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Behavioral Health > SSRIs > Flashcards

SSRIs Flashcards

1
Q

citalopram

A

celexa

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2
Q

escitalopram

A

lexapro

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3
Q

fluoxetine

A

prozac

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4
Q

fluvoxamine

A

luvox

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5
Q

paroxetine

A

paxil

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6
Q

sertraline

A

zoloft

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7
Q

MOA of SSRIs

A

increase serotonin activity by decreasing action of the presynaptic serotonin uptake pump

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8
Q

indications for SSRIs

A
  • anxiety d/o (OCD, panic, SAD, PTSD, GAD)
  • anorexia/bulimia nervosa
  • premenstrual dysphroic disorder
  • MDD, dysthymia
  • with a mood stabilizer for bipolar depression
  • some efficacy in pain syndromes (migraine or chronic pain)
  • may be effective in impulse control d/o and emotional physical symptoms of menopause
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9
Q

dosing of SSRIs

A

QDaily

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10
Q

is there a linear relationship between SSRI dose and response?

A

NO, don’t have to max out dose before switching drugs

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11
Q

which disorders require high dosing of SSRIs?

A

OCD, anorexia/bulimia nervosa (may even be BID)

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12
Q

which disorders only need low dosing of SSRIs?

A

panic

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13
Q

metabolism of SSRIs

A

CYP450 in the liver EXCEPT celexa and lexapro

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14
Q

time to steady state for SSRI?

A

5 days for everything but prozac (over a month)

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15
Q

how long until symptoms are alleviated from SSRIs?

A

2-4 weeks

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16
Q

how long should SSRI treatment be continued before it is considered refractory?

A

6-8 weeks

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17
Q

is the lack of a response to one SSRI predictive of effectiveness of another?

A

NOPE

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18
Q

is measuring plasma levels indicated for SSRIs?

A

NOPE

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19
Q

are SSRIs safe in overdose

A

YUP

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20
Q

can SSRIs induce mania or rapid cycline in bipolar patients?

A

YUP, just like all other antidepressants

21
Q

what do SSRIs have on TCAs and MAIOs int he side effects category?

A
  • NO orthostatic hypotension (not blocking adrenergic receptors)
  • LESS sedation (minimal action on histamine)
  • NO dry mouth, constipation, blurred vision, urinary retention (minimal muscarinic cholinertic recepto action)
  • LOWER seizure rate than TCAs
22
Q

time-limited side effects of SSRIs?

A

nausea, jitteriness

23
Q

sexual dysfunction side effects of SSIRs?

A

usually not time limited, most common SE (loss of libido, inability/delayed orgasm, nonsustaining erection)

24
Q

GI side effects of SSIRs?

A

diarrhea and nausea, usually resolves in a few days, food may help, may cause a decreased appetite

25
Q

CV side effects of SSIRs?

A

main issue is QT prolongation

26
Q

which SSRI has an FDA warning about CV effects?

A

citalopram

27
Q

are headaches a side effect of SSIRs?

A

usually transient and occur at the start of treatment but can persist in some

28
Q

worst SSRI offender for headaches?

29
Q

CNS side effects of SSIRs?

A

anxiety, insomnia, sedation, somnolence, emotional blunting, yawning

30
Q

worst SSRI offender for anxiety?

A

prozac (time limited)

31
Q

worst SSRI offenders for insomnia?

A

prozac and zoloft (take in the AM, duh)

32
Q

worst SSRI offenders for sedation?

A

paxil and luvox (take at night)

33
Q

why can people yawn when on SSRIs?

A

effect on hypothalamus, not related to being tired

34
Q

hematologic side effect of SSIRs?

A

platelet dysfunction, not reduction in the number (remember that serotonin is in platelets too) -> they bleed

35
Q

pregnancy category of SSIRs

A

C = teratogenic and should be avoided if possible

36
Q

can patients breast feed while on SSRIs?

A

NO, SSRIs are secreted in breast milk

37
Q

is there a difference in drugs within the SSRI class?

A

NOPE, but may be patient specific

38
Q

what meds should patients taking SSRIs avoid?

A

other meds that effect serotonin (SEROTONIN SYNDROME) - triptans and tramadol

39
Q

who is at greatest risk for serotonin syndrome?

A

drug-drug interactions

40
Q

presentation of serotonin syndrome

A

nausea, diarrhea, restlessness, extreme agitation, hyperreflexia, autonomic instability (fluctuations in vitals), myclonus, seizures, coma, CV collapse

41
Q

treatment of serotonin syndrome

A

benzos for agitation

cyrohepadine for serotonin antagonism

42
Q

SSRI discontinuation syndrome

A

some patients may experience transient dizziness, lethargy, nausea, irritabilitiy and headache

43
Q

worst offenders for SSRI discontinuation syndrome

A

paxil and luvox

44
Q

how can SSRI discontinuation syndrome be prevented?

A

slowly tapering over several weeks

45
Q

considerations when selecting an SSRI

A

patient response to prior antidepressants, comorbid illness, family history of response to antidepressants

46
Q

which SSRIs can be used in kids?

A

prozac (MDD/OCD) and zoloft (OCD)

47
Q

FDA black box warning for SSRIs

A

SUICIDE in kids and young adults - lower risk as age rises

48
Q

Worst SSRI offender of GI disturbance

49
Q

Only SSRI approved for OCD

Behavioral Health (15 decks)

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