SSRIs Flashcards
1
Q
Name the 8 SSRIs
A
Citalopram
Escitalopram
Fluoxetine
Fluvoxamine
Paroxetine
Sertraline
Vortioxetine
Vilazodone
2
Q
Brand name of citalopram
A
Celexa
3
Q
Brand name of Escitalopram
A
Lexapro
4
Q
Brand name of fluoxetine
A
prozac
5
Q
brand name of fluvoxamine
A
luvox
6
Q
brand name of paroxetine
A
paxil
7
Q
brand name of sertraline
A
zoloft
8
Q
brand name of vortioxetine
A
trintellix
9
Q
which 3 SSRIs cause increased sweating
A
citalopram
paroxetine
sertraline
10
Q
what can increased doses of citalopram treat
A
binge eating
11
Q
dosage range for citalopram
A
20-40mg in am with food
12
Q
main off label use for citalopram
A
binge eating
13
Q
what is the maximum dose of citalopram for patients over 60 and why
A
20mg daily due to QT prolongation
14
Q
What baseline test should you get on patients starting citalopram who are over 40
A
ECG d/t prolongation risk
15
Q
what is the max dose of citalopram in hepatic impairment
A
20mg qd
16
Q
citalopram pregnancy risk
A
Low
17
Q
what medications cannot be taken with citalopram d/t increased risk of QT prolongation
A
hydroxyzine
TCAs
Mellaril
Geodon
18
Q
when is citalopram contraindicated
A
mania or seizures
19
Q
what increases concentration of citalopram
A
prilosec
20
Q
dosage range for escitalopram
A
10-20mg qd
21
Q
what is the max dose of escitalopram for the elderly
A
10mg qd
22
Q
pregnancy risk of escitalopram
A
low
23
Q
which 2 SSRIs increase bleeding risk when taken with NSAIDs, ASA, or anticoagulants
A
escitalopram
sertraline
24
Q
dosage range for fluoxetine
A
20-80 qam
25
dosage adjustments to fluoxetine for the elderly
start with 10mg
max dose 60mg
26
which SSRIs require ECG if QT prolongation risk
citalopram
escitalopram
fluoxetine
27
contraindications for fluoxetine
MAOIs
seizures
28
which SSRIs decrease the effectiveness of narcotic analgesics
fluoxetine
paroxetine
29
which SSRIs increase the concentration of THC
fluoxetine
fluvoxamine
30
starting dose for IR fluvoxamine
50mg
31
starting dose for ER fluvoxamine
100mg
32
dosage range for fluvoxamine
50-300mg qd
33
2 FDA approved uses of fluvoxamine
OCD
social anxiety
34
geriatric considerations for fluvoxamine
titrate slowly
35
pregnancy risk with fluvoxamine
low
36
which 3 SSRIs have to be tapered to dc
fluvoxamine
paroxetine
sertraline
37
fluvoxamine greatly increases the concentration of which meds
duloxetine
caffeine
38
dosage range for paroxetine
20-60mg at night with food
39
max dose of paroxetine for the elderly
40mg
40
Labs to monitor for paroxetine
creatinine and LDL
41
pregnancy risk for paroxetine
teratogenic
42
which antidepressant has the highest anticholinergic and sexual side effects
paroxetine
43
dosage range for sertraline
50-200mg qd with food
44
labs to monitor with sertraline
cholesterol
45
pregnancy risk for sertraline
low
46
sertraline effects on drug tests
can cause false positive for benzodiazepines
47
dosage range for vortioxetine
5-20mg daily
48
which SSRI is especially effective in the elderly
vortioxetine
49
pregnancy risk of vortioxetine
low
50
which SSRI is great for severe GAD
vorioxetine
51
which SSRI has the least sexual dysfunction side effects
vortioxetine
52
which SSRI has the potential for more drug interactions and why
fluoxetine as it has a marked effect on many CYP enzymes
53
which 2 SSRIs interfere w/ efficacy of opioids
fluoxetine and paroxetine
54
which SSRIs are the most selective inhibitors
citalopram
escitalopram
55
which 2 meds when administered together increases brain concentrations of norepinephrine
fluoxetine/olanzapine combo
56
which SSRI is not approved as an antidepressant and what is it approved for
fluvoxamine treats OCD
57
when is the period pf maximum risk and and why should you monitor closely
first few days-weeks after starting antidepressant and risk is higher for paradoxical suicide
58
congenital risks of SSRIs
none significant except with paroxetine
59
which SSRI can cause discontinuation syndrome in an infant
paroxetine
60
why are SSRIs good for elderly and chronically ill patients
little to no cardiotoxic, anticholinergic, antihistaminergic, or a-adrenergic adverse effects
61
Which SSRI has anticholinergic effects
paroxetine
62
which class of meds is particularly effective for post CVA depression
SSRIs
