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SSRIs > Fluoxetine (Prozac, Sarafem) > Flashcards

Fluoxetine (Prozac, Sarafem) Flashcards

1
Q

Brands (3)

A
  • Prozac
  • Prozac weekly
  • Sarafem
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2
Q

Class

A

SSRI (serotonin 1A)

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3
Q

Uses

A
  • Major depressive disorder (8 yr+)
  • OCD (7 yr+)
  • PMDD
  • Bulimia
  • Panic disorder
  • Bipolar depression (along with Olanzapine)
  • Treatment resistant depression (with Olanzapine)
  • Social anxiety disorder
  • PTSD
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4
Q

MOA

A
  • Selective serotonin 1A reuptake inhibitor
  • Blocks serotonin reuptake pump
  • Desensitizes serotonin receptors
  • Also antagonizes serotonin 2C receptors (which increase NE and DA transmission)
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5
Q

Onset of action

A
  • 2-4 weeks
  • may cause increased energy initially
  • if nothing after 6-8 weeks, increase dose or change
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6
Q

If it works

A
  • If first episode - continue till 1 year after all symptoms gone
  • If second or more- continue indefinitely
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7
Q

If it doesn’t work

A

*Dose change, switch or augment in case of partial response, no response or no longer responding

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8
Q

Augment with

A

*Insomnia - Trazodone
*Depression persists - Can add bupropion, mirtazapine, reboxetine, atomoxetine
*Fatigue, sleepiness, lack of conc - Modafinil
*Bipolar- Mood stabilizers or atypical antipsychotics
FLUOXETINE + OLANZAPINE is EXCELLENT combo for bipolar depression, psychotic depression, t/t resistant unipolar depression
*Anxiety- Gabapentin, Tiagabine

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9
Q

S/Es, why they happen

A

*Caused due to inc serotonin in receptors in other parts of brain and body -
sleep centers - insomnia
gut - diarrhea

  • inc serotonin can dec dopamine release - emotional flattening, cognitive slowing, apathy
  • Serotonin 2C antagonism - anxiety, agitation
  • Notable S/Es-
  • Sexual dysfunction.
  • GI - N/V, constipation, diarrhea, dry mouth
  • CNS - insomnia, sedation, agitation, tremors, headache, dizziness
  • Sweating, bruising, SIADH

*Rare-
seizures
induce mania
suicidal ideation (less than 24 y/o)

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10
Q

What to do about S/Es

A
  • wait
  • If insomnia - take in morning
  • reduce dose to 10, then keep at 10 or increase to 20
  • switch or augment
  • sexual dysfunction - Bupropion, sildenafil, vardenafil, tadalafil
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11
Q

Dosing

A

*Depression 20-80 mg
Anxiety, OCD 20-80 mg
Start at 20 in morning, assess in a few weeks, inc upto 80 max

*Bulimia 60-80 mg in morning

*Forms - 
capsule 10, 20, 40, 60 mg
tablet 10 mg
liquid 20 mg/5 ml - 120 ml bottles
weekly capsule 90 mg
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12
Q

Dosing tips

A
  • Once daily orally, usually in morning
  • weekly may inc compliance
  • more anxious pt - low starting dose, slow titration
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13
Q

OD, Taper or not

A

Rarely lethal in mono therapy OD
Resp depression, esp with alcohol, ataxia, sedation, seizures

Taper rarely necessary due to long half life

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14
Q

Half life parent drug

A

2-3 days

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15
Q

Half life metabolite

A

Norfluoxetine - 2 weeks

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16
Q

CYP action

A

Inhibits CYP450 2D6 and 3A4

17
Q

DI with Tramadol

A

Seizure risk high

18
Q

DI with TCAs

A

can inc TCA levels

19
Q

DI with MAOIs

A
  • Fatal serotonin syndrome - no overlap for 14 days after MAOI stopped.
  • Don’t use MAOI for 5 weeks after stopping fluoxetine.
20
Q

DI with warfarin

A

Can displace it from protein - inc warfarin level - bleeding, bruising risk

21
Q

NSAIDs + SSRIs

A

NSAIDs reduce effectiveness of SSRIs

22
Q

DI due to CYP 2D6 action

A
  • Inhibition could interfere with analgesic action of codeine
  • Inhibition inc plasma levels of beta blockers and atomoxetine
  • Inhibition inc conc of thioridazine - cardiac arrhythmia
23
Q

DI due to CYP 3A4 action

A

Inhibits CYP 3A4 -

  • inc level of alprazolam, buspirone, triazolam
  • inc pimozide - QTc prolongation - cardiac arrhythmia

Inhibit HMG CoA reductase inhibitors -

  • inc conc of simva, atorva, lovastatin - rhabdomyolysis
  • no effect on prava, fluvastatin
24
Q

DI with Diazepam, Trazodone

A

can inc their levels by reducing clearance

25
Q

Precautions

A
  • Cautious to start another antidepressant for upto 5 weeks after stopping fluoxetine
  • Cautious with seizure history pts
  • Cautious in bipolar pts
  • Warn about suicidal ideation, esp in kids
26
Q

C/I

A 
Don't give with 
*MAOI
* thioridazine
*pimozide
*tamoxifen
Allergic
27
Q

Renal, hepatic, cardiac pts

A
  • Half dose in hepatic impairment pts

* Safe and even protective in MI/Angina pts, improve survival and mood

28
Q

Elderly, Kids, Pregnancy, BF

A

Same as Sertraline

29
Q

Advantages

A
  • Atypical depression (hypersomnia, inc appetite)
  • fatigue and low energy
  • comorbid eating disorder
  • Generic less expensive than brand name
  • weekly administration possible
  • kids with OCD or depression
30
Q

Disadvantages

A
  • Anorexia
  • starting t/t in anxious, agitated pts
  • starting t/t in severe insomnia
31
Q

Target symptoms

A
  • depressed mood
  • energy, motivation, interest
  • anxiety (can inc short term anxiety in the beginning tho)
  • sleep disturbance (can inc short term)
32
Q

Of note

A
  • Maybe first choice for atypical depression
  • Avoid in agitated insomniacs
  • Not as well tolerated for panic disorder, anxiety disorder
  • long half life, even longer metabolite half life
  • Helpful in mood disorder with eating disorder

SSRIs (6 decks)

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