June09 psychotherapeutic agents- mirtazapine

Peak Development for .
Vol. 10 Issue 6
Medication Administration
June 2009
Psychotherapeutic Agents:
Mirtazapine (Remeron)
Peak Development Resources P.O. Box 13267 After completion the learner should be able to: 1. Identify appropriate indications for use of unknown. It is believed to increase levels of neurotransmitters, such as norepinephrine and 2. Relate general characteristics of mirtazapine to specific patient situations. serotonin. The drug antagonizes selected 5-HT receptors. It also produces significant 3. Apply nursing process considerations for Peak Development for… Medication antihistamine and alpha-adrenergic blocking Administration and Competency mirtazapine to specific patient situations. effects, resulting in effects such as drowsiness Administration are components of Depression
Absorption—Rapidly and completely absorbed health disorder, affecting nearly 30% of adults at some time during their lives. Three forms of Distribution—Highly protein bound; studies depression include major depression, dysthymia have shown that the drug enters breast milk and bipolar disorder. The Diagnostic and Metabolism—Metabolized in the liver; effects Statistical Manual of Mental Disorders 4th edition characterizes symptoms of depression as depressed mood or loss of interest or pleasure in all usual activities. Other common Elimination—Predominantly via the kidneys, symptoms include weight loss and anorexia, Peak Development for… Medication with a smaller amount eliminated via the Administration is intended only as insomnia or hypersomnia, fatigue, inability to concentrate, feelings of worthlessness and guilt, administer medications. Every effort has been made to verify the depression is believed to involve an insufficiency Alcohol and other CNS depressants: of the neurotransmitters serotonin and/or Concurrent use may increase CNS depression. norepinephrine. Environmental, social, and Antihypertensive drugs: Concurrent use may in the field of drug therapy, the reader is advised to consult the genetic factors also play an important role. Medication is the primary therapy for MAO Inhibitors: Concurrent use may result in depression. Other treatment options include serious adverse effects, including seizures, information. This is particularly important for new or seldom used electro-convulsive therapy and psychotherapy. severe hypertension and/or hyperthermia. These drugs should not be administered within judgment is required in all patient care situations. It is the reader’s Mirtazapine (Remeron)
Mirtazapine is indicated for the treatment Sedation with resulting drowsiness is a of major depressive disorder. It is not for use in treatment of bipolar disorder. Mirtazapine is approximately half of patients who take the classified as a tetracyclic antidepressant, and is drug. This may or may not resolve over time. structurally unrelated to selective serotonin orthostatic hypotension, constipation, nausea, increased appetite, weight gain, or muscle pain. antidepressants, and monoamine oxidase Changes in mood or mental status may occur, including anxiety, agitation, confusion, hallucinations, or mania. with meals. The dosage is most commonly administered in a The drug may also cause decreased saliva production, causing single daily dose, usually at bedtime, due to the sedative effects. dry mouth and increasing the risk for dental caries, gingivitis, and Observe for therapeutic effects: It is important to note that oral yeast. Blood dyscrasias, such as neutropenia or therapeutic effects of mirtazapine may not begin until 1-4 weeks agranulocytosis, may rarely occur, increasing risk for infection. following initial administration. Behavior indicating a positive Mirtazapine has less adverse effect on sexual function than other therapeutic response includes increased feelings of worth and antidepressants, which may be helpful for patients who have had well being, interest in surrounding environment, increased participation in social activities and improved appearance. Mirtazapine is contraindicated for use in patients who have drowsiness, nausea, weight gain, constipation, or changes in known hypersensitivity to this drug. Caution should be used in mood or mental status. Because there may be increased risk of patients with hepatic or renal impairment, hypotension, heart suicide with antidepressant therapy, each patient must be failure or other cardiovascular problems made worse by carefully screened for suicide risk. This is especially important at hypotension, and history of seizures, mania, or drug the onset of treatment and with dosage changes, when risk appears to increase. Blood pressure and white blood cell count Nursing Process
should also be monitored periodically to assess for hypotension Determine baseline status: A complete mental/psychological status assessment is necessary to measure therapeutic effect, as mirtazapine focuses on measures to promote compliance and well as to determine suicide potential. Any patient who is a risk to safety with drug regimen. Patients and family members should himself or others requires hospitalization for initial intervention. Take note of the patient’s affect, thought patterns, appetite, sleep • The medication may need to be taken for several weeks patterns and appearance. In addition, perform a complete before significant improvement in symptoms is noted. physical assessment and review renal and liver function studies, • Continue taking the medication even when mood is improved. as well as baseline white blood cell count. • Do not discontinue the medication or change the dosage Identify risk factors: Screen for factors that may increase risk without contacting the prescriber. of adverse drug reactions, such as hypotension, liver or renal • Change positions slowly until drug effects are known. impairment, blood dyscrasias, history of seizures, mania or drug • Avoid hazardous activities involving machinery and driving dependence. A complete medication history is important to until drug effects are known, due to potential effects of prevent serious complications related to drug interactions. If MAO inhibitor drugs have been taken, document discontinue • Do not use any prescription or over-the-counter drugs without checking with the doctor who prescribed the mirtazapine. • Engage in exercise and reduce caloric intake to prevent There are no documented adverse effects to a nursing infant. This drug is used in pregnant and breastfeeding women only • Watch for suicidal ideation, particularly at onset of treatment when drug benefits outweigh possible risks. Safety and efficacy for use in the pediatric population have not been established. • Avoid the use of alcohol or CNS depressant medications. There are no known problems that limit use in the geriatric • Brush and floss teeth daily, and have regular dental exams. population, although this group is more likely to have renal or • Seek immediate treatment if adverse changes in mental status occur, such as confusion, agitation, mania, or suicidal • Contact physician promptly if signs of infection occur, such as The desired outcomes of therapy are decreased symptoms of depression and absence of suicidal ideation. • Keep all appointments for medical follow-up or psychological Medication administration: Mirtazapine is available in oral tablet form (Remeron) and in oral disintegrating tablet form (Remeron SolTab). The oral disintegrating tablet is placed on top Appropriate use of antidepressant medication, along with of the tongue, where it immediately dissolves. Mirtazapine may education, monitoring, and counseling, can help patients to be administered without regard to meals. If nausea occurs, manage symptoms of depression and enjoy improved quality of however, the patient may find it helpful to take the medication Peak Development for… Medication Administration
Psychotherapeutic Agents: Mirtazapine (Remeron)

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