant
drugs during and for 3–7 days after therapy has been
Pharmacologic Class: Tetracyclic antidepressant
discontinued.
 Advise patient, family, and caregivers to look for INDICATION
suicidality, especially during early therapy or dose
changes. Notify health care professional immediately if  Depression
thoughts about suicide or dying, attempts to commit
suicide, new or worse depression or anxiety, agitation or MECHANISM OF ACTION
restlessness, panic attacks, insomnia, new or worse
irritability, aggressiveness, acting on dangerous impulses, Thought to enhance central noradrenergic and serotonergic
mania, or other changes in mood or behavior or if activity
symptoms of serotonin syndrome occur.
 Instruct patient to notify health care professional if SIDE EFFECTS/ADVERSE REACTIONS
urinary retention occurs or if dry mouth or constipation
persists. Sugarless candy or gum may diminish dry CNS: somnolence, suicidal behavior, dizziness, asthenia,
abnormal dreams, abnormal thinking, tremors, confusion
 CV: edema, peripheral edema  Use cautiously in patients with condition that
GI: increased appetite, dry mouth, constipation, nausea predispose them to hypotension, such as dehydration,
GU: urinary frequency hypovolemia, or antihypertensive therapy
Meta: weight gain  Give drug cautiously to elderly patients; decreased
Musculo: back pain, myalgia clearance has occurred in this age group
Respi: dyspnea
Other: flulike syndrome MEDICATION

NURSING RESPONSIBILITIES Generic Name: Amoxapine

 Record mood changes. Watch for suicidal tendencies Brand Name: Asendin
 Drug may increase risk of suicidal thinking and behavior
in children, adolescents, and young adults ages 18 to 24 DRUG CLASSIFICATION
with major depressive or other psychiatric disorder
 Advise families and caregivers to closely observe patient Therapeutic Class: Antidepressant
for increasing suicidal thinking and behavior
 Instruct patient to take drug at bedtime. Caution patient Pharmacologic Class:
not to perform hazardous activities if he gets too sleepy
INDICATION
 Instruct patient not to use alcohol or other CNS
depressants while taking drug
 Treatment of various types of depression.
 Stress importance of following prescriber’s orders  Unlabeled Uses: Anxiety, insomnia, neuropathic
and chronic pain syndromes
CONTRAINDICATIONS AND CAUSES
MECHANISM OF ACTION
 Contraindicated in patients hypersensitive to drug and within
14 days of MAO inhibitor therapy Potentiates the effects of serotonin and norepinephrine in the
 Mirtazapine isn’t approved for use in children CNS. Has significant anticholinergic properties. Also has
 Use cautiously in patients with CV or cerebrovascular antianxiety effect related to sedative properties. Therapeutic
disease, seizure disorders, suicidal thoughts, hepatic or renal Effects: Antidepressant and antianxiety action
impairment, or history of mania or hypomania
SIDE EFFECTS/ADVERSE REACTIONS
 CNS: neuroleptic malignant syndrome, fatigue, sedation,
extrapyramidal reactions, tardive dyskinesia.
CV: arrhythmias, hypotension, ECG changes.
EENT: blurred vision, dry eyes, dry mouth.
GI: constipation, increased appetite, weight gain, paralytic
ileus.
GU: testicular swelling, urinary retention
Hema: blood dyscrasias
Skin: photosensitivity, rash. Endo: gynecomastia, sexual
dysfunction
Other: fever
NURSING RESPONSIBILITIES
 Monitor mental status (orientation, mood, behavior)
frequently. Assess for suicidal tendencies, especially
during early therapy. Restrict amount of drug available to
patient.
 Monitor BP and pulse before and during initial therapy.
Notify physician or other health care professional of
decreases in BP (10–20 mmHg) or sudden increase in
pulse rate. Patients taking high doses or with a history of
cardiovascular disease should have ECG monitored
before and periodically during therapy.
 Observe for onset of extrapyramidal side effects (akathisia
—restlessness; dystonia—muscle spasms and twisting
motions; pseudoparkinsonism—mask facies, rigidity,
tremors, drooling, shuffling gait, dysphagia, pill-rolling
motions of hands). Dose reduction or discontinuation may
be necessary. Trihexyphenidyl or diphenhydramine may
be used to control these symptoms.
 Monitor for tardive dyskinesia (lip smacking or
puckering, puffing of cheeks, rhythmic chewing or worm-
like movement of tongue and mouth, uncontrolled
movements of extremities). Notify health care
professional immediately if these symptoms occur; they
may be irreversible.
