Week 13 - SSRIs Flashcards
1
Q
Metabolism and excretion
A
Significant first pass effect
2
Q
Pharmacokinetics
A
- Half-life varies: 16-144 hours
- Fluoxetine (Prozac) has the longest half-life
- Half-lives shorter in children
- Increased risk of withdrawal
3
Q
SSRIs: caution and contraindications
A
Cautions
- Suicidality: increased risk in children, adolescents, and young adults
- Monitor for behavior changes, advise family/caregivers to give close observation
Contraindications
- Hypersensitivity to SSRIs
- Received MAOI in past two weeks
- Severe hepatic or renal insufficiency
4
Q
Causes of serotonin syndrome
A
Taking more than one serotonin-related medication (either prescription or CAM meds)
- CAM meds - St. John’s wart, grapefruit, ergot, woodrose, SAMe, cesium, lithium
5
Q
Symptoms of serotonin syndrome
A
- Autonomic instability (breathing and BP)
- Restlessness, agitiation, tremor
- Myoclonus, hyperreflexia
- Hyperthermia, diaphoresis
- Altered sensorium
- Chills
- Diarrhea, cramps
- Ataxia
- Headache
- Insomnia
6
Q
Treatment for serotonin syndrome
A
- D/c SSRI
- Muscle relaxants
- Serotonin-blocking agents
- Oxygen, IV fluids
- Medications to control BP and HR
- Breathing tube and medication to paralyze your muscles
7
Q
Usual course of serotonin syndrome
A
- Milder cases resolve in 24-72 hours
- Moderate to severe cases can take weeks
8
Q
Which two SSRIs are FDA approved in pediatrics?
A
Fluoxetine (Prozac) and escitalopram (Lexapro)
9
Q
SSRI considerations for the elderly
A
- Require lower oral doses and have lower tolerance than younger patients
- Monitor for hepatic and renal metabolic function
- Fluoxetine, fluvoxamine, paroxetine associated w/ higher risk for drug-drug interactions
- Paroxetine (Paxil) has high anticholinergic effect
- After achieving remission, therapy should continue for at least 4-9 months
10
Q
Discontinuation syndrome: symptoms
A
- Flu-like symptoms
- Myalgia
- Fatigue, lethargy, insomnia
- Decreased concentration
- N/V
- Impaired memory
- Shock-like sensations
- Irritability and anxiety
- Crying w/o provocation
- Dizziness and vertigo
11
Q
Discontinuation syndrome: course
A
1-2 weeks
