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Meds > SSRIs > Flashcards

SSRIs Flashcards

1
Q

Name the 8 SSRIs

A

Citalopram
Escitalopram
Fluoxetine
Fluvoxamine
Paroxetine
Sertraline
Vortioxetine
Vilazodone

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2
Q

Brand name of citalopram

A

Celexa

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3
Q

Brand name of Escitalopram

A

Lexapro

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4
Q

Brand name of fluoxetine

A

prozac

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5
Q

brand name of fluvoxamine

A

luvox

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6
Q

brand name of paroxetine

A

paxil

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7
Q

brand name of sertraline

A

zoloft

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8
Q

brand name of vortioxetine

A

trintellix

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9
Q

which 3 SSRIs cause increased sweating

A

citalopram
paroxetine
sertraline

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10
Q

what can increased doses of citalopram treat

A

binge eating

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11
Q

dosage range for citalopram

A

20-40mg in am with food

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12
Q

main off label use for citalopram

A

binge eating

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13
Q

what is the maximum dose of citalopram for patients over 60 and why

A

20mg daily due to QT prolongation

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14
Q

What baseline test should you get on patients starting citalopram who are over 40

A

ECG d/t prolongation risk

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15
Q

what is the max dose of citalopram in hepatic impairment

A

20mg qd

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16
Q

citalopram pregnancy risk

A

Low

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17
Q

what medications cannot be taken with citalopram d/t increased risk of QT prolongation

A

hydroxyzine
TCAs
Mellaril
Geodon

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18
Q

when is citalopram contraindicated

A

mania or seizures

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19
Q

what increases concentration of citalopram

A

prilosec

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20
Q

dosage range for escitalopram

A

10-20mg qd

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21
Q

what is the max dose of escitalopram for the elderly

A

10mg qd

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22
Q

pregnancy risk of escitalopram

A

low

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23
Q

which 2 SSRIs increase bleeding risk when taken with NSAIDs, ASA, or anticoagulants

A

escitalopram
sertraline

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24
Q

dosage range for fluoxetine

A

20-80 qam

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25
Q

dosage adjustments to fluoxetine for the elderly

A

start with 10mg
max dose 60mg

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26
Q

which SSRIs require ECG if QT prolongation risk

A

citalopram
escitalopram
fluoxetine

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27
Q

contraindications for fluoxetine

A

MAOIs
seizures

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28
Q

which SSRIs decrease the effectiveness of narcotic analgesics

A

fluoxetine
paroxetine

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29
Q

which SSRIs increase the concentration of THC

A

fluoxetine
fluvoxamine

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30
Q

starting dose for IR fluvoxamine

A

50mg

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31
Q

starting dose for ER fluvoxamine

A

100mg

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32
Q

dosage range for fluvoxamine

A

50-300mg qd

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33
Q

2 FDA approved uses of fluvoxamine

A

OCD
social anxiety

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34
Q

geriatric considerations for fluvoxamine

A

titrate slowly

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35
Q

pregnancy risk with fluvoxamine

A

low

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36
Q

which 3 SSRIs have to be tapered to dc

A

fluvoxamine
paroxetine
sertraline

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37
Q

fluvoxamine greatly increases the concentration of which meds

A

duloxetine
caffeine

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38
Q

dosage range for paroxetine

A

20-60mg at night with food

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39
Q

max dose of paroxetine for the elderly

A

40mg