 Monitor for development of neuroleptic malignant
syndrome (fever, respiratory distress, tachycardia,
convulsions, diaphoresis, hypertension or hypotension,
pallor, tiredness, severe muscle stiffness, loss of bladder
control). Notify health care professional immediately if
these symptoms occur
 Instruct patient to take medication as directed. Abrupt
discontinuation may cause nausea, headache, and malaise.
 Inform patient of the possibility of extrapyramidal
symptoms and tardive dyskinesia. Instruct patient to
report these symptoms immediately.
 May cause drowsiness and blurred vision. Caution patient
to avoid driving and other activities requiring alertness
until response to drug is known.
 Orthostatic hypotension, sedation, and confusion are
common during early therapy, especially in geriatric
patients. Protect patient from falls and advise patient to
make position changes slowly.
 Refer patient to nutritional or weight management
program as appropriate.
 Advise patient to avoid alcohol or other CNS depressant
drugs during and for 3–7 days after therapy.
 Therapy for depression is usually prolonged. Emphasize
the importance of follow-up exams to monitor
 effectiveness and side effects and to improve coping
skills.
 Treatment is not a cure since symptoms can recur after
discontinuation of medication.
 Caution parents/guardians of teenagers or children taking
this medication about possible increase in suicide risk.
Teach parents how to assess for suicidal thoughts and to
report concerns immediately.
CONTRAINDICATIONS AND CAUSES
 Contraindicated in: Angle-closure glaucoma; Recent MI;
Prolongation of QTc interval; Cardiac arrhythmia; Heart
failure.
 Use Cautiously in: Pre-existing cardiovascular disease;
Prostatic hyperplasia (increased susceptibility to urinary
retention); History of seizures (threshold may be
lowered); May ↑ risk of suicide attempt/ideation
especially during dose early treatment or dose adjustment;
OB: Use only if clearly needed and maternal benefits
outweigh risk to fetus; Lactation: May result in sedation
in infant; discontinue drug or bottle feed; Pedi: Suicide
risk, especially at initiation of therapy, may be greater in
children and adolescents; Geri: May be more susceptible
to adverse effects; dosage reduction required.
MEDICATION
Generic Name: Clomipramine
Brand Name: Anafranil
DRUG CLASSIFICATION
Therapeutic Class: Antidepressant
Pharmacologic Class: Tricyclic antidepressant
INDICATION
 Obsessive-compulsive disorder
 To manage panic disorder with or without
agoraphobia
 Depression; chronic pain
MECHANISM OF ACTION
Unknown. A tricyclic antidepressant that inhibits reuptake of
serotonin and norepinephrine at the presynaptic neuron
SIDE EFFECTS/ADVERSE REACTIONS
CNS: somnolence, tremor, dizziness, headache, insomnia,
nervousness, myoclonus, fatigue, ECG changes, seizures
CV: orthostatic hypotension, palpitations, tachycardia
EENT: pharyngitis, rhinitis, visual changes
GI: dry mouth, constipation, nausea, dyspepsia, increased
appetite, diarrhea, anorexia, abdominal pain
GU: urinary hesitancy, UTI, dysmenorrhea, ejaculation
failure, impotence
Hema: purpura
Meta: weight gain
Musculo: myalgia
 Skin: diaphoresis, rash, pruritus, dry skin
Other: altered libido
NURSING RESPONSIBILITIES
 Monitor mood and watch for suicidal tendencies. Allow
patient to have only minimal amount of drug
 Don’t withdraw drug abruptly
 Relieve dry mouth with sugarless or gum. Saliva substitutes
may be needed
 Warn patient to avoid hazardous activities requiring alertness
and good coordination, especially during adjustment.
Daytime sedation and dizziness may occur
 Tell patient to avoid alcohol during drug therapy
 Warn patient not to stop drug suddenly
CONTRAINDICATIONS AND CAUSES
 Contraindicated in patients hypersensitive to drug or other
tricyclic antidepressants, in those who have taken MAO
inhibitors within previous 14 days, and in patients in acute
recovery period after MI
 Use cautiously in patients with history of seizure disorders or
with brain damage of varying cause; in patients receiving
other seizure threshold-lowering drugs; in patients at risk for
suicide; and in those undergoing elective surgery
OTHER COMPOUNDS
MEDICATION
Generic Name: Buproprion
Brand Name: Aplenzin
DRUG CLASSIFICATION
Therapeutic Class: Antidepressant
Pharmacologic Class: Aminoketone
INDICATION
 Major depressive disorder (Aplenzin only)
 Seasonal affective disorder (Wellbutrin XL only)
 Depression
MECHANISM OF ACTION
Unknown. Drug doesn’t inhibit MAO, but it weakly inhibits
norepinephrine, dopamine, and serotonin reuptake.
