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Course: Mental Health Nursing�Topic: Psychopharmacology Part - I

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Module Goals

Learners will be able to:

Identify the psychotropic medications.
Describe the mechanism of action, indications and contraindications for the classes of psychotropic medications.
Describe the client considerations concerning use of psychotropic medications.
Describe the nursing responsibilities related psychotropic medications.

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Nursing Process for Psychopharmacology

Assessment

Collect important data, assess the client’s condition, and feelings.

Interventions

Perform medication rights, check allergies, anticipate common side effects, assess lab values if necessary.

Evaluation

Effects of medication: assess mood/behaviour/movement for improvement or deterioration, monitor side defects, report changes to the team.

Ernstmeyer & Christman, 2020

Contact info: info@nursesinternational.org

Assessment:

Each medication is given for a specific purpose. The nurse’s responsibility is to assess client responses safely administer medication.

As a nurse, you will be not only performing the skill of administering medications but also being expected to think critically about your client and the safety of any medication at any particular time.

A nursing assessment completed prior to administering CNS medication will likely look different than an assessment for other types of medication because most of the associated assessments are done by collecting subjective data rather than objective data.

Prior to administering CNS medication, a nurse will use therapeutic communication to ask questions to gather subjective data about how the client is feeling. After reviewing the possible diseases connecting with the CNS system, you probably noticed that there is usually an associated imbalance of a neurotransmitter. As a nurse, you cannot directly measure a neurotransmitter to determine the effects of the medication, but you can ask questions to determine how your client is feeling emotionally and perceiving the world, which is influenced by neurotransmitter levels. An example of a nurse using therapeutic communication to perform subjective assessment is asking a question such as, “Tell me more about how you are feeling today?” The nurse may also use general survey techniques such as simply observing the client assess for cues of behavior. Examples of data collected by a general survey could be assessing the client’s mood, hygiene, appearance, or movement.

Implementation of Interventions

With the administration of any medications, it is important always to perform the five rights (right client, medication, dose, route, and time) and to check for allergies prior to administration.

It is important to anticipate any common side effects and the expected outcome of the medication. When you administer CNS medication, it is key to perform assessments before administering medication because many clients may have changing behaviors and habits that influence the way they think and feel about taking their medication.

Additionally, some medications require an assessment of lab values before administration. Many CNS medications may also have cumulative effects when used in conjunction with other medications, so careful assessment of the impact of the medications on one another is needed.

Evaluation

Finally, it is always essential to evaluate the client’s response to a medication.

Some CNS medications will take weeks to become therapeutic for the client. It is vital to teaching the client when the medication is expected to produce an effect.

Nurses should assess for mood, behavior, and movement improvement. I

f medications are effective; then clients should report fewer negative thoughts, worry, and symptomatic behaviors, as well as demonstrate fewer abnormal movements.

Nurses also need to continually monitor for adverse effects, some of which can be life-threatening and require prompt notification to the prescribing provider.

Additionally, if symptoms are not improving or the client’s condition is worsening, the nurse should promptly notify the prescribing provider for further orders. For example, a symptom or adverse reaction of several CNS medications is increased thoughts of suicide. If a client is experiencing thoughts of suicide, immediate assistance should be obtained to keep them safe. For more information about suicide, see the link to information about suicide prevention below.

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Psychotropic Medications:

CNS Depressants
CNS Stimulants
Antidepressants
Antimanic
Antipsychotics
Anticonvulsants
Antiparkinson
Anti anxiety

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CNS Depressant Drugs: Benzodiazepines

Example: Lorazepam

Availability: Tablets, Intramuscular, intravenous.

Mechanism of actions: Bind to the GABA receptors to increase effect of GABA.

Indications: Sedation, anti anxiety, anti convulsant, Injectable lorazepam is used in status epilepticus, used as preanesthetic medication to produce sedation, relieve anxiety.

