SSRI_Side_Effects_Flashcards

Question 1

What are the most common side-effects of SSRIs?

Answer 1

Gastrointestinal symptoms are the most common side-effects of SSRIs.

Question 2

What is the risk associated with gastrointestinal bleeding in patients taking SSRIs?

Answer 2

There is an increased risk of gastrointestinal bleeding in patients taking SSRIs.

Question 3

What should be prescribed if a patient taking SSRIs is also taking an NSAID?

Answer 3

A proton pump inhibitor should be prescribed if a patient taking SSRIs is also taking an NSAID.

Question 4

What electrolyte imbalance can be caused by SSRIs?

Answer 4

SSRIs can cause hyponatraemia.

Question 5

What should patients be vigilant for after starting an SSRI?

Answer 5

Patients should be vigilant for increased anxiety and agitation after starting an SSRI.

Question 6

Which SSRIs have a higher propensity for drug interactions?

Answer 6

Fluoxetine and paroxetine have a higher propensity for drug interactions.

Question 7

What warning did the MHRA release regarding citalopram in 2011?

Answer 7

The MHRA released a warning in 2011 that citalopram and escitalopram are associated with dose-dependent QT interval prolongation.

Question 8

What are the conditions under which citalopram should not be used?

Answer 8

Citalopram should not be used in patients with congenital long QT syndrome, known pre-existing QT interval prolongation, or in combination with other medicines that prolong the QT interval.

Question 9

What is the maximum daily dose of citalopram for adults, patients older than 65 years, and those with hepatic impairment?

Answer 9

The maximum daily dose of citalopram is 40 mg for adults, 20 mg for patients older than 65 years, and 20 mg for those with hepatic impairment.

Question 10

What does NICE advise regarding the use of SSRIs with NSAIDs?

Answer 10

NICE advises ‘do not normally offer SSRIs’ with NSAIDs, but if given, co-prescribe a proton pump inhibitor.

Question 11

What does NICE recommend regarding the use of SSRIs with warfarin or heparin?

Answer 11

NICE recommends avoiding SSRIs with warfarin or heparin and considering mirtazapine.

Question 12

What does NICE advise regarding the use of SSRIs with aspirin?

Answer 12

NICE advises avoiding SSRIs with aspirin.

Question 13

What is the recommendation for SSRIs and triptans?

Answer 13

SSRIs should be avoided with triptans.

Question 14

When should patients normally be reviewed by a doctor after initiating antidepressant therapy?

Answer 14

Patients should normally be reviewed by a doctor after 2 weeks of initiating antidepressant therapy.

Question 15

When should patients under the age of 30 years or at increased risk of suicide be reviewed after starting antidepressant therapy?

Answer 15

Patients under the age of 30 years or at increased risk of suicide should be reviewed after 1 week of starting antidepressant therapy.

Question 16

How long should a patient continue on antidepressant therapy after remission to reduce the risk of relapse?

Answer 16

Patients should continue on antidepressant therapy for at least 6 months after remission to reduce the risk of relapse.

Question 17

How should the dose of an SSRI be reduced when stopping?

Answer 17

The dose of an SSRI should be gradually reduced over a 4-week period when stopping.

Question 18

Which SSRI does not require dose reduction when stopping?

Answer 18

Fluoxetine does not require dose reduction when stopping.

Question 19

Which SSRI has a higher incidence of discontinuation symptoms?

Answer 19

Paroxetine has a higher incidence of discontinuation symptoms.

Question 20

What are some discontinuation symptoms associated with stopping SSRIs?

Answer 20

Discontinuation symptoms associated with stopping SSRIs include increased mood change, restlessness, difficulty sleeping, unsteadiness, sweating, gastrointestinal symptoms (pain, cramping, diarrhoea, vomiting), and paraesthesia.

Question 21

An 80-year-old female presents to general practice for an annual general check-up. She has no particular complaints and on examination, no abnormalities were found.

You check the blood test results which were sent by the nurse prior to the appointment:

Na+ 129 mmol/l
K+ 4 mmol/l
Urea 3 mmol/l
Creatinine 80 µmol/l

You decide to review her medications.

Which of the following medications is most likely to have caused her electrolyte abnormality?

Aspirin
Bisoprolol
Ramipril
Sertraline
Sildenafil

Answer 21

Sertraline

SSRIs are associated with hyponatraemia
Important for meLess important
Aspirin is not associated with hyponatraemia. A common side effect is dyspepsia.

Bisoprolol is a beta-blocker, which is not commonly associated with hyponatraemia. The main side effects are bradycardia.

Ramipril is an ACE inhibitor, which is associated with hyperkalaemia, particularly in those with reduced renal function.

Sertraline is a selective serotonin reuptake inhibitor (SSRI). This class of drugs are known to be associated with hyponatraemia, especially in the elderly

Sildenafil, also known as viagra, is not associated with hyponatraemia.