Noradrenergic or dopaminergic mechanisms, or both, may
cause drug’s effect
SIDE EFFECTS/ADVERSE REACTIONS
CNS: abnormal dreams, insomnia, headache, sedation,
tremor, agitation, dizziness, seizures, suicidal behavior,
anxiety, confusion, delusions, euphoria, fever, hostility,
impaired concentration, impaired sleep quality, akinesia,
akathisia, fatigue, syncope, somnolence
CV: tachycardia, arrhythmias, hypertension, hypotension,
palpitations, chest pain
 EENT: blurred vision, rhinitis auditory disturbances,
epistaxis, pharyngitis, sinusitis, dry mouth
GI: constipation, nausea, vomiting, anorexia, taste
disturbance, dyspepsia, diarrhea, abdominal pain
GU: impotence, menstrual complaints, urinary frequency,
urine retention
Meta: increased appetite, weight loss, weight gain
Musculo: arthritis, myalgia
Respi: upper respiratory complaints, increase in coughing
Skin: excessive sweating, pruritus, rash, cutaneous
temperature disturbance, urticaria
Other: chills, decreased libido, accidental injury, hot flashes
NURSING RESPONSIBILITIES
 Many patients experience a period of increased
restlessness, including agitation, insomnia, and anxiety,
especially at start of therapy
 To minimize the risk of seizures, don’t exceed maximum
recommend dose
 Patient with major depressive disorder may experience
worsening depression or suicidal thoughts. Carefully
monitor patient for worsening of depression or suicidal
thoughts, especially at the beginning of therapy and
during dosage changes
 Drug may increase the risk of suicidal thinking and
behavior in children, adolescents, and young adults with
major depressive disorder
 Drug may cause hostility, agitation, and depressed mood
 Closely monitor patient with history of bipolar disorder.
Antidepressants can cause manic episodes during the
depressed phase of bipolar disorder. This may be less
likely to occur with bupropion than with other
antidepressants
 Advise families and caregivers to closely observe patient
for increased suicidal thinking and behavior and hostility,
agitation, and depressed mood
 Tell patient not to chew, crush, or divide tablets
 Tell patient that it may take 4 weeks to reach full
antidepressant effect
 Advise patient to report mood swings or suicidal thoughts
immediately
CONTRAINDICATIONS AND CAUSES
 Contraindicated in patients hypersensitive to drug, in
those who have taken MAO inhibitors within previous 14
days, and in those with seizure disorders or history of
bulimia or anorexia nervosa because of a higher risk of
seizures
 Contraindicated in patients abruptly stopping use of
alcohol or sedatives
 Bupropion isn’t approved for use in children
 Use cautiously in patients with recent history of MI,
unstable heart diseases, renal or hepatic impairment, a
history of seizures, head trauma, or other predisposition to
seizures, and in those treated with drugs lower seizure
threshold
MEDICATION
Generic Name: Venlafaxine
 Brand Name: Effexor Skin: diaphoresis, rash
Other: yawning, chills, infection
DRUG CLASSIFICATION
NURSING RESPONSIBILITIES
Therapeutic Class: Antidepressant
 Closely monitor patients being treated for depression for
Pharmacologic Class: SSNRI signs and symptoms of clinical worsening and suicidal
ideation, especially at the beginning of therapy and with
INDICATION dosage adjustments. Symptoms may include agitation,
insomnia, anxiety, aggressiveness, or panic disorders
 Depression  Drug may increase the risk of suicidal thinking and
 Generalized anxiety disorder behavior in children, adolescent, and young adults ages
 Panic disorder 18-24, especially during the first few months of treatment,
 Social anxiety disorder especially those with major depressive disorder or other
psychiatric disorder
MECHANISM OF ACTION
 Monitor patients weight, particularly underweight
depressed patients
May increase the amount of norepinephrine, serotonin, or both in the
CNS by blocking their reuptake by the presynaptic neurons  Warn family members to closely monitor patient for signs
of worsening condition or suicidal ideation
SIDE EFFECTS/ADVERSE REACTIONS  Tell patient to take each dose with food and a full glass of
water
CNS: asthenia, headache, somnolence, dizziness,
nervousness, insomnia, suicidal behavior, anxiety, tremor, CONTRAINDICATIONS AND CAUSES
abnormal dreams, paresthesia, agitation
CV: hypertension, tachycardia, vasodilation  Contraindicated in patients hypersensitive to drug
EENT: blurred vision or within 14 days of MAO inhibitor therapy
GI: nausea, constipation, dry mouth, anorexia, vomiting,  Use cautiously in patients with renal impairment,
diarrhea, dyspepsia, flatulence diseases or conditions that could affect
GU: abnormal ejaculation, impotence, urinary frequency, hemodynamic responses or metabolism, and in
impaired urination those with history of mania or seizures
Meta: weight loss, hyponatremia
 MEDICATION Skin: hyperhidrosis. rash
Other: sexual dysfunction, yawning
Generic Name: Desvenlafaxine
NURSING RESPONSIBILITIES
Brand Name: Pristiq
 Closely monitor patient being treated for
DRUG CLASSIFICATION depression for signs and symptoms of clinical
worsening and suicidal ideation, especially at the
Therapeutic Class: Antidepressant beginning of therapy and with dosage adjustments.