Ernstmeyer & Christman, 2020

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CNS Depressant Drugs: Benzodiazepines

Adverse Effects

May result in profound sedation, respiratory depression, coma, and death

Sedation & drowsiness
Respiratory depression (dose dependant)
Hypotension, and unsteadiness may occur (with oral dosages as well)
Physical and psychological dependence
Abrupt termination causes withdrawal symptoms

Note: The benzodiazepine antagonist flumazenil may be used in hospitalized clients in the management of benzodiazepine overdose

Ernstmeyer & Christman, 2020

Contact info: info@nursesinternational.org

Black Box Warning: Use of benzodiazepines and opioids may result in profound sedation, respiratory depression, coma, and death.

The most important risk associated with the intravenous use of lorazepam injection is respiratory depression. Accordingly, airway patency must be assured and respiration monitored closely. Ventilatory support should be given as required. The additive central nervous system effects of other drugs, such as phenothiazines, narcotic analgesics, barbiturates, antidepressants, scopolamine, and monoamine-oxidase inhibitors should be considered when these other drugs are used concomitantly with, or during the period of recovery from, lorazepam injection. Sedation, drowsiness, respiratory depression (dose dependant), hypotension, and unsteadiness may occur with oral dosages as well. The use of benzodiazepines may lead to physical and psychological dependence. Abrupt termination of treatment may be accompanied by withdrawal symptoms. Benzodiazepines should be prescribed for short periods only (e.g., 2 to 4 weeks). Extension of the treatment period should not take place without reevaluation of the need for continued therapy.

Overdosage

Manifested by varying degrees of central nervous system depression, ranging from drowsiness to coma. Vital signs and fluid balance should be carefully monitored in conjunction with close observation of the client. An adequate airway should be maintained and assisted respiration used as needed.

The benzodiazepine antagonist flumazenil may be used in hospitalized clients in the management of benzodiazepine overdose.

There is a risk of seizure in association with flumazenil treatment, particularly in long-term benzodiazepine users. If overdose occurs, consult with a Certified Poison Control Center or go to the emergency room.

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CNS Depressant Drugs: Benzodiazepines

Nursing Considerations

Monitor for: Abnormal vitals, change in level of consciousness, respiratory problems.
Adjust dose per the client’s response.
Prepare: May require respiratory assistance.
Special consideration with clients with hepatic insufficiency.
Contraindicated in pregnancy.
Children and eldery: Paradoxical effects
Elderly: Sedative and respiratory depression.

Ernstmeyer & Christman, 2020

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Nursing Considerations Across the Lifespan

Adjust dose as per the client’s response (initial dose should not exceed 2 mg)
Paradoxical effect is an effect of a chemical substance, typically a medical drug, that is opposite to what would usually be expected.
Benzodiazepines may cause fetal harm when administered to pregnant women. Children and the elderly are more likely to experience Paradoxical Reactions to benzodiazepines: Tremors, agitation, or visual hallucinations.
Elderly or debilitated clients may be more susceptible to the sedative and respiratory depressive effects of lorazepam. Therefore, these clients should be monitored frequently and have their dosage adjusted carefully according to client response; the initial dosage should not exceed 2 mg.
Dosage for clients with severe hepatic insufficiency should be adjusted carefully according to client response.

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CNS Depressants: Benzodiazepines

Client Teaching & Education

Avoid driving and operating machineries or engaging in hazardous activities for 24-48 hours.
Risk of fall: Encourage client to arise from bed slowly and with assistance if needed.
Avoid alcoholic beverages for at least 48 hrs.
May cause sleepiness for up to 6 hrs.
Actions in emergency situations.

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CNS Depressant Drugs:Barbiturates

Example: Phenobarbital

Mechanism of Action: Alters cerebellar function to cause sedation and drowsiness and depress the actions of brain and sensory cortex.

Indications: Used for sedation and seizures.

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CNS Depressant Drugs

Adverse/Side Effects

CNS depression
Suicidal thoughts or behaviors
GI disturbances
Rashes
Fatal blood disorders
May be habit forming

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CNS Depressant Drugs

Overdosage

High doses: Overdose and may cause death.
Overdose: Consult with a Certified Poison Control Center or go to emergency room.

Note: Naloxone is antidote for Phenobarbital overdose

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CNS Depressant Drugs

Nursing Considerations

Monitor client carefully

Vital signs, level of consciousness
Richmond Agitation And Sedation Scale (RASS)

Contraindicated in children less than 1 month of age.
Barbiturates may harm the growing fetus.
Avoid use in geriatic clients.

