Adverse Effects, Special Considerations

Question 1

Short Half-Life

Answer 1

Zoloft

Paxil

Effexor

Question 2

Intermediate Half-Life

Answer 2

Celexa

Question 3

Potential to cause GI Issues

Answer 3

Zoloft

Celexa

Effexor

Question 4

Elderly population MDD

Answer 4

Effexor (watch out for hypertension)

Cymbalta (watch out for liver damage)

Remeron

Question 5

Increased risk of seizure

Answer 5

Wellbutrin
*rule out TBI, bulimia, anorexia

Clozapine–especially combined with LIthium

Question 6

Increased risk of mania

Answer 6

Effexor

Prozac

Question 7

Significant weight gain

Answer 7

Remeron, Paxil

Most AP’s, but Clozapine and Zyprexa the most

Question 8

Also treat neuropathic pain

Answer 8

TCA’s

SNRI–effexor, cymbalta

MAOI’s

Lamictal, Depakote

Question 9

Lethal in overdose

Answer 9

TCA’s

Lithium

Question 10

Few drug-drug interactions

Answer 10

Celexa–fewest of all SSRI’s

Zoloft

Effexor

Question 11

Significant drug-drug interactions

Answer 11

Paxil

Prozac

Abilify

Question 12

Risk of Agranulocytosis

Answer 12

Clozapine

Remeron

Question 13

Possible liver damage (transaminitis)

Answer 13

Cymbalta

Atypicals: Clozapine Seroquel, Zyprexa

Question 14

Increased risk of hypertension

Answer 14

Effexor

MAOI’s + Tyramine rich foods

Question 15

Good GI absorption

Answer 15

Prozac

Paxil

Question 16

Choices for treatment-resistant depression

Answer 16

MAOI’S

Effexor

Question 17

Long half-life

Answer 17

Prozac–decreased risk of overdose and withdrawal

Question 18

Reduce painful physical symptoms of depression

Answer 18

Cymbalta

Question 19

Low risk of weight gain

Answer 19

Cymbalta

Geodon

Abilify

Wellbutrin

Question 20

Q-T prolongation

Answer 20

Atypical AP: Sertindole–biggest effect; also Geodon

TCA’s

Wellbutrin

Question 21

Overly sedating

Answer 21

Celexa

Cymbalta

Clozapine

Remeron

Question 22

Low risk of inducing mania

Answer 22

Wellbutrin

Question 23

Abuse potential, psychosis in large doses

Answer 23

Wellbutrin

Question 24

May increase anxiety

Answer 24

Celexa

Prozac

Wellbutrin

Question 25

May cause insomnia

Answer 25

Cymbalta

Prozac

Wellbutrin

Question 26

Pregnancy Contraindications

Answer 26

SSRI: Paxil

BP: Lithium, most Anticonvulsants

Question 27

Risk of Stevens-Johnson Syndrome

Answer 27

Lamictal

Question 28

Preganancy, general consideration

Answer 28

Highest risk = teratogenesis
*malformation of fetus or fetal organs

*1st trimester poses greatest risk to developing organs

Most drugs cross the placenta, so fetal exposure will continue during pregnancy

Question 29

Good choice for: Depressed elderly, failure to thrive, marked weight loss

Answer 29

Remeron

Question 30

GI irritation upon starting Lithium

Answer 30

Leave at current dose

Encourage fluid intake

See if side effects improve

Question 31

SSRI’s that have sig. drug interactions with Abilify

Answer 31

Prozac

Paxil

Question 32

EPS

Answer 32

First generation Typicals, especially high potency: Haldol, Prolixin

Question 33

Akathisia

Answer 33

Abilify

Question 34

Orthostatic Hypotension

Answer 34

Seroquel

MAOI’s

TCA’s