Symptoms may include agitation, insomnia,
Pharmacologic Class: SNRI anxiety, aggressiveness, or panic attacks
 Record mood changes. Monitor patient for suicidal
INDICATION tendencies and allow patient only minimum
supply of the drug
 Major depressive disorder
CONTRAINDICATIONS AND CAUSES
MECHANISM OF ACTION
 Contraindicated in patients hypersensitive to drug or
Thought to stimulate receptos, increasing the release of serotonin and
within 14 days of MAO inhibitor therapy
norepinephrine
 Use cautiously in elderly patients and in patients with
SIDE EFFECTS/ADVERSE REACTIONS renal impairment, diseases or conditions that could affect
hemodynamic responses or metabolism, and in those with
CNS: abnormal dremas, anxiety, asthenia, chills, dizziness, a history of mania or seizures.
fatigue, jittery feeling, headache, insomnia, irritability,
paresthesia, somnolence, tremor MEDICATION
CV: hot flashes, hypertension, palpitations, tachycardia
Generic Name: Trazodone
EENT: blurred vision, mydriasis, tinnitus
GI: constipation, diarrhea, dry mouth, dysgeusia, GI
Brand Name: Oleptro
bleeding, nausea, vomiting
GU: proteinuria
DRUG CLASSIFICATION
Meta: decreased appetite, weight loss
 Therapeutic Class: Antidepressant  Monitor patient for signs and symptoms of serotonin
syndrome or neuroleptic malignant syndrome. If these
Pharmacologic Class: Triazolopyridine derivative signs and symptoms occur, immediately discontinue
trazodone and any other serotogenic, antidopaminergic, or
INDICATION antipsychotic drugs
 Record mood changes. Monitor patient for suicidal
 Depression tendencies and allow only minimum supply of drug
 Insomnia  Drug may increase the risk of suicidal thinking and
 Prevention of migraine behavior in children, adolescents, and young adults ages
18-24, especially those with major depressive disorder or
MECHANISM OF ACTION
other psychiatric disorder
Unknown. Inhibits CNS neuronal uptake of serotonin; not a tricyclic  Tell patient to report a persistent painful erection
derivative (priapism) right away because he may need immediate
intervention
SIDE EFFECTS/ADVERSE REACTIONS  Warn patient to avoid activities that require alertness and
good coordination until effects of drugs are known.
CNS: drowsiness, dizziness, nervousness, fatigue, confusion, tremor, Drowsiness and dizziness usually subside after first few
weakness, hostility, anger, nightmares, vivid dreams, headache, weeks
insomnia, syncope  Teach caregivers how to recognize signs and symptoms of
CV: orthostatic hypotension, tachycardia, hypertension, shortness of suicidal tendency or suicidal thoughts
breath, ECG changes
EENT: blurred vision, tinnitus, nasal congestion CONTRAINDICATIONS AND CAUSES
GI: dry mouth, dysgeusia, constipation, nausea, vomiting, anorexia
GU: urine retention, priapism possibly leading to impotence,  Contraindicated in patients hypersensitive to drug
hematuria  Use cautiously in patients with cardiac disease or
Hema: anemia in the initial recovery phase of MI and in patients
Skin: rash, urticaria, diaphoresis at risk for suicide
Other: decreased libido
MEDICATION
NURSING RESPONSIBILITIES
Generic Name: Nefazodone
 Brand Name: Serzone
DRUG CLASSIFICATION
Therapeutic Class: Antidepressant
Pharmacologic Class:
INDICATION
 Depression
MECHANISM OF ACTION
Unknown. Thought to be linked to drug’s inhibition of CNS neuronal
uptake of serotonin and norepinephrine; it also occupies serotonin
and alpha1-adrenergic receptors in the CNS
SIDE EFFECTS/ADVERSE REACTIONS
CNS: fever, headache, somnolence, dizziness, asthenia,
insomnia, lightheadedness, confusion, memory impairment,
paresthesia, vasodilation, abnormal dreams, impaired
concentration, ataxia, incoordination, psychomotor
retardation, tremor, hypertonia, suicidal behavior
CV: orthostatic hypotension, hypotension, peripheral edema
EENT: blurred vision, abnormal vision, tinnitus, visual field
defect, pharyngitis
GI: dry mouth, nausea, constipation, taste perversion,
dyspepsia, diarrhea, increased appetite, vomiting
GU: urinary frequency, UTI, urine retention, vaginitis
Hepa: liver failure
Musculo: neck rigidity, arthralgia
Respi: cough
Skin: pruritus, rash
Other: infection, flulike syndrome, chills, breast tenderness,
thirst
NURSING RESPONSIBILITIES
 A thorough risk-versus-benefit assessment should be
considered before using nefazodone to treat depression,
taking into account the risk for hepatic failure and
emergence of suicidal thoughts and attempts
 Warn patient not to engage in hazardous activity until
