Chapter 3 CNS - Selective serotonin uptake inhibitors

Question 1

Fluoxetine (prozac)

Answer 1

• selective serotonin reuptake inhibitor

indication
* depression
* obsession compulsive disorder (OCD)
* bulimia nervosa

effects
* drug d/c in 15% of pt d/t
1) nausea
2) headache
3) nervousness
4) insomnia
5) anxiety or diarrhea
6) altered platelet function (component of platelet for serotonin)
7) rash (SSRI-drugs increase serotonin concentrations and are known to have pruritus and other dermal side effects, including macular rash.)

drug interactions
* life threatening rxn possible with MAOI and with cisapride (GERD); do not use within 2 weeks

increased suicide rate with pts using this drug

Question 2

sertraline (zoloft)

Answer 2

• SSRI

indication:
* depression
* obsessive compulsive disorder
* panic disorder

effect
* nausea
* headache
* diarrhea
* dry mouth (GI related.. w/ serotonin?)
* dizziness
* insomnia
* fatigue
* abnormal ejaculation
* altered platelet function (component of platelet – serotonin)

PO
high plasma protein binding (once daily)

drug interaction
* MAOI interaction?
* does not affect other protein bound drugs

Question 3

fluvoxamine (luvox)

Answer 3

• SSRI

indication:
* obsessive compulsive disorder (OCD)

effect:
* nausea
* dry mouth (GI related.. w/ serotonin?)
* asthenia (abnormal physical weakness or lack of energy)

PO
reduce dose with liver dysfunction

Contraindicated with cisapride (GERD)

Question 4

Paroxetine (paxil)

Answer 4

• SSRI

indication
* depression
* OCD
* panic d/o

effects:
* n/v
* somnolence (excess sleepiness, drowsiness)
* insomnia
* dizziness
* agitation/anxiety
* weakness
* headache
* abnormal ejactulation
* altered platelet functon (serotonin - important platelet component)

drug interaction
* Contraindicated with cisapride
* Cimetidine (gastric acid reducer used in the short-term treatment of duodenal and gastric ulcers + anthistamine?) increases paroxetine
* Paroxetine reduces phenytoin + digoxin while increasing warfarin!

Question 5

citalopram (celexa)
escitalopram (lexapro)

Answer 5

• depression

Question 6

trazodone

Answer 6

• SSRI
• serotonin receptor antagonists and reuptake inhibitors (SARIs)

indication
* depression; can be used tx aggressive d/o

effects:
* rash (SSRI-drugs increase serotonin concentrations and are known to have pruritus and other dermal side effects, including macular rash.)
* HTN
* tachycardia
* SOB
* CNS effects
* loss appetite
* priaprism

PO

substructure for cytochrome CYP206