Week 13: SSRI

Question 1

Selective serotonin reuptake inhibitor MOA & indication

Answer 1

“-pram” , “-ine”
fluoxetine (Prozac), Paroxetine (Paxil), Citalopram (Celexa), Escitalopram (Lexapro)

MOA: block reuptake of serotonin in postsynaptic receptors

indications:
- depression, anxiety, panic, OCD, body dysmorphic, bulimia, premenstrual dysphoric disorder, PTSD, vasomotor sx’s of menopause

Question 2

which SSRI least likely to gain weight, can be activating/energizing (bad for anxiety) and long half life?

Answer 2

fluoxetine (prozac)

Question 3

which SSRI has nasty withdrawal side effects, can cause suicidal or underlying bipolar, highest weight gain, and sedating?

Answer 3

paroxetine (Paxil)

Question 4

which SSRI don’t want to give someone with cardiac conditions?

Answer 4

citalopram (Celexa)

BBW QT prolongation

Question 5

which SSRI is weight neutral and neither sedating nor activating? (good for depression and anxiety)

Answer 5

escitalopram (Lexapro)

Question 6

SSRI cautions/contraindications

Answer 6

BBW: suicidal/self harming if < 24 years old (children, adolescents)

contraindications:
-MAOI in past 2 weeks
severe hepatic/renal insuff

Question 7

SSRI general ADE’s

Answer 7

serotonin syndrome 
n/v/d
agitation/anxiety
upper GI bleed
h/a 
blurred vision
hyponatremia
QT prolongation (citalopram)
changes in weight
dry mouth
tremor
constipation
rash/itching

Question 8

taking more than 1 SSRI related medication can cause ? sx’s of that?

Answer 8

serotonin syndrome

Autonomic instability (breathing and BP), restlessness, agitation, myoclonus (sudden, involuntary jerking of a muscle or group of muscles), hyperreflexia (overactive or over responsive reflexes), hyperthermia, diaphoresis, altered sensorium, tremor, chills, diarrhea and cramps, ataxia (loss of full control of bodily movements), headache, insomnia

Question 9

which 2 meds FDA approved for pediatrics

Answer 9

fluoxetine and escitalopram

Question 10

which ssri has high anticholinergic effects? bad for elderly?

Answer 10

paroxetine (paxil)

increased morbidity and mortality bc falls, confusion, hip fractures

Question 11

what is discontinuation syndrome and the sx’s?

Answer 11

stopping ssri abruptly

sx's that will taper off in 1-2 weeks:
"F.I.N.I.S.H."
Flu
Insomnia
Nausea/vomiting
Imbalance (dizziness and vertigo)/Impaired memory, Irritability and anxiety, decreased concentration, Myalgia
Shock-like sensations in head 
Hyperarousal (crying)

Fatigue and lethargy

Question 12

SSRI’s from most energizing to sedating

Answer 12

fluoxetine (prozac)
sertraline (zoloft)
citalopram (celexa)
escitalopram (lexapro) - weight neutral and neutral in stimulating/sedating = nice go to  
paroxetine (paxil) 
fluvoxamine (luvox)