effects of drug are known
 Inform family members to be particularly vigilant for
suicidal tendencies during therapy with nefazodone
 Instruct patient to avoid alcohol during therapy
 Inform patient that several weeks of therapy may be
needed to obtain full antidepressant effect. Once
improvement occurs, advise him not to stop drug until
directed by prescriber
CONTRAINDICATIONS AND CAUSES
 Contraindicated in patients hypersensitive to drug or
other phenylpiperazine antidepressants; also
contraindicated within 14 days of MAO inhibitor
therapy
 Contraindicated in patients who stopped using
nefazodone because of liver injury
  Use cautiously in patients with CV or cerebrovascular CNS: dizziness, fatigue, headache, insomnia, somnolence,
disease that could be worsened by hypotension and suicidal thoughts, fever, hypoesthesia, irritability, lethargy,
conditions that would predispose patients to nervousness, nightmares, restlessness, sleep disorder, anxiety,
hypotension asthenia, tremor
 Use cautiously in patients with a history of mania CV: hot flashes, hypertension, increased heart rate
EENT: blurred vision, nasopharyngitis, pharyngolaryngeal
MEDICATION pain
GI: constipation, diarrhea, dry mouth, nausea, dyspepsia,
Generic Name: Duloxetine gastritis, vomiting
GU: abnormal orgasm, abnormally increased frequency of
Brand Name: Cymbalta urinating, delayed or dysfunctional ejaculation, dysuria,
erectile dysfunction, urinary hesitation
DRUG CLASSIFICATION Meta: decreased appetite, hypoglycemia, increased appetite,
weight gain or loss, hyponatremia
Therapeutic Class: Antidepressant Musculo: muscle cramps, myalgia
Respi: cough
Pharmacologic Class: SSNRI Skin: increased sweating, night sweats, pruritus, rash
Other: decreased libido, rigors
INDICATION
NURSING RESPONSIBILITIES
 Major depressive disorder
 Generalized anxiety disorder  Monitor patient for worsening of depression or suicidal
 Neuropathic pain related to diabetic peripheral behavior, especially when therapy starts or dosage
neuropathy changes
 Drug may increase risk of suicidal thinking and behavior
MECHANISM OF ACTION
in children, adolescents, and young adults ages 18 to 24,
especially during the first few months of treatment,
May inhibit serotonin and norepinephrine reuptake in the CNS
especially in those with major depressive disorder or other
SIDE EFFECTS/ADVERSE REACTIONS psychiatric disorder
  If taken with tricyclic antidepressants, duloxetine
metabolism will be prolonged, and patient will need
extended monitoring
 Periodically reassess patient to determine the need for
continued therapy
 Decreased dosage gradually, and watch for symptoms that
may arise when drug is stopped, such as dizziness,
nausea, headache, paresthesia, vomiting, irritability, and
nightmares
 If intolerable symptoms arise when decreasing or stopping
drug, restart at previous dose and decrease even more
gradually
 Monitor blood pressure periodically during treatment
 Older patients may be more sensitive to drug effects than
younger adults
 Warn families or caregivers to report signs of worsening
depression and signs of suicidal behavior to prescriber
immediately
 Urge patient to avoid activities that are hazardous or
require mental alertness until he knows how the drug
affects him
 If patient takes drug for depression, explain that it may
take 1 to 4 weeks to notice an effect
CONTRAINDICATIONS AND CAUSES
 Contraindicated in patients hypersensitive to drug or its
ingredients, patients taking MAO inhibitors, patients with
uncontrolled angle-closure glaucoma, and patients with a
creatinine clearance less than 30mL/minute. Drug isn’t
recommended for patients with hepatic dysfunction or end-
stage renal disease
 Use cautiously in patients with a history of mania or
seizures, patients who drink substantial amounts of
alcohol, patients with hypertension, patients with
controlled angle-closure glaucoma, and those with
conditions that slow gastric emptying
MONOAMINE OXIDASE INHIBITORS
MEDICATION
Generic Name: Phenelzine
Brand Name: Nardil
DRUG CLASSIFICATION
Therapeutic Class: Antidepressants
Pharmacologic Class: MAO inhibitor
INDICATION
 Treatment of neurotic or atypical depression
(usually reserved for patients who do not tolerate
or respond to other modes of therapy [e.g. tricyclic
antidepressants, SSRIs, SSNRIs or
electroconvulsive therapy])
MECHANISM OF ACTION
 Inhibits the enzyme monoamine oxidase, resulting in an
accumulation of various neurotransmitters (dopamine,
epinephrine, norepinephrine, and serotonin) in the body.
