Psychiatric Mental Health Nursing by Videbeck

15 MOODDISORDERS ANDSUICIDE 339

benzodiazepines (alprazolam, estazolam, and triazo-
lam) and the H 2 blocker terfenadine. Remeron also
inhibits the reuptake of serotonin and norepineph-
rine, has few sexual side effects, but has higher inci-
dence of weight gain, sedation, and anticholinergic
side effects (Facts and Comparisons, 2002).

MAOIs. This class of antidepressants is used infre-
quently because of potentially fatal side effects and
interactions with numerous drugs, both prescription

and over-the counter preparations (Table 15-4). The

most serious side effect is hypertensive crisis,a

life-threatening condition that can result when a

client taking MAOIs ingests tyramine-containing

foods and fluids or other medications. Symptoms are

occipital headache, hypertension, nausea, vomiting,

chills, sweating, restlessness, nuchal rigidity, dilated

pupils, fever, and motor agitation. These can lead

to hyperpyrexia, cerebral hemorrhage, and death.

The MAOI-tyramine interaction produces symp-

Table 15-2

TRICYLICANTIDEPRESSANTMEDICATIONS

Generic (Trade) Name Side Effects Nursing Implications

amitriptyline (Elavil)

amoxapine (Asendin)

doxepin (Sinequan)

imipramine (Tofranil)

desipramine

(norpramine)

nortriptyline

(Pamelor)

Dizziness, orthostatic hypotension,

tachycardia, sedation, headache,

tremor, blurred vision, constipation,

dry mouth and throat, weight gain,

urinary hesitancy, sweating

Dizziness, orthostatic hypotension,

sedation, insomnia, constipation,

dry mouth and throat, rashes

Dizziness, orthostatic hypotension,

tachycardia, sedation, blurred vision,

constipation, dry mouth and throat,

weight gain, sweating

Dizziness, orthostatic hypotension,

weakness, fatigue, blurred vision,

constipation, dry mouth and throat,

weight gain

Cardiac dysrhythmias, dizziness,

orthostatic hypotension, excitement,

insomnia, sexual dysfunction, dry

mouth and throat, rashes

Cardiac dysrhythmias, tachycardia,

confusion, excitement, tremor,

constipation, dry mouth and throat

Assist client to rise slowly from sitting

position.

Administer at bedtime.

Encourage use of sugar-free beverages

and hard candy.

Ensure adequate fluids and balanced

nutrition.

Encourage exercise.

Monitor cardiac function.

Assist client to rise slowly from sitting

position.

Administer at bedtime if client is sedated.

Ensure adequate fluids.

Encourage use of sugar-free beverages

and hard candy.

Report rashes to physician.

Assist client to rise slowly from sitting

position.

Administer at bedtime if client is sedated.

Ensure adequate fluids and balanced

nutrition.

Encourage use of sugar-free beverages

and hard candy.

Encourage exercise.

Assist client to rise slowly from sitting or

supine position.

Ensure adequate fluids and balanced

nutrition.

Encourage use of sugar-free beverages

and hard candy.

Encourage exercise.

Monitor cardiac function.

Assist client to rise slowly from sitting

position.

Administer in AM if client is having

insomnia.

Encourage sugar-free beverages and

hard candy.

Report rashes or sexual difficulties to

physician.

Monitor cardiac function.

Administer in am if stimulated.

Ensure adequate fluids.

Encourage use of sugar-free beverages

and hard candy.

Report confusion to physician.