Pharmacologic Therapies

Question 1

What are the two most common, first line uses of SSRI medications?

Answer 1

Depression and anxiety

Question 2

What is the typical duration for SSRI use?

Answer 2

Take 1-2 months to begin working. Continue for 12 months after symptom free.

Question 3

What are the advantages of SSRI medications?

Answer 3

Easy dosing, few AEs, low risk in overdose

Question 4

List some examples of SSRI medications.

Answer 4

Fluvoxamine (Luvox), Fluoxetine (Prozac), Paroxetine (Paxil), Sertraline (Zoloft), Citalopram (Celexa), Escitalopram (Lexapro)

Question 5

Are SSRIs metabolized hepatically or renally?

Answer 5

hepatically

Question 6

SSRIs should be avoided in patients with what psychiatric condition?

Answer 6

Bipolar –> can trigger manic episode

Question 7

Describe the clinical presentation of serotonin syndrome.

Answer 7

Hyperthermia, hypertension, hallucinations, dizziness, ataxia, tremors, sweating, diarrhea, dilated pupils

Question 8

How should SSRI medications be discontinued and with which SSRIs is this most important?

Answer 8

Slow taper to avoid flu-like symptoms. Most important with paroxetine and sertraline (shortest half-lives)

Question 9

What SSRI is least associated with weight gain? Most associated?

Answer 9

Least: Sertraline
Most: Paroxetine

Question 10

Which SSRI should be avoided in pregnancy?

Answer 10

Paroxetine s/p cardiac abnormality risk

Question 11

List some examples of SNRI medications.

Answer 11

Venlafaxine (Effexor), Desvenlafaxine (Pristiq), Duloxetine (Cymbalta), Milnacipran (Savella), Levomilnacipran (Fetzima)

Question 12

Describe the uses of SNRI medications.

Answer 12

Pain or fatigue syndromes, especially associated with depression.
Second line for depression refractory to SSRIs
Off-label for ADHD, especially ADHD plus depression

Question 13

Which SNRI is best for low back pain, osteoarthritis, and fibromyalgia?

Answer 13

Duloxetine (Cymbalta)

Question 14

Resume with atypicals on page 26

Answer 14

A