63
which SSRI is consistently effective in youths
fluoxetine
64
which 4 SSRIs are approved for OCD in patients 18+
fluvoxamine, paroxetine, sertraline, and fluoxetine
65
which 3 SSRIs are approved for OCD in youths
fluvoxamine, fluoxetine, and sertraline
66
are dosages for OCD typically higher or lower than depression
higher
67
which 3 SSRIs are approved for panic disorder
paroxetine, fluoxetine, sertraline
68
why must fluoxetine be initiated at a low dose when used in panic disorder
risk of initial anxiety
69
what 4 clusters of symptoms are targeted for treatment in PTSD
re-experiencing
avoidance behavior
negative changes in mood/thinking
arousal
70
which PTSD sx are markedly improved w/ SSRIs
intrusive and avoidant sx
71
which SSRI is approved to tx bulimia
fluoxetine
72
what sx of anorexia are targeted by SSRIs
associated mood disturbance and OCD
73
SSRI that is modestly effective for weight in concert w/ behavior modification program
fluoxetine
74
which 4 SSRIs are used for PMDD
sertraline
paroxetine
fluoxetine
fluvoxamine
75
off label uses for SSRIs
premature ejaculation
paraphilias
autism
76
which SSRIs are used for premature ejaculation and why
fluoxetine and sertraline d/t anorgasmic effects
77
autistic features that may be responsive to SSRIs and clomipramine
obsessive-compulsive behaviors
poor social relatedness
aggression
78
2 SSRIs used for aggression, self-injurious and repetitive behaviors of autism
sertraline and fluvoxamine
79
most common side effect that leads to discontinuation of SSRIs
sexual side effects
80
which 2 SSRIs have the most intense GI side effects
sertraline
fluvoxamine
81
which SSRI often causes initial anorexia
fluoxetine
82
which SSRI is associated with weight gain
paroxetine
83
cardiovascular effect of all SSRIs
QT prolongation
84
which SSRI has most significant effect on QT interval
citalopram
85
when is 20mg the max dose of citalopram
hepatic impairment
>60
CYP2C19 poor metabolizers
taking cimetidine
86
which SSRI has the smallest effect on QT interval
vilazodone
87
which SSRI is most likely to cause headaches
fluoxetine
88
when are SSRIs used prophylactically
migraine and tension headaches
89
which 2 SSRIs are less likely to cause initial anxiety
paroxetine
escitalopram
90
which SSRI is the most likely to cause insomnia
fluoxetine
91
which 2 SSRIs are more likely to cause somnolence
citalopram
paroxetine
92
is citalopram or escitalopram more likely to interfere with sleep
escitalopram
93
sleep side effects of SSRIs
vivid dreams/nightmares
bruxism
restless legs
nocturnal myoclonus
sweating
94
what is emotional blunting
inability to cry
feelings of apathy/indifference
restriction in intensity of emotional experiences
95
which side effect is the result of SSRI effects on the hypothalamus
yawning
96
potential hematologic effects of SSRIs
functional impairment of platelet aggregation
97
what med increases risk of gastric bleeding when given with SSRI
NSAIDs
98
electrolyte and glucose disturbances associated with SSRIs
acute decrease in glucose but increased with chronic use
hyponatremia
SIADH
99
potential endocrine and allergic reactions associated with SSRIs
increased prolactin levels
rash
100
symptoms of serotonin syndrome in order of appearance
-diarrhea
-restlessness
-extreme agitation, hyperreflexia, and autonomic instability (rapid changes in VS)
-myoclonus, seizures, hyperthermia, shivering, rigidity
-delirium, coma, status epilepticus, cardi collapse, and death
101
treatment of serotonin syndrome
remove offending agent and provide comprehensive supportive care
102
what is used to treat sweating side effect of SSRIs
terazosin 1-2mg is dramatically effective
103
which 2 SSRIs are most likely to cause discontinuation syndrome
paroxetine
fluvoxamine
104
which SSRI is least likely to cause discontinuation syndrome
fluoxetine d/t long half-life
105
why can't you use SSRIs with clozapine
they increase clozapine's concentration increasing risk for seizures
106
fluoxetine and warfarin
may increase bleeding time
107
sertraline and warfarin
may displace warfarin from plasma proteins increasing prothrombin time
108
which SSRIs can increase bleeding risk when given with warfarin
paroxetine
sertraline
fluoxetine
109