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CNS Depressant Drugs

Client Teaching & Education

Importance of taking prescribed medications as directed.
Risk of seizure activity with abrupt discontinuation after prolonged use.
Drowsiness is associated with these medications.
Restricted use of use of alcohol and other CNS depressants when using this CNS depressants.
Use non-hormonal contraceptive methods.

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Critical Thinking Question

Prior to administering a scheduled dose of a benzodiazepine, the nurse observes the client to appear sedated, sluggish, and with slurred speech. What should the nurse do next?

Administer the medication as ordered
Encourage the client to lay down and then administer the medication
Hold the medication and notify the provider
Hold the medication and reassess the client in one hour

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CNS Stimulant Drugs

Example: Methylphenidate

Mechanism of Action:

Stimulates brain, blocks the reuptake of norepinephrine and dopamine into the presynaptic neuron.

Indications:

Used to treat ADHD (Attention Deficit Hyperactivity Disorder).

Ernstmeyer & Christman, 2020

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Nursing Considerations

Should be avoided in the client with structural cardiac abnormalities, cardiomyopathies, heart arrhythmias, coronary artery diseases
Monitor blood pressure and heart rate in all clients
Contraindicated in clients less than six years old; associated with weight loss and growth retardation in child, peripheral vasculopathy, Raynaud’s phenomenon (signs and symptoms include: fingers or toes feeling numb, cool, painful, or changing color from pale, to blue, to red)
Administer methylphenidate hydrochloride extended-release capsules orally once daily in the morning. Extended-release capsules should not be crushed, chewed, or divided. Monitor for signs of abuse and dependence while on therapy

Adverse/Side Effects

Serious cardiovascular events have occurred (sudden death) in pediatric clients with structural cardiac abnormalities or other serious heart problems.
Sudden death, stroke, and myocardial infarction have also been reported in adults with CNS-stimulant treatment at recommended doses.
Methylphenidate may cause increased blood pressure and increased heart rate.
The use of stimulants may cause psychotic or manic symptoms in clients with no prior history and may cause priapism (painful or prolonged penile erections).
The most common adverse reactions are headache, insomnia, upper abdominal pain, decreased appetite, and anorexia.
Alcohol should be avoided because it may cause a rapid release of the drug in extended-release formulations.

Overdose

If an overdose occurs, consult with a Certified Poison Control Center or go to the emergency room and seek medical help.

Client Teaching & Education

There are several important topics to provide clients or parents of minor children.

It is a controlled substance with a high risk of abuse and dependency. Do not share medication with others.
Store it locked drawer.
Serious Cardiovascular Risks: serious cardiovascular risks like myocardial infarction, stroke, hypertension, and even death are associated with the use. Therefore, advise a client to seek medical help in case of any symptoms or unexplained chest pain and syncope.
Blood Pressure and Heart Rate Increases: Educate the client about the side effect of this medication on the cardiovascular system, i.e., increased blood pressure and heart rate. Advise them to monitor blood pressure and heart rate routinely and seek medical help in event of any changes.
Psychiatric Risks: Advise clients that methylphenidate may cause psychotic or manic symptoms, even in clients without prior history of psychotic symptoms or mania.
Priapism: Advise clients of the possibility of painful or prolonged penile erections and to seek immediate medical attention if this occurs.
Circulation Problems in Fingers and Toes: Instruct clients to begin treatment with methylphenidate about the risk of peripheral vasculopathy and associated signs and symptoms: fingers or toes may feel numb, cool, painful, or change color from pale to blue to red. Instruct client to seek medical help immediately in case of these signs.
Suppression of Growth: Advise parents that methylphenidate may cause slowing of growth and weight loss.
Alcohol Effect: Advise clients to avoid alcohol while taking extended-release capsules

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CNS Stimulant Drugs

Adverse/Side Effects

Serious cardiovascular events have occurred including sudden death in clients with structural cardiac abnormalities or other serious heart problems.
Sudden death, stroke, and myocardial infarction.
Increased blood pressure and increased heart rate.
Psychotic or manic symptoms.
The most common adverse reactions: headache, insomnia, upper abdominal pain, decreased appetite, and anorexia.