Therapeutic Effects: Improved mood in depressed patients
SIDE EFFECTS/ADVERSE REACTIONS
CNS: seizures, dizziness, drowsiness, fatigue, headache,
hyperreflexia, insomnia, tremor, twitching, weakness, euphoria,
paresthesia, restlessness.
CV: hypertensive crisis edema, orthostatic hypotension
EENT: blurred vision, glaucoma, nystagmus
GI: constipation, dry mouth, abdominal pain, liver function test
elevation, nausea, vomiting
GU: sexual dysfunction, urinary retention
Meta: weight gain
Skin: pruritus, rashes
NURSING RESPONSIBILITIES
 Assess mental status, mood changes, and anxiety level
frequently. Assess for suicidal tendencies, especially during
early therapy. Restrict amount of drug available to patient.
 Monitor BP and pulse rate before and frequently during
therapy. Report significant changes promptly.
 Monitor intake and output ratios and daily weight. Assess
patient for peripheral edema and urinary retention.
 Monitor serum glucose closely in diabetic patients;
hypoglycemia may occur.
 Toxicity and Overdose: Concurrent ingestion of tyramine-rich
foods and many medications may result in a life-threatening
hypertensive crisis. Signs and symptoms of hypertensive
crisis include chest pain, tachycardia or bradycardia, severe
headache, nausea, vomiting, photosensitivity, neck stiffness,
sweating, and enlarged pupils. Treatment includes IV
phentolamine
 Instruct patient to take medication as directed. Take
missed doses if remembered within 2 hr; otherwise, omit
and return to regular dosage schedule. Do not discontinue
abruptly as withdrawal symptoms (nausea, vomiting,
malaise, nightmares, agitation, psychosis, seizures) may
occur.
 Caution patient to avoid alcohol, CNS depressants, OTC
drugs, and foods or beverages containing tyramine or
excessive caffeine during and for at least 2 wk after
therapy has been discontinued; they may precipitate a
hypertensive crisis. Instruct patient to notify health care
professional immediately if symptoms of hypertensive
crisis develop.
 Instruct parents or guardians of children to contact health
care professional immediately if child exhibits any
suicidal thoughts or behaviors
 May cause dizziness or drowsiness. Caution patient to
avoid driving and other activities requiring alertness until
response to medication is known.
 Caution patient to change positions slowly to minimize
orthostatic hypotension. Geriatric patients are at increased
risk for this side effect.
 Instruct patient to consult with health care professional
before taking any new prescription, OTC, or herbal
product.
  Advise patient to notify health care professional if dry
mouth, urinary retention, or constipation occurs. Frequent
rinses, good oral hygiene, and sugarless candy or gum
may diminish dry mouth. An increase in fluid intake,
fiber, and exercise may prevent constipation.
CONTRAINDICATIONS AND CAUSES
 Contraindicated in: Hypersensitivity; Liver disease; Severe
renal disease; Pheochromocytoma; Heart failure; Patients
undergoing elective surgery requiring general anesthesia
(should be discontinued at least 10 days before surgery);
Excessive consumption of caffeine; Concurrent use of
meperidine, SSRI antidepressants, SSNRI antidepressants,
tricyclic antidepressants, tetracyclic antidepressants,
nefazodone, trazodone, procarbazine, selegiline, linezolid,
carbamazepine, cyclobenzaprine, bupropion, buspirone,
sympathomimetics, other MAO inhibitors, dextromethorphan,
narcotics, alcohol, general anesthetics, diuretics, or
tryptophan; Concurrent use of foods containing high
concentrations of tyramine (see Appendix J); Lactation.
