Selective serotonin reuptake inhibitors Flashcards
What is the class of drug that is considered first line in the treatment of depression?
Selective serotonin reuptake inhibitors (SSRI)
What are the two preferred selective serotonin reuptake inhibitors (SSRIs) as first line in the treatment of depression?
Sertraline (in Notts - cheapest)
Fluoxetine
Citalopram
What is the selective serotonin reuptake inhibitor (SSRI) that is first line in the management of depression post myocardial infarction?
Sertraline
What are the common side effect of SSRIs?
Gastrointestinal symptoms including GI bleeding - most common
Increased anxiety, insomnia and agitation after starting SSRI
Which class of drug increases the likelihood of GI bleeding in a patient on SSRIs?
NSAIDs
Which class of drug should be prescribed to patient on SSRIs if they are also taking NSAIDs?
Proton pump inhibitors - eg omeprazole
Which two SSRIs have the highest propensity for drug interactions?
Fluoxetine
Paroxetine
Which SSRIs are particularly associated with QT interval prolongation?
Citalopram
Escitalopram
In which patients should citalopram be avoided?
Those who:
Have congenital long QT syndrome
Have pre-existing QT interval prolongation
Are currently on other medications that prolong QT interval
Other than citalopram and escitalopram, what commonly prescribed drugs are known to prolong QT interval?
Class 3 antiarrhythmics - Amiodarone and sotalol
Class 1a antiarrhythmics - Quinine and procainamide
Tricyclic antidepressants - Amitriptyline
Methadone
Chloroquine
Erythromycin
Haloperidol
Which SSRI should patients on antithrombotic agents such as warfarin or heparin be offered?
NICE guidelines recommends avoiding SSRIs in those patients on warfarin or heparin due to interactions. They should be offered mirtazapine instead (SNRI).
What are the drugs that should be avoided if possible if a patient is on SSRI, or conversely a patient being on which drugs may contraindicate starting them on a SSRI?
NSAIDs - avoid if possible or start on PPI
Warfarin/heparin - offer mirtazapine (SNRI) instead
Triptans - avoid SSRI
How long after starting a patient on a SSRI should the GP review them?
2 weeks - most patients
1 week - if under 30 or at an increased risk of suicide
If a patient has a good response to a SSRI, what is the minimum length of time that they should be continued on the medication to reduce chance of relapse?
6 months after remission
When stopping a SSRI, how should this be done?
Gradual dose reduction over a 4 week period