Ernstmeyer & Christman, 2020

Contact info: info@nursesinternational.org

Adverse/Side Effects

Serious cardiovascular events have occurred including sudden death in pediatric clients with structural cardiac abnormalities or other serious heart problems.

Sudden death, stroke, and myocardial infarction have also been reported in adults with CNS-stimulant treatment at recommended doses.

Methylphenidate may cause increased blood pressure and increased heart rate.

The use of stimulants may cause psychotic or manic symptoms in clients with no prior history and may cause priapism (painful or prolonged penile erections).

The most common adverse reactions are headache, insomnia, upper abdominal pain, decreased appetite, and anorexia.

Alcohol should be avoided because it may cause a rapid release of the drug in extended-release formulations.

Overdose

If an overdose occurs, consult with a Certified Poison Control Center or go to the emergency room and seek medical help.

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CNS Stimulant Drugs

Nursing Considerations

Contraindicated in clients with structural cardiac abnormalities.
Monitor blood pressure and heart rate.
Contraindicated in clients less than 6 years old.
Monitor warning signs and symptoms.
Administer methylphenidate hydrochloride extended-release capsules orally once daily in the morning.
Do not crush, divide or chew extended-release capsules.
Monitor for signs of abuse and dependence.

Ernstmeyer & Christman, 2020

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Nursing Considerations

Should be avoided in the client with structural cardiac abnormalities, cardiomyopathies, heart arrhythmias, coronary artery diseases
Blood pressure and heart rate should be monitored in all clients.
Contraindicated in clients less than six years old; associated with weight loss and growth retardation in child, peripheral vasculopathy, Raynaud’s phenomenon (signs and symptoms include: fingers or toes feeling numb, cool, painful, or changing color from pale, to blue, to red)
Monitor signs and symptoms include: fingers or toes feeling numb, cool, painful, or changing color from pale, to blue, to red.
Administer methylphenidate hydrochloride extended-release capsules orally once daily in the morning. Extended-release capsules should not be crushed, chewed, or divided. Monitor for signs of abuse and dependence while on therapy.

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CNS Stimulant Drugs

Client Teaching & Education

Topics to provide for clients and/or parents of minor children:

Risk of dependency and abuse:

Advise clients not to share medication with others.
Store in locked drawer.

Serious Cardiovascular Risks:

Risk of myocardial infarction, stroke, hypertension and even death.
Seek medical help if experiencing symptoms or unexplained chest pain and syncope.

Ernstmeyer & Christman, 2020

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CNS Stimulant Drugs

Client Teaching & Education

Side effect in cardiovascular system i.e increase blood pressure and heart rate.
Risk of increased blood pressure and pulse.
Psychotic or manic symptoms in clients without prior history of psychotic symptoms or mania.
Priapism: Potential for painful or prolonged penile erections.
When to seek emergency help.

Ernstmeyer & Christman, 2020

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CNS Stimulant Drugs

Client Teaching & Education

Circulation Problems in Fingers and Toes:

Risk of peripheral vasculopathy and associated signs and symptoms: Seek medical help immediately if symptoms occur.

Regarding children:

May cause slowing of growth and weight loss.

Alcohol Effect:

Avoid alcohol while taking extended-release capsules as it may increase effects.

Ernstmeyer & Christman, 2020

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Critical Thinking Question

A nurse understands that more teaching is indicated when nurse or makes orientee makes which of the following statements about CNS stimulants?

“They work by increasing the release and blocking the reuptake of neurotransmitters.”
“Clients are at risk for hypertension, stroke, or myocardial infarction.”
“It is okay to cut extended release tablets for people who do not like to swallow whole pills.”
“Clients should be counseled not to share their medications to other people.”

