Antidepressant ( Luvox and Prozac )

 Introduction to Pharmacology

     Pharmacology came from a Greek word, pharmakon which means drugs and logos which means science. Pharmacology is basically the study of drugs and their actions on living organisms. Drug is a substance used to diagnose, treat or prevent a condition or disease.

 Classification of Drugs

     In this report, the drugs that we are going to explained about classified as Antidepressant. Antidepressant is used to treat major depressive disorder, some anxiety disorders, some chronic pain conditions and also to help manage some addictions.

 Name of Medications

     Selective Serotonin Reuptake Inhibitors (SSRIs) are the most commonly prescribed class of antidepressants. These drugs fight depression symptoms by decreasing serotonin reuptake in your brain. SSRIs include:

·         Fluoxetine (Prozac)

·         Fluvoxamine (Luvox)

·         Sertraline (Zoloft)

·         Citalopram (Celexa)

·         Escitalopram (Lexapro)

·         Paroxetine (Paxil, Pexeva, Brisdelle)

 Action of Medication     (Prozac)

     Serotonin and norepinephrine, both biological amines, have been shown to play a role in depression. Low concentrations of serotonin appear in the cerebrospinal fluid of patients with depression. Additionally, lower levels of serotonin uptake sites are also present on the platelets of patients with depression. Presynaptic serotonin (5HT1A) receptors are in the dorsal raphe nucleus and project to the prefrontal cortex. Fluoxetine exerts its effects by blocking the reuptake of serotonin neurons by blocking transporter protein located in the synaptic terminal. Fluoxetine also has mild activity at the 5HT2A and 5HT2C receptors.

     Fluoxetine has minimal activity on noradrenergic reuptake. Due to its reuptake of serotonin, fluoxetine produces an activating effect, and due to its long half-life (2 to 4 days), the initial antidepressant effect emerges within 2 to 4 weeks. Fluoxetine's active metabolite is norfluoxetine, which gets produced when the cytochrome P450 enzyme (CYP2D6) acts on it. It is important to remember that fluoxetine has several drug-drug interactions due to its metabolism at the CYP2D6 isoenzyme. Additionally, norfluoxetine can have an inhibitory effect on CYP3A4. It is also important to keep in mind that fluoxetine has a half-life of 2 to 4 days, and its active metabolite, norfluoxetine has a half-life of 7 to 9 days.

 Action of Medication     (Luvox)

     The exact mechanism of an action of fluvoxamine has not been fully determined, but appears to be linked to its inhibition of CNS neuronal uptake of serotonin label 1,2. Fluvoxamine blocks the reuptake of serotonin at the serotonin reuptake pump of the neuronal membrane, enhancing the actions of serotonin on FHT1A auto receptors Label 1,2. Studies have also demonstrated that fluvoxamine has virtually no affinity for α1 or α2 adrenergic, β adrenergic, muscarinic, dopamine D2, histamine H1, GABA-benzodiazepine, opiate, 5-HT1, or 5-HT2 receptors, despite having an affinity for binding to α1 receptors.

 Indication of Medication     (Prozac)

Prozac is indicated for the treatment of acute and maintenance treatment of:

·         Major Depressive Disorder (MDD)

·         Obsessive Compulsive Disorder (OCD)

·         Binge-eating and vomiting behaviours in patients (Bulimia Nervosa)

·         Panic Disorder

·         Premenstrual Dysphoric Disorder

·         Bipolar Depression (as an adjunct with Olanzapine)

Indication of Medication   (Luvox)

Luvox is indicated for the treatment of acute and maintenance treatment of:

·         Obsessive Compulsive Disorder (OCD)

·         Major Depressive Disorder (MDD)

·         Social Phobia

·         Panic disorder

·         Posttraumatic Stress Disorder (PSD)

·         Anxiety Disorder

Contraindication of Medication     (Prozac)

·         Never initiate fluoxetine in a patient receiving linezolid because it will cause seizures

·         Not recommended for use during pregnancy

·         Patients with fluoxetine hypersensitivity

·         Avoid abrupt discontinuation of any SSRI if possible.

·         The dose for children, adolescents or young adults must be weighed against the risk of suicidality

·         Potential for growth inhibition in paediatric patient should be monitored during SSRI therapy

·         Use of monoamine oxidase inhibitors (MAOI) for psychiatric disorders should avoid fluoxetine within 2 weeks of discontinuing MAOI

·         If a patient develops manic symptoms, fluoxetine should be withheld

·         Patients with hepatic disease or dysfunction

Contraindication of Medication     (Luvox)

l  A disorder with excess antidiuretic hormone called syndrome of inappropriate antidiuretic hormone.

l  Low amount of sodium in the blood.

l  An increased risk of bleeding.

l  Manic behavior

l  A form of mania that has a lower severity of symptoms.

l  Manic-depression.