 Use Cautiously in: Patients who may be suicidal or have a
history of drug dependency; Pedi: May ↑ risk of suicide
attempt/ideation especially during first 1–2 mo of treatment
or with dose adjustments; Schizophrenia; Bipolar disorder;
Seizure disorders; Diabetes (↑ risk of hypoglycemia); Geri:
Geriatric patients (↑ risk of adverse reactions); Pregnancy
(safety not established) Children (safety and effectiveness not
established)
MEDICATION
Generic Name: Tranylcypromine
Brand Name: Parnate
DRUG CLASSIFICATION
Therapeutic Class: Antidepressant
Pharmacologic Class: MAO inhibitor
INDICATION
 Treatment of major depressive episode without
melancholia (usually reserved for patients who
do not tolerate or respond to other modes of
therapy [e.g. tricyclic antidepressants, SSRIs,
SSNRIs or electroconvulsive therapy])
MECHANISM OF ACTION
Inhibits the enzyme monoamine oxidase, resulting in an
accumulation of various neurotransmitters (dopamine,
epinephrine, norepinephrine, and serotonin) in the body.
Therapeutic Effects: Improved mood in depressed patients.
SIDE EFFECTS/ADVERSE REACTIONS
CNS: seizures, confusion, dizziness, drowsiness, headache,
insomnia, restlessness, tremor, paresthesia, weakness
CV: hypertensive crisis, edema, orthostatic hypotension,
tachycardia
EENT: blurred vision, tinnitus
 GI: abdominal pain, anorexia, constipation, diarrhea, dry
mouth, hepatitis, nausea. GU: sexual dysfunction, urinary
retention.
Hema: agranulocytosis, leukopenia, thrombocytopenia
Musculo: muscle spasm
Skin: alopecia, rashes
NURSING RESPONSIBILITIES
 Assess mental status, mood changes, and anxiety level
frequently. Assess for suicidal tendencies, especially during
early therapy. Restrict amount of drug available to patient.
 Monitor serum glucose closely in diabetic patients;
hypoglycemia may occur.
 Toxicity and Overdose: Concurrent ingestion of tyramine-rich
foods and many medications may result in a life-threatening
hypertensive crisis. Signs and symptoms of hypertensive
crisis include chest pain, tachycardia or bradycardia, severe
headache, nausea, vomiting, photosensitivity, neck stiffness,
sweating, and enlarged pupils
 Instruct patient to take medication as directed. Take missed
doses if remembered within 2 hr; otherwise, omit and return
to regular dosage schedule. Do not discontinue abruptly as
withdrawal symptoms may occur.
 Caution patient to avoid alcohol, CNS depressants, OTC
drugs, and foods or beverages containing tyramine or
excessive caffeine during and for at least 2 wk after therapy
has been discontinued; they may precipitate a hypertensive
crisis. Instruct patient to notify health care professional
immediately if symptoms of hypertensive crisis develop.
 Instruct parents or guardians of children to contact
health care professional immediately if child exhibits
any suicidal thoughts or behaviors
 May cause dizziness or drowsiness. Caution patient to
avoid driving and other activities requiring alertness until
response to medication is known.
 Caution patient to change positions slowly to minimize
orthostatic hypotension. Geriatric patients are at increased
risk for this side effect.
 Instruct patient to consult with health care professional
before taking any new prescription, OTC, or herbal
product.
 Instruct patient to carry identification describing
medication regimen at all times.
 Emphasize the importance of participation in
psychotherapy if recommended by health care
professional and follow-up exams to evaluate progress.
CONTRAINDICATIONS AND CAUSES
 Contraindicated in: Hypersensitivity; Liver disease;
Cerebrovascular disease; Cardiovascular disease;
Hypertension; Pheochromocytoma; Patients undergoing
elective surgery requiring general anesthesia History of
headache; Excessive consumption of caffeine; Concurrent
use of meperidine, SSRI antidepressants, SSNRI
antidepressants, tricyclic antidepressants, tetracyclic
antidepressants, nefazodone, trazodone, procarbazine,
selegiline, linezolid, carbamazepine, cyclobenzaprine,
bupropion, buspirone, sympathomimetics, other MAO
inhibitors, dextromethorphan, narcotics, alcohol, general
 anesthetics, diuretics, antihistamines, or tryptophan;
Concurrent use of foods containing high concentrations of
tyramine; Lactation.