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Antidepressant Drugs

Four classes of antidepressants

Tricyclic antidepressants (TCAs)
Selective serotonin reuptake inhibitors (SSRIs)
Serotonin norepinephrine reuptake inhibitors (SNRIs)
Monoamine oxidase inhibitors (MAOIs)

Ernstmeyer & Christman, 2020

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Antidepressant Drugs:

Tricyclic Antidepressants (TCAs)

Example: Amitriptyline

Mechanism of action: Unknown, believed that it Inhibits the uptake of norepinephrine and serotonin in adrenergic and serotonergic neurons.

Indcations: Depression, neuropathic pain and insomnia.

Adverse/Side Effects: Constipation, urinary retention, and drowsiness. cardiac conduction disturbances and hypotension, sedation, cause sexual dysfunction, Black Box Warnings: Higher risk of suicide.

Overdose: Seek medical help, may cause CNS depression ( including respiratory failure and death)

Ernstmeyer & Christman, 2020

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Tricyclic Antidepressants

Mechanism of Action

Amitriptyline is an antidepressant with sedative effects. Its mechanism of action is not known. Amitriptyline inhibits the membrane pump mechanism responsible for the uptake of norepinephrine and serotonin in adrenergic and serotonergic neurons. This interference with the reuptake of norepinephrine and/or serotonin is believed to underlie the antidepressant activity of amitriptyline.

Adverse/Side Effects

Constipation, urinary retention, and drowsiness
Blockage of adrenergic and dopaminergic receptors can cause cardiac conduction disturbances and hypotension.
Histaminergic blockage can cause sedation, and serotonergic blockade can alter the seizure threshold and cause sexual dysfunction.
Black Box Warnings: Higher risk of suicide.

Overdosage

Death may occur from overdosage with this class of drugs. Multiple drug ingestion (including alcohol) is common in deliberate tricyclic antidepressant overdose. If an overdose occurs, consult with a Certified Poison Control Center or go to an emergency room to seek medical help.

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Antidepressant Drugs:

Tricyclic Antidepressants (TCAs)

Nursing Considerations Across the Lifespan

Administer at bedtime due to sedating effects.
Contraindicated with MAOIs.
Special consideration for geratric clients.

In elderly clients, start on low doses and observe closely.

Take precautions to reduce the risk of fall: Fall risk assessment.
Monitor client for worsening depression and change in behaviour.
Taper the dose if discontinuing after prolonged use.

Ernstmeyer & Christman, 2020

Contact info: info@nursesinternational.org

Nursing Considerations Across the Lifespan

TCAs are often administered at bedtime due to sedating effects and are contraindicated with MAOIs.
Geriatric clients are particularly sensitive to the anticholinergic side effects of tricyclic antidepressants.
Peripheral anticholinergic effects include tachycardia, urinary retention, constipation, dry mouth, blurred vision, and exacerbation of narrow-angle glaucoma.
Central nervous system anticholinergic effects include cognitive impairment, psychomotor slowing, confusion, sedation, and delirium.
Elderly clients taking amitriptyline may be at increased risk for falls. Elderly clients should be started on low doses of amitriptyline and observed closely.
Clients receiving antidepressants should be monitored for signs of worsening depression or changing behavior, especially when the medication is started or dosages are changed.
After prolonged administration, abrupt cessation of treatment may produce nausea, headache, and malaise. The dose should be gradually tapered, but transient symptoms may still occur.

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Antidepressant Drugs:

Tricyclic Antidepressants (TCAs)

Client Teaching & Education

Risk of suicide with antidepressants.
Potential side effects (discussed in previous slide) should be reviewed with client.

Ernstmeyer & Christman, 2020

Contact info: info@nursesinternational.org

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Antidepressant Drugs:

Selective Serotonin Reuptake inhibitor (SSRI)

Second generation antidepressant
Has fewer side effects

Example: Fluoxetine and citalopram.

Mechanism of Action: Inhibits the reuptake of serotonin

Indications: Depression, obsessive compulsive disorder, bulimia, panic disorder, posttraumatic stress disorder, other forms of anxiety, premenstrual syndrome, and migraines.

Side effects: Increased risk of suicide, serotonin syndrome,rash, mania, seizures, decreased appetite and weight, increased bleeding, hyponatremia, anxiety, and insomnia.

