SSRIs Flashcards
Name all available selective serotonin re-uptake inhibitors?
Citalopram, Escitalopram, Fluoxetine, Paroxetine, Fluvoxamine, Sertraline :)
SSRI’s contraindications ?
poorly controlled epilepsy, should be stopped when patient enters manic phase
SSRI’s cautions ?
Cardiac disease
Concurrent electroconvulsive therapy
DM
Epilepsy ( discontinue if convulsions develop)
History of GI bleeding / bleeding disorders
History of mania
Susceptibility to angle closure glaucoma
When would prescription for elderly patients for SSRI’s would be deemed inappropriate to continue/prescribe?
( Hint: STOPP criteria)
Current or recent significant hyponatraemia, serum sodium less than 130 mmol/l
Common/very common SIDE EFFECTS of SSRI/s?
Anxiety appetite abnormal arrhythmias arthralgia asthenia concentration impaired confusion constipation depersonalisation diarrhoea dizziness drowsiness dry mouth fever gastrointestinal discomfort; haemorrhage; headache; hyperhidrosis; malaise; memory loss; menstrual cycle irregularities; myalgia; mydriasis; nausea (dose-related); palpitations; paraesthesia; QT interval prolongation; sexual dysfunction; skin reactions; sleep disorders; taste altered; tinnitus; tremor; urinary disorders; visual impairment; vomiting; weight changes; yawning
Uncommon SIDE EFFECTS of SSRI’s?
Alopecia; angioedema; behaviour abnormal; hallucination; mania; movement disorders; photosensitivity reaction; postural hypotension; seizure; suicidal tendencies; syncope
Rare or very rare SIDE EFFECTS of SSRI’s?
Galactorrhoea; hepatitis; hyperprolactinaemia; hyponatraemia; serotonin syndrome; severe cutaneous adverse reactions (SCARs); SIADH; thrombocytopenia
What are the symptoms of poisoning by SSRI’S ?
Nausea Vomiting Agitation Tremor Nystagmus Drowsiness Sinus tachycardia Convulsions may occur
Describe symptoms of serotonin syndrome ?
marked neuropsychiatric effects
neuromuscular hyperactivity
autonomic instability; hyperthermia, rhabdomyolysis, renal failure, and coagulopathies may develop.
What are the risks of using SSRI’s during pregnancy?
There is a small increased risk of congenital heart defects when taken during early pregnancy. If used during the third trimester there is a risk of neonatal withdrawal symptoms, and persistent pulmonary hypertension in the newborn has been reported.
What are the most common symptoms of abrupt withdrawal of SSRI’s or marked reduction in dose?
Gastro-intestinal disturbances, headache, anxiety, dizziness, paraesthesia, electric shock sensation in the head, neck, and spine, tinnitus, sleep disturbances, fatigue, influenza-like symptoms sweating
After how long withdrawal effects may occur?
Within 5 days of stopping
When is the risk of withdrawal symptoms increased?
If antidepressant is stopped abruptly after regular administration for eight weeks or more.
Which SSRIs are associated with higher propensity for drug interactions?
Fluoxetine, fluvoxamine and paroxetine
Which SSRI is associated with higher incidence of discontinuanion symptoms?
Paroxetine, it has shorter half life
Which SSRI has been shown to be safe in patients with unstable angina or who have had a recent myocardial infarction ?
Sertraline
To what electrolyte disturbances use of SSRI may lead and what symptoms would indicate it?
Hyponatraemia. Hyponatraemia should be considered in all patients who develop drowsiness, confusion, or convulsions while taking an antidepressant.
What are the characteristic symptoms of serotonin syndrome?
The characteristic symptoms of serotonin syndrome fall into 3 main areas, although features from each group may not be seen in all patients—neuromuscular hyperactivity (such as tremor, hyperreflexia, clonus, myoclonus, rigidity), autonomic dysfunction (tachycardia, blood pressure changes, hyperthermia, diaphoresis, shivering, diarrhoea), and altered mental state (agitation, confusion, mania).
Maximum sertraline dose?
200mg
Which two SSRIs cause QT prolongation ?
Citalopram, Escitalopram
Which SSRI is used in children?
Fluoxetine
Why are SSRIs preferred over TCA’s?
Less sedating, less antimuscarinic, less cardiotoxic
Explain interaction: Grapefruit Juice + SSRIs
Grapefruit juice increases SSRI conc
Explain interaction: SSRIs + NSAIDS/ASPIRIN/Anticoagulants
Increased risk of bleeding
