Antidepressants- SSRI's

Question 1

What does SSRI stand for?

Answer 1

Selective serotonin reuptake inhibitors

Question 2

What is the main use for SSRI’s?

Answer 2

Depression

Question 3

What is the mechanism of SSRI’s?

Answer 3

Block the presynaptic serotonin reuptake

Question 4

What are the 2 most commonly used SSRI’s?

Answer 4

Sertraline
Fluoxetine

Question 5

What is the more useful SSRI post MI?

Answer 5

Sertraline

Question 6

What tends to be the drug of choice when an antidepressant is indicated?

Answer 6

Fluoxetine

Question 7

What is the most common side effect of SSRI’s?

Answer 7

Gastrointestinal symptoms- Increased risk of GI bleeding

Question 8

What should be give if a patient is taking an SSRI and NSAID?

Answer 8

Proton Pump Inhibitor

Question 9

How might a patient feel after starting on an SSRI?

Answer 9

Increasing anxious and agitated

Question 10

What is the main adverse effect of citalopram?

Answer 10

Can cause a prolonged QT interval

Question 11

In which patients should citalopram not be used?

Answer 11

Patients with:
• Congenital long QT syndrome
• Known pre-existing QT interval prolongation
• In combination with other medicines that prolong the QT interval

Question 12

Which drugs to SSRI’s interact with?

Answer 12

NSAID's 
Warfrain/heparin 
Triptans
Aspirin 
Monoamine Oxidase Inhibitors (MAOIs)

Question 13

What do triptans increase the risk of when given with an SSRI?

Answer 13

Serotonin syndrome

Question 14

What do Monoamine Oxidase Inhibitors increase the risk of when given with an SSRI?

Answer 14

Serotonin syndrome

Question 15

When should a patient be reviewed after starting an Antidepressant?

Answer 15

After 2 weeks

Question 16

When should patients under 30 or at increased risk of suicide be reviewed after starting an Antidepressant?

Answer 16

After 1 week

Question 17

How long should a patient be kept on an antidepressant to prevent risk of relapse?

Answer 17

At least 6 months

Question 18

When stopping an SSRI, over how long of a period should the dose be reduced?

Answer 18

Over a 4 week period

not with fluoxetine

Question 19

What are the symptoms of discontinuation syndrome?

Answer 19

• increased mood change
• restlessness
• difficulty sleeping
• unsteadiness
• sweating
• gastrointestinal symptoms: pain, cramping, diarrhoea, vomiting
• paraesthesia

Question 20

What does the use of SSRI’s in the first trimester of pregnancy increase the risk of?

Answer 20

Congenital Heart Defects

Question 21

What does the use of SSRI’s in the third trimester of pregnancy increase the risk of?

Answer 21

Persistent pulmonary hypertension of the baby

Question 22

What are the 2 main issues with Paroxetine?

Answer 22

Higher incidence of discontinuation symptoms.

Increased risk of congenital malformations, especially in first trimester

Question 23

What are the characteristic features of sertraline?

Answer 23

Short half- life
needs to be taken with food- GI upset

Question 24

What are the characteristic features of Fluoxetine?

Answer 24

Long half-life
Initially will increase anxiety and insomnia

Question 25

What are the 2 main side effects of SSRI’s?

Answer 25

GI upset
Sexual dysfunction

Question 26

What is the problem with taking an SSRI and NSAID?

Answer 26

Increase the risk of GI bleeding