 Use Cautiously in: Patients who may be suicidal or have a
history of drug dependency; Pedi: May ↑ risk of suicide
attempt/ideation especially during first 1–2 mo of
treatment or with dose adjustments; Hyperthyroidism;
Schizophrenia; Bipolar disorder; Seizure disorders; Renal
dysfunction; Diabetes (↑ risk of hypoglycemia); Geri:
Geriatric patients (↑ risk of adverse reactions); Pregnancy
(safety not established); Children (safety and
effectiveness not established).
MEDICATION
Generic Name: Isocarboxazid
Brand Name: Marplan
DRUG CLASSIFICATION
Therapeutic Class: Antidepressant
Pharmacologic Class: MAO inhibitor
INDICATION
 Treatment of depression (usually reserved for patients
who do not tolerate or respond to other modes of therapy
MECHANISM OF ACTION
Inhibits the enzyme monoamine oxidase, resulting in an
accumulation of various neurotransmitters (dopamine,
epinephrine, norepinephrine, and serotonin) in the body
SIDE EFFECTS/ADVERSE REACTIONS
CNS: seizures, dizziness, headache, akathisia, anxiety, ataxia,
drowsiness, euphoria, insomnia, restlessness, weakness
CV: hypertensive crisis, orthostatic hypotension
EENT: blurred vision
GI: nausea, black tongue, constipation, diarrhea, dry mouth
GU: dysuria, sexual dysfunction, urinary incontinence,
urinary retention
Skin: photosensitivity.
NURSING RESPONSIBILITIES
 Assess mental status, mood changes, and anxiety level
frequently. Assess for suicidal tendencies, especially
during early therapy. Restrict amount of drug available to
patient.
 Monitor serum glucose closely in diabetic patients;
hypoglycemia may occur.
 Toxicity and Overdose: Concurrent ingestion of tyramine-
rich foods and many medications may result in a life-
threatening hypertensive crisis. Signs and symptoms of
hypertensive crisis include chest pain, tachycardia or
bradycardia, severe headache, nausea, vomiting,
photosensitivity, neck stiffness, sweating, and enlarged
pupils
 Instruct patient to take medication as directed. Take
missed doses if remembered within 2 hr; otherwise, omit
and return to regular dosage schedule. Do not discontinue
abruptly as withdrawal symptoms may occur.
 Caution patient to avoid alcohol, CNS depressants, OTC
drugs, and foods or beverages containing tyramine or
excessive caffeine during and for at least 2 wk after
therapy has been discontinued; they may precipitate a
hypertensive crisis. Instruct patient to notify health care
professional immediately if symptoms of hypertensive
crisis
 Instruct parents or guardians of children to contact health
care professional immediately if child exhibits any
suicidal thoughts or behaviors
 May cause dizziness or drowsiness. Caution patient to
avoid driving and other activities requiring alertness until
response to medication is known.
 Caution patient to change positions slowly to minimize
orthostatic hypotension. Geriatric patients are at increased
risk for this side effect.
 Instruct patient to consult with health care professional
before taking any new prescription, OTC, or herbal
product.
 Advise patient to notify health care professional of
medication regimen before surgery. If possible, therapy
should be discontinued at least 2 wk before surgery.
 Instruct patient to carry identification describing
medication regimen at all times.
 Emphasize the importance of participation in
psychotherapy if recommended by health care
professional and follow-up exams to evaluate progress.
CONTRAINDICATIONS AND CAUSES
 Contraindicated in: Hypersensitivity; Liver disease;
Severe renal disease; Cerebrovascular disease;
Cardiovascular disease; Uncontrolled hypertension;
Pheochromocytoma; History of severe or frequent
headaches; Patients undergoing elective surgery requiring
general anesthesia (should be discontinued at least 10
days before surgery); Excessive consumption of caffeine;
Concurrent use of meperidine, SSRI antidepressants,
SSNRI antidepressants, tricyclic antidepressants,
tetracyclic antidepressants, nefazodone, trazodone,
procarbazine, selegiline, linezolid, carbamazepine,
cyclobenzaprine, bupropion, buspirone,
sympathomimetics, other MAO inhibitors,
dextromethorphan, narcotics, alcohol, general anesthetics,
diuretics, tryptophan, or antihistamines; Concurrent use of
foods containing high concentrations of tyramine;
Lactation; Children <16 yr (safety and effectiveness not
established).
 Use Cautiously in: Patients who may be suicidal or have a
history of drug dependency; Pedi: May ↑ risk of suicide
attempt/ideation especially during first 1–2 mo of
treatment or with dose adjustments (approved for use in
children ≥16 yr); Hyperthyroidism; Schizophrenia;
Bipolar disorder; Seizure disorders;