Pharmacology

STUDENT ACTIVITY SHEET BS NURSING / SECOND YEAR

Session 9

LESSON TITLE: ANTIDEPRESSANT & MOOD Materials:

STABILIZER
LEARNING OUTCOMES:
At the end of the lesson, the nursing student can:
1. Define the various categories of antidepressants;
2. Identify the side effects and adverse reactions of
antidepressants; and,
3. Develop a drug study guide . (therapeutic action,
indication, contraindication, most common adverse
reaction And nursing responsibility ) of antidepressants.
Notebook, Pharmacology book, Drug handbook,
pens & paper
References:
Kee, Joyce LeFever, Hayes, Evelyn R. &
McCuistion E. Pharmacoloy A Nursing
Process Approach 6th edition.. Singapore:
Elsevier Saunders Company.

LESSON REVIEW/ PREVIEW OR HOOK ACTIVITY (5 minutes)

PICTURE PROMPT
Write at least three sentences on your understanding of the picture and justify your points. Relate it to the lesson.

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MAIN LESSON (50 minutes)

Affective Disorders vs Depression

o Affective disorder : A person’s mood goes far beyond the normal “ups and downs”
o Depression : Severe and long-lasting feelings of sadness beyond the precipitating event

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Signs and Symptoms of Depression
o Low energy level
o Sleep disturbances
o Lack of appetite
o Limited libido
o Inability to perform activities of daily living
o Overwhelming feelings of sadness, despair, hopelessness, and disorganization
Biogenic Amine Theory of Depression
o Depression results from a deficiency of norepinephrine (NE), dopamine, or serotonin (5HT)
 Monoamine oxidase (MAO) may break them down to be recycled or restored in the neuron
 Rapid fire of neurons may lead to their depletion
 The number or sensitivity of postsynaptic receptors may increase, depleting neurotransmitter levels
Actions of Antidepressant Therapy
o Inhibits the effects of MAO, leading to increased NE or 5HT in the synaptic cleft
o Blocks reuptake by the releasing nerve, leading to increased neurotransmitter levels in the synaptic cleft
o Regulates receptor sites and breakdown of neurotransmitters, leading to an accumulation of neurotransmitters in
the synaptic cleft

Classifications of Antidepressants
o Tricyclic antidepressants (TCAs)
o Monoamine Oxidase inhibitors (MAOIs)
o Selective serotonin reuptake inhibitors (SSRIs)
o Atypical antidepressant (second generation)

Sites of Action for Selected Antidepressants

TRICYCLIC ANTIDEPRESSANTS
o Actions : Reduce the reuptake of 5HT and NE into nerves
o Use : All TCAs are similar, Choice depends on individual response to the drug and tolerance of adverse effects
o Indications
 Relief of symptoms of depression
 Used for patients with sleep disorders
 Treatment of enuresis
 Chronic pain
o Pharmacokinetics
 Absorbed from the GI tract
 Peak in 2 to 4 hours

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  Bound to plasma proteins and lipid soluble
 Metabolized in the liver and excreted in the urine
 T½ 8 to 46 hours
o Contraindications : Known allergy, recent MI, myelography, pregnancy, and lactation
o Cautions : CV disease, angle closure glaucoma, urinary retention, and manic depression
o Adverse reactions : Sedation, sleep disturbances, fatigue, hallucinations, ataxia, dry mouth, constipation, nausea,
and vomiting
o Drug-to-drug interactions : MAOIs, cimetidine, fluoxetine, ranitidine, and oral anticoagulants

Monoamine Oxidase Inhibitors (MAOIs)

o Isocarboxazid (Marplan) : Used for patients who do not respond to or cannot take newer, safer antidepressants
o Phenelzine (Nardil) : Used for some patients who do not respond to newer, safer antidepressants
o Tranylcypromine (Parnate) : Used for adult outpatients with reactive depression
o Action : Irreversibly inhibit MAOs, allowing norepinephrine, serotonin, and dopamine to accumulate in the synaptic
cleft
o Indication : Treatment of patients with depression who are unresponsive to or unable to take other antidepression
agents
o Pharmacokinetics
 Absorbed from the GI tract
 Peak in 2 to 3 hours
 Metabolized in the liver and excreted in the urine
 Cross placenta and enter breast milk
o Contraindications : Known allergy, pheochromocytoma, CV disease, headaches, and renal or hepatic impairment
o Adverse reactions : Dizziness, excitement, nervousness, mania, hyperreflexia, tremors, confusion, insomnia,
agitation, liver toxicity, nausea, vomiting, diarrhea or constipation, anorexia, weight gain, dry mouth, and abdominal
pain
o Drug-to-drug interactions
 Other antidepressants: hypertensive crisis and coma
 Methyldopa: sympathomimetic effects increase
 Insulin or oral antidiabetic agents: additive hypoglycemia
o Food interactions : Tyramine or pressor amines: increase blood pressure

Selective Serotonin Reuptake Inhibitors (SSRIs)

o The newest group of antidepressant drugs
o Specifically block the reuptake of 5HT, with little to no known effect on NE
o Do not have the many adverse effects associated with TCAs and MAOIs
o Action : Inhibit CNS neuronal reuptake of serotonin with little effect on norepinephrine and little affinity for
cholinergic, histaminic, or alpha-adrenergic sites
o Indications : Depression, OCD, panic attacks, bulimia, PMDD, posttraumatic stress disorders, social phobias, and
social anxiety disorders
o Pharmacokinetics
 Absorbed from the GI tract
 Metabolized in the liver
 Associated with congenital abnormalities
o Contraindications : Known allergy, pregnancy, lactation, and impaired renal or hepatic function
o Adverse reactions : Headache, drowsiness, dizziness, insomnia, anxiety, tremor, and agitation
o Drug-to-drug interactions
 MAOIs
 TCAs increase therapeutic and toxic effect

Atypical (Heterocyclic or Second Generation) Antidepressant

Miscellaneous Antidepressants
o Bupropion (Wellbutrin, Zyban)
o Mirtazapine (Remeron)
o Nefazodone (Serzone)
o Trazodone (Desyrel)
o Venlafaxine (Effexor)

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 MOOD STABILIZER - LITHIUM
Trade name : Eskalith, Lithane, Lithonate, Lithobid

Therapeutic action : treat bipolar manic depressive psychosis, manic episodes

o Alteration of ion transport in muscle and nerve cells; increase receptor sensitivity to serotonin.
o Alters sodium transport in nerve and muscle cells
o Inhibits the release of norepinephrine and dopamine—but not serotonin—from stimulated neurons
o Increases the intraneuronal stores of norepinephrine and dopamine slightly
o Decreases intraneuronal content of second messengers

Contraindications : Liver and renal disease, pregnancy, lactation, severe cardiovascular disease, severe dehydration, brain
tumor or damage , sodium depletion, children 12 years old and below.

Side effects : headache, lethargy, drowsiness, dizziness, tremors, slurred speech, dry mouth, anorexia, vomiting diarrhea,
polyuria, hypotension abdominal pain, muscle weakness and restlessness
Use of Antidepressant Agents Across the Lifespan

Adverse reaction : urinary incontinence, clonic movements, stupor, azotemia, leucocytosis, nephrotoxicity
o Cardiac dysrhythmias, circulatory collapse

Nursing responsibilities
o Observe for signs and symptoms of depression: mood changes, insomnia, apathy, or lack of interest in activities
o Monitor vital signs : orthostatic hypotension is common
o Monitor for suicidal tendencies when marked depression Is present.
o Evaluate client’s urine output and body weight. Fluid volume deficit may occur as a result of polyuria.
o Observe client for fine and gross motor tremors and presence of slurred speech which are signs of adverse reaction
o Check client’s cardiac status. Loss of fluids and electrolytes may cause cardiac dysrhythmias
o Monitor for signs of lithium toxicity.

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CHECK FOR UNDERSTANDING (30 minutes)

You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to correct
answer and another one (1) point for the correct rationalization. Superimpositions or erasures in you answer/ratio is not
allowed. You are given 25 minutes for this activity:

Multiple Choice
1. A secondary amine tricyclic antidepressant is prescribed for a patient. The medication will significantly increase the
availability of which neurotransmitter?
a. GABA
b. Glutamate
c. Serotonin
d. Norepinephrine
ANSWER: ________
RATIO:___________________________________________________________________________________________
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2. Nortriptyline (Aventyl) was prescribed for a 68-year-old patient diagnosed with depression and insomnia. Benefits specific
to use of nortriptyline would include:
a. Regular bowel movements.
b. Improved sleep pattern.
c. Weight loss.
d. Anhedonia.
ANSWER: ________
RATIO:___________________________________________________________________________________________
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3. Priority assessments for a patient beginning amitriptyline (Elavil) include:

a. Nausea, diarrhea, and irritability.
b. Seizures, agranulocytosis, and insomnia.
c. Headache, sexual dysfunction, and weight loss.
d. History of falls, arrhythmias, and blurred vision.
ANSWER: ________
RATIO:___________________________________________________________________________________________
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4. A 75-year-old patient with a long history of depression begins amitriptyline (Elavil) 100 mg/day. The patient also takes a
diuretic daily for hypertension. The highest priority nursing diagnosis is risk for:
a. Falls related to dizziness and orthostatic hypotension.
b. Ineffective thermoregulation related to anhidrosis.
c. Infection related to suppressed white blood cell count.
d. Constipation related to slowed peristalsis.
ANSWER: ________
RATIO:___________________________________________________________________________________________
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5. A depressed patient prepares for discharge. The patient is prescribed desipramine (Norpramin) and will have outpatient
visits. The patient reports, "They gave me only a 1-week supply of my medicine." Select the nurse's best reply.
a. "Federal law limits the amount you may be given at any one time."
b. "It will save you money if the drug doesn't work well for your symptoms."
c. "This is a way of ensuring that you will come in for your follow-up appointment."
d. "Prescribing a small amount of drug addresses our concerns for your continuing safety."
ANSWER: ________
RATIO:___________________________________________________________________________________________
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6. Evaluation of a patient's response after 1 week of tricyclic antidepressant therapy would be expected to show:
a. No change in objective or subjective symptoms.
b. Increased appetite and weight gain.
c. Decreased suicidal ideation.
d. Improved mood and affect.
ANSWER: ________
RATIO:___________________________________________________________________________________________
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7. A patient diagnosed with depression who has reported vague suicidal ideation will stay at home, have close family
supervision, and make weekly visits to the health care provider. Bupropion (Wellbutrin) is prescribed. What is the benefit of
bupropion in this scenario?
a. It has antianxiety properties as well as antidepressant effects.
b. It lowers the seizure threshold to a lesser extent than TCAs.
c. There is reduced potential for lethal overdose.
d. It stimulates appetite and weight gain.
ANSWER: ________
RATIO:___________________________________________________________________________________________
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8. A patient with depression has taken an SSRI for 1 month. The nurse should use direct questions to evaluate which
potential side effect?
a. Aggressive impulses
b. Sexual dysfunction
c. Paranoid delusions
d. Weight gain
ANSWER: ________
RATIO:___________________________________________________________________________________________
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9. A patient prescribed fluoxetine (Prozac) is being changed to tranylcypromine (Parnate). The nurse schedules a time lapse
between the last dose of fluoxetine and the first dose of tranylcypromine of at least:
a. 7 days.
b. 14 days.
c. 3 weeks.
d. 6 weeks.
ANSWER: ________
RATIO:___________________________________________________________________________________________
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10. A patient tells the nurse that he stopped taking sertraline (Zoloft) because the drug made him impotent. The nurse can
be most helpful by saying:
a. "Your doctor wants you to continue taking your medication."
b. "Have you talked with your therapist regarding your feelings about sex?"
c. "Let's talk with your doctor. Changing your medication might be a possibility."
d. "Our priority is to treat your depression. Impotence can be addressed in a few weeks."
ANSWER: ________
RATIO:___________________________________________________________________________________________
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11. A client is to receive a dose of fluphenazine hydrochloride (Prolixin) by intramuscular injection. What is the most
important nursing intervention related to the injection?
a. Massage the site vigorously after injection.
b. Administer the drug using Z-tracking.

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c. Avoid rotating the injection sites.
d. Select a 22- to 23-gauge needle.
ANSWER: ________
RATIO:___________________________________________________________________________________________
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12. The client has been diagnosed with schizophrenia and is exhibiting a loss of function and motivation. The nurse
recognizes that these symptoms are categorized as:
a. Positive.
b. Paranoiac
c. Negative
d. Incoherent.
ANSWER: ________
RATIO:___________________________________________________________________________________________
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13. What is a common side effect for which the nurse must monitor during administration of both phenothiazine and non-
phenothiazine medications?
a. Hypertension
b. Renal failure
c. Increase in number of white blood cells
d. Extrapyramidal symptoms
ANSWER: ________
RATIO:___________________________________________________________________________________________
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14. The client with a major depressive disorder taking the selective serotonin reuptake inhibitor (SSRI) fluoxetine (Prozac)
calls the psychiatric clinic and reports feeling confused and restless and having an elevated temperature. Which action
should the psychiatric nurse take?
a. Determine if the client has flulike symptoms
b. Instruct the client to stop taking the SSRI
c. Recommend the client take the medication at night.
d. Explain that these are expected side effects
ANSWER: ________
RATIO:___________________________________________________________________________________________
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15. The client diagnosed with depression is prescribed phenelzine (Nardil), a monoamine oxidase (MAO) inhibitor. Which
statement by the client indicates to the nurse the medication teaching is effective?
a. "I am taking the herb ginseng to help my attention span"
b. "I drink extra fluids, especially coffee and iced tea"
c. "I am eating three well-balanced meals a day"
d. "At a family cookout I had chicken instead of a hotdog"
ANSWER: ________
RATIO:___________________________________________________________________________________________
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RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE TO FACE INTERACTION)
The instructor will now rationalize the answers to the students. You can now ask questions and debate among yourselves.
Write the correct answer and correct/additional ratio in the space provided.

1. ANSWER: ________
RATIO:_______________________________________________________________________________________
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2. ANSWER: ________

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 RATIO:_______________________________________________________________________________________
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15. ANSWER: ________
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LESSON WRAP-UP (5 minutes)

You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help you
track how much work you have accomplished and how much work there is left to do.

You are done with the session! Let’s track your progress.

DAILY DOZEN
Student choose two questions from a generic list to respond to about the day’s lesson. Daily Dozen
1. The thing that made the most sense to me today was…
2. One thing that I just don’t understand is…
3. When someone asks me what I did in math today, I can say…
4. One thing I would like more information about is…
5. I need more examples of…
6. I enjoyed…
7. The most important concept that we discussed today was…
8. Today’s class would have been even better if we had…
9. I was confused by…
10. The thing we did in class today that best fit my learning style was…
11. The one thing the teacher did today that worked well for me was…
12. The one thing the teacher did today that did not work well for me was…

A. ___________________________________________________________________________

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B. ___________________________________________________________________________

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For next session, review CNS Stimulants and Depressants

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