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Drugs - CPT Sem 4 > SSRI's > Flashcards

SSRI's Flashcards

1
Q

Give 4 examples of SSRIs

A
  • Citalopram
  • Fluoxetine
  • Paroxetine
  • Sertraline
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2
Q

How do SSRIs work?

A

Selectively inhibit serotonin re-uptake in the synaptic cleft to increase its action

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3
Q

Why is serotonin action increase helpful in depression?

A

It is strongly involved in mood regulation and low levels have been seen in depression

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4
Q

How are SSRIs administered?

A

PO

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5
Q

What are SSRI’s first line treatment for?

A

Depression

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6
Q

What is another indication of SSRIs?

A

GAD

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7
Q

What are the specific indications for fluoxetine?

A
  • Childhood depression

- Bulimia nervosa

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8
Q

What is a specific indication for citalopram?

A

Panic disorder

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9
Q

What is a specific indication for sertraline?

A

Obsessive-compulsive disorder

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10
Q

What specific risk is fluoxetine associated with?

A

Increased risk of self-harm and suicidal ideation

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11
Q

When are SSRIs contraindicated?

A
  • Pregnancy
  • Poorly controlled epilepsy
  • During mania
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12
Q

When should caution be used with SSRIs?

A
  • Epilepsy
  • Cardiac disease
  • Diabetes
  • ECT
  • Acute angle-closure glaucoma
  • History of bleeding disorders
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13
Q

What can SSRIs interact with?

A
  • Alcohol
  • NSAIDs
  • Aspirin
  • Anti-epileptics
  • Theophylline
  • Monoamine oxidase inhibitors
  • Tramadol
  • St Johns Wort
  • Grapefruit (sertraline)
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14
Q

How can SSRIs interact with alcohol?

A

Increase sedation

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15
Q

How can SSRIs interact with NSAIDs and aspirin?

A

Increased risk of bleeding

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16
Q

How can SSRIs interact with anti-epileptics?

A

Reduce the seizure threshold

17
Q

When should MAOIs be started after stopping SSRI?

A

A week after (5 for fluoxetine)

18
Q

When should SSRIs be started after stopping a MAOI?

A

2 weeks after

19
Q

How can SSRIs interact with tramadol and St John’s Wort?

A

Increased risk of serotonin discontinuation syndrome

20
Q

What monitoring should patients on SSRIs receive?

A
  • Improvement of symptoms check every 1-2 weeks for first 6 weeks
  • Ask about suicide and self-harm
21
Q

After how long of no results should SSRI be switched?

A

1 month (6 weeks in elderly)

22
Q

How long should patients be left at the same dose following remission?

A

6-12 months

23
Q

What should be given to patients after cessation of treatment with anti-depressants?

A

Follow-up appointment

24
Q

What are the common side-effects of SSRIs?

A
  • GI upset
  • Nausea
  • Hyponatraemia
  • Dry mouth
  • Sexual dysfunction
  • Anorexia and weight loss
25
Q

What are the rarer side-effects of SSRIs?

A
  • Increased bleeding risk
  • Suicidal ideation
  • Convulsions
  • QT interval prolongation
  • Serotonin syndrome
  • SSRI discontinuation syndrome
26
Q

What causes serotonin syndrome?

A

Increased serotonin activity

27
Q

Which SSRI most commonly causes SSRI discontinuation syndrome?

A

Paroxetine

28
Q

What mnemonic can help to remember the side-effects of SSRIs?

A

SSRIS

29
Q

What does SSRIS mnemonic stand for?

A
  • Sore tummy
  • Sexual dysfunction
  • Reduced weight/salivation
  • Increased bleeding risk
  • Serotonin toxicity
30
Q

What counselling should a patient starting SSRIs receive?

A
  • Mode of action
  • Side-effects
  • Lifestyle measures
  • Onset and compliance
  • Duration
  • Withdrawal
  • Switching
  • Serotonin syndrome
  • Signs of SSRI discontinuation syndrome
31
Q

What is it important to say about side-effects of SSRIs?

A

They are mostly mild and often transient

32
Q

What lifestyle measures may help to improve the action of SSRIs?

A
  • Healthy diet
  • Regular exercise
  • Adequate sleep
33
Q

What is important to tell patients about the onset and compliance with SSRIs?

A

Onset may take several weeks so is important to persist with the treatment

34
Q

What should patients on SSRIs be told about the duration?

A

They may need to take for some time after episode has resolved

35
Q

What should patients be told about withdrawal from SSRIs?

A

Withdrawal must be done slowly to avoid side-effects

36
Q

What information should be given to patients wishing to switch from an SSRI to another anti-depressant?

A

May need time in between

37
Q

What signs of serotonin syndrome should the patient starting an SSRI be told about?

A
  • Agitation
  • Confusion
  • Nystagmus
  • Myoclonus
  • Tremor
  • Seizures
  • Autonomic instability
38
Q

What advice should patients be given if they experience symptoms of serotonin syndrome?

A

Seek urgent medical help

39
Q

What are the symptoms of SSRI discontinuation syndrome?

A
  • Headache
  • Paraesthesia
  • Shock sensations
  • GI upset
  • Lethargy
  • Insomnia
  • Mood changes

Drugs - CPT Sem 4 (81 decks)

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