Side Effects of Medication     (Prozac)

·         Nausea

·         Drowsiness / Dizziness

·         Anxiety

·         Insomnia

·         Loss of appetite

·         Tiredness / Yawning

·         Sweating

·         Stuffy nose / Flu

·         Sinus pain

·         Sore throat

·         Decreased sex drive

·         Difficulty having an orgasm

Side Effects of Medication     (Luvox)

l  Drowsiness l  Dizziness l  Shaking l  Feeling anxious l  Depressed mood l  Heavy menstrual periods

l  Insomnia l  Upset stomach l  Loss of appetite l  Vomiting l  Dry mouth l  Muscle pain

Adverse Effect     (Prozac)

     Most common side effects include insomnia, nausea, diarrhoea, anorexia, dry mouth, headache, drowsiness, anxiety, nervousness, yawning, decreased libido, decreased arousal (decreased lubrication in women and decreased erectile function in men), bruising, hyperhidrosis, also may be due to underlying psychosis, induction of mania, rare activation of suicidal thoughts and behaviour in teenagers, weight gain or loss, decreased orgasm, muscle weakness, tremors, and pharyngitis.

     The 5HT2C antagonism is what is thought to contribute to the anxiety, insomnia, and agitation that patients experience with fluoxetine. Patients may also have a panic attack with the administration of fluoxetine. Thus, it is the clinician's responsibility to educate patients.

     Most side effects are immediate and disappear over time. It is preferable to wait for the side effects to subside before altering treatment. Most side effects are dose-dependent and time-dependent. It is important to pay attention to the appearance of agitation or activation, which may indicate a bipolar state that require the addition of a mood stabilizer or an atypical antipsychotic. Fluoxetine can be activating, therefore, if insomnia is present, consider taking the medicine early in the morning. One may reduce the dose if side effects are too distressing for the patient. The patient should be warned about side effects. If they persist, switching to a different antidepressant may be indicated after a few weeks.

     It is best to try another antidepressant before relying on augmentation strategies. This approach can minimize polypharmacy and encourage adherence to psychotropic medications. Trazodone, mirtazapine, or a hypnotic may be options for insomnia. Mirtazapine may also help with agitation or gastrointestinal side effects. Benzodiazepines may be used to treat anxiety. Bupropion or a phosphodiesterase inhibitor may address sexual dysfunction.

 

Adverse Effect     (Luvox)

     The adverse effects of prolonged oral administration of fluvoxamine on haematology, biochemical parameters and fertility in male rats were evaluated in this study. Sixty adult male rats were allocated into five equal teams and orally treated with fluvoxamine 9 mg kg−1 b.wt. (low therapeutic dose, LTD) and 27 mg kg−1 b.wt. (high therapeutic dose, HTD), whereas the control rats received 0.5 ml distilled water for 8 weeks. The fourth and fifth groups were gavage with LTD and HTD of fluvoxamine for 8 weeks and left untreated for another 8 weeks. HTD of fluvoxamine induced leucocytosis, lymphocytosis and monocytosis. LTD and HTD of fluvoxamine evoked hepatic, renal and cardiac dysfunction. Moreover, fluvoxamine treatment may cause male infertility, which is indicated by its deleterious impacts on spermiogram and steroidogenesis hormones. They also induced oxidative stress, apoptosis in testicular tissue. Fortunately, the previous alterations were mostly reversed throughout the recovery period

Nursing Responsibilities

     At the point when medications are used in a clinical setting, they can possibly give restorative advantages to patients who are tormented with quite a few ailments and illnesses. Scientific advancements in the field of clinical pharmacology are working on the manners by which medications cooperate with people. However, considerable challenges are as of now thwarting new medication advancement. Doctors of Nursing Practice (DNPs) have an obligation to offer their patients viable consideration and guidance, while likewise staying aware of the freshest advancements inside the field of clinical pharmacology.

Prozac: Nursing Responsibilities

ASSESSMENT

§  History: Hypersensitivity to fluoxetine, impaired hepatic or renal function, diabetes mellitus, lactation, pregnancy and seizures

§  Physical: Skin rash, lesions, reflexes, affect; bowel sounds, liver evaluation, peripheral perfusion, urinary output, renal function tests

 

INTERVENTIONS

1. Arrange for lower or less frequent doses in elderly patients and patients with hepatic or renal impairment.
2. Establish suicide precautions for severely depressed patients. Limit quantity of capsules dispensed; high risk in children and adolescents.
3. Administer drug in the morning.
4. Monitor patient for response to therapy for up to 4 weeks before increasing dose.
5. Switch to once-a-week therapy by starting weekly dose 7 days after last 20 mg/day dose. If response is not satisfactory, reconsider daily dosing.

Luvox: Nursing Responsibilities

ASSESSMENT

§  Hypersensitivity to fluvoxamine, lactation, impaired hepatic function, suicidal tendencies, seizures, mania, labour and delivery, pregnancy

§  Skin rash, lesions; reflexes, bowel sounds, liver evaluation, peripheral perfusion, renal function tests

 

INTERVENTIONS

1. Give lower or less frequent doses in elderly patients and with hepatic or renal impairment.
2. Establish suicide precautions for severely depressed patients, children, and adolescents. Limit quantity of tablets dispensed.
3. Administer drug at bedtime. If dose exceeds 100 mg, divide dose and administer the largest dose at bedtime.
4. Monitor patient for therapeutic response for up to 4–7 days before increasing dose.
5. Monitor patient for serotonin hypertension syndrome, elevated fever, severe anxiety, rigidity.
6. When discontinuing the drug, taper dose by 50 mg/day every 5–7 days.