which pain reliever can increase risk of serotonin syndrome when taken with paroxetine
tramadol
110
which SSRI has the highest risk of drug interactions
fluvoxamine
111
which medications can have dramatically increased concentrations when administered with escitalopram
desipramine
metoprolol
112
effect of food on fluoxetine
take with food to minimize nausea
113
sertraline and food
food may reduce GI side effects
114
oral concentration of sertraline
contains alcohol so it must be diluted
115
initial dose of sertraline when used for panic disorder
25mg to reduce risk of provoking a panic attack
116
paroxetine and food
may minimize GI upset
117
starting dose of paroxetine for depression and panic disorder
25mg for depression
12.5mg for panic disorder
118
fuvoxamine and food
take with food
119
max dose of citalopram in elderly or hepatic impairment
20mg
120
citalopram and food
with or without
121
vilazodone and food
take with food or effectiveness may be diminished
122
percentage of SERTs that must be occupied for therapeutic action of SSRIs
80-90%
123
is fluoxetine activating? why or why not
yes because of 5HT2C antagonism
124
is fluoxetine's half-life long or short
long
125
"well-oft"
adds weak DAT inhibition of sertraline with wellbutrin
126
which citalopram enantiomer is in escitalopram
S enantiomer
127
benefits of escitalopram over citalopram
-no high dose restriction to avoid QTc prolongation
-no antihistaminic properties
128
what is the best tolerated SSRI with the least CYP450 drug interactions
escitalopram
129
which SSRI is FDA approved for pediatric depression
fluoxetine
130
which 6 SSRIs are FDA-approved for MDD in adults
citalopram
escitalopram
fluoxetine
paroxetine
sertraline
vilazodone
131
which 2 SSRIs are approved for GAD in adults
escitalopram
paroxetine
132
which 4 SSRIs are approved for OCD in adults
fluoxetine
fluvoxamine
paroxetine
sertraline
133
which 3 SSRIs are approved for pediatric OCD
fluoxetine
fluvoxamine
sertraline
134
which 3 SSRIs are approved for panic disorder in adults
fluoxetine
paroxetine
sertraline
135
which 2 SSRIs are approved for PTSD in adults
paroxetine
sertraline
136
which2 SSRIs are approved for social anxiety disorder in adults
paroxetine
sertraline
137
which 3 SSRIs are approved for PMDD
fluoxetine
paroxetine
sertraline
138
Tramadol increases risk of serotonin syndrome when taken with which SSRI
paroxetine
139
symptoms of SSRI withdrawal
dizziness/weakness
nausea
HA
rebound mood sx
insomnia
URI sx
migraine sx
140
time frame for SSRI withdrawal sx
usually don't experience until after 6 weeks of tx and typically disappears in 3 weeks
141
which SSRIs increase concentration of TCAs leading to toxicity
fluoxetine
sertraline
paroxetine
142
what causes the interaction between some SSRIs and narcotic painkillers and tomoxifen
inhibition of 2D6
143
SSRIs and ambien
SSRIs may increase duration and severity of ambien
144
cimetidine increases concentration of what 2 SSRIs
sertraline
paroxetine
145
paroxetine is an inhibitor of what CYP450 enzyme
2D6
146
fluoxetine inhibits what CYP450 enzyme
2D6
147
what CYP450 enzyme is potently inhibited by paroxetine
2D6
148
which benzodiazepines have an increased half-life when coadministered with fluvoxamine
alprazolam
triazolam
diazepam
149
which enzyme metabolizes fluvoxamine
3A4
150
citalopram and cimetidine
increased concentration of citalopram
151
citalopram and metoprolol
increased concentration of metoprolol
152
which CYP enzyme is inhibited by escitalopram
2D6
153
how is fluoxetine marketed for PMDD
as sarafem
154
initial dose of fluoxetine
10-20mg
155
initial dose of sertraline
50mg
156
initial dose of paroxetine
10-20mg
157
when do you increase the dose of paroxetine
if no response is seen in 1-3 weeks raise by 10mg weekly to max dose of 50mg
158
how quickly do you taper paroxetine when dc
dosage reduction q2-3 weeks
159
starting dose of fluvoxamine
50mg at hs x1 week then adjust based on effectiveness
160
recommended daily dose of escitalopram
10mg
161
initiation of vilazodone
10mg qd x1 wk
20mg qd x1 wk
then 40mg
162
starting dose of vortioxetine
10mg qd
163
side effects of trintellix
N/V and constipation
164
what other actions does vortioxetine have besides inhibiting SERT
5HT1A agonist
5HT1B partial agonist
5HT3, 5HT1D, and 5HT7 antagonist