Ernstmeyer & Christman, 2020

Contact info: info@nursesinternational.org

A second-generation antidepressant and have fewer side effects than TCAs and MAOIs.

Indications: Treat depression, but are also used to treat obsessive-compulsive disorder, bulimia, panic disorder, posttraumatic stress disorder, other forms of anxiety, premenstrual syndrome, and migraines.

Adverse/Side Effects

Black Box Warnings are in place for all classes of antidepressants used with children, adolescents, and young adults for higher risk of suicide.

Clients receiving antidepressants should be monitored for signs of worsening depression or changing behavior, especially when the medication is started or dosages are changed.

The development of a potentially life-threatening serotonin syndrome or neuroleptic malignant syndrome (NMS)-like reactions has been reported with SNRIs and SSRIs, particularly with concomitant use of serotonergic drugs, drugs that impair the metabolism of serotonin (including MAOIs), or with antipsychotics or other dopamine antagonists.

Symptoms of serotonin syndrome may include mental status changes (e.g., agitation, hallucinations, coma), autonomic instability (e.g., tachycardia, labile blood pressure, hyperthermia), neuromuscular aberrations (e.g., hyperreflexia, incoordination), and/or gastrointestinal symptoms (e.g., nausea, vomiting, diarrhea). Serotonin syndrome, in its most severe form, can resemble neuroleptic malignant syndrome (NMS), which includes hyperthermia, muscle rigidity, autonomic instability with possible rapid fluctuation of vital signs, and mental status changes. Clients should be monitored for the emergence of serotonin syndrome or NMS-like signs and symptoms.

Other side effects include rash, mania, seizures, decreased appetite, and weight; increased bleeding associated with the concomitant use of fluoxetine and NSAIDs, aspirin, warfarin, or other drugs that affect coagulation; hyponatremia; anxiety; and insomnia.

Abrupt discontinuation may cause several adverse effects, so a gradual reduction in the dose rather than abrupt cessation is recommended whenever possible.

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Antidepressant Drugs:

Selective Serotonin Reuptake inhibitor (SSRI)

Nursing Considerations Across the Lifespan

Special consideration in the client with liver dysfunction or those taking other CNS medications.
Contraindicated with Monoamine oxidase inhibitors (MAOIs).
Monitor for suicide ideation, serotonin syndrome.
Risk of fall.
Avoid grapefruit.
Do not stop abruptly; taper dose.
It may take up to 12 weeks before achieving therapeutic effect.

Ernstmeyer & Christman, 2020

Contact info: info@nursesinternational.org

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Antidepressant Drugs:

Selective Serotonin Reuptake inhibitor (SSRI)

Client Teaching & Education

Importance of taking medication as directed
Negative effects are associated with the abrupt discontinuation
Risk of drowsiness and confusion
Do not consume with alcoholic beverages
Risk of suicidal ideations asssociated with this medication
Photosensitivity: Use sunglass and sunscreen when in the sun
Risk of decreased libido, urinary retention, constipation

Ernstmeyer & Christman, 2020

Contact info: info@nursesinternational.org

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Antidepressant Drugs:

Serotonin Norepinephrine Reuptake Inhibitor (SNRI)

Example: Venlafaxine

Mechanism of action: Inhibits the reuptake of serotonin and norepinephrine.

Indications: Treatment of major depressive disorder

Adverse effects: Increased suicidality, serotonin syndrome, elevated BP, anxiety,insomnia, decreased appetite, weight loss, mania, hyponatremia, increased bleeding, elevated cholesterol, somnolence, nausea and constipation.

Ernstmeyer & Christman, 2020

Contact info: info@nursesinternational.org

Serotonin Norepinephrine Reuptake Inhibitor (SNRI)

Mechanism of Action

Venlafaxine inhibits the reuptake of serotonin and norepinephrine, with weak inhibition of dopamine reuptake.

Adverse/Side Effects

Children, adolescents, and young adults for a higher risk of suicide. Clients receiving antidepressants should be monitored for signs of worsening depression or changing behavior, especially when the medication is started or dosages are changed.

SNRI medication may cause sustained increase in blood pressure.

Serotonin syndrome:

Symptoms of Serotonin Syndrome:

Insomnia
Anxiety
Decreased appetite
Weight loss
Mania
Hyponatremia
Increased bleeding (especially with the concomitant use of fluoxetine and NSAIDs, aspirin, warfarin, or other drugs that affect coagulation)
Elevated serum cholesterol
Somnolence
Nausea

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Antidepressant Drugs:

Serotonin Norepinephrine Reuptake Inhibitor (SNRI)

Nursing Considerations:

Monitor the behavior changes in client; assess the risk of suicide.
Monitor blood pressure.
Contraindicated with MAOIs or within 14 days of use.
Use with caution with clients with liver or renal disease.
Watch for the signs of hyponatremia in elderly clients.
Use with caution with other serotonin medications.
Client education for use and effects.

Ernstmeyer & Christman, 2020

Contact info: info@nursesinternational.org

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Antidepressant Drugs:

Serotonin Norepinephrine Reuptake Inhibitor (SNRI)

Client Teaching & Education

Importance of taking medication as directed.
Negative effects associated with the abrupt discontinuation of this medication.
Risk of dizziness and drowsiness as side effects of the medication.
Risk associated with alcoholic beverages consumption.
Risk for suicidal behaviors.

Ernstmeyer & Christman, 2020

Contact info: info@nursesinternational.org

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Antidepressant Drugs:

Monoamine Oxidase Inhibitors (MAOI)

First generation antidepressants

Example: Tranylcypromine

Mechanism of action: Assumed to potentiate monoamine neurotransmitter activity in central nervous system.

Indications: Major depressive disorder; When a client does not respond to other antidepressants.

Adverse effect: Increased suicidality, hypertensive crisis, serotonin syndrome, mania, orthostatic hypotension, hepatotoxicity, seizures, hypoglycemia in diabetic clients.

Ernstmeyer & Christman, 2020

Contact info: info@nursesinternational.org

Monoamine Oxidase inhibitors (MAOI)

Mechanism of Action:

The mechanism of action of tranylcypromine tablets as an antidepressant is not fully understood, but is presumed to be linked to potentiation of monoamine neurotransmitter activity in the central nervous system resulting from its irreversible inhibition of the enzyme monoamine oxidase (MAO). MAO inactivates norepinephrine, dopamine, epinephrine, and serotonin. By inhibiting MAO, the levels of these transmitters rise

Indications:

Tranylcypromine is indicated for the treatment of major depressive disorder in adult clients who have not responded adequately to other antidepressants. The drug may also be used to treat Parkinson’s disease.

Adverse/Side Effects

Clients receiving antidepressants should be monitored for signs of worsening depression or changing behavior, especially when the medication is started or dosages are changed.

Hypertensive crisis: Severe hypertension (blood pressure greater than 180/120 mm Hg) with evidence of organ dysfunction.

Symptoms of hypertensive crisis:

Occipital headache which may radiate frontally
Palpitations
Neck stiffness or soreness
Nausea or vomiting
Sweating
Dilated pupils
Photophobia
Shortness of breath, or confusion
Constricting chest pain with either tachycardia or bradycardia
Seizures
Intracranial bleeding

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Antidepressant Drugs:

Monoamine Oxidase Inhibitors (MAOI)

Nursing Considerations

Watch for the signs of hepatotoxicity, hyprtensive crisis, serotonin syndrome.
*Serious interactions with several medications, as well as foods and beverages containing tyramine.
Anticipate postural hypotension and serious adverse effects in elderly clients.
Anticipate and prepare for abuse and dependence.
Expect withdrawal effects to last for several weeks after discontinuation.

Ernstmeyer & Christman, 2020

Contact info: info@nursesinternational.org

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Antidepressant Drugs:

Monoamine Oxidase Inhibitors (MAOI)

Client Teaching & Education

Take medication as directed.
Withdrawal symptoms if abruptly discontinued.
Refrain from consuming alcoholic beverages and other CNS depressants at least for 2 weeks.
Hypertensive crisis and adverse symptoms.
Refrain from activities as driving or operating machinery.
Check food labels for tyramine.

Ernstmeyer & Christman, 2020

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Contact info: info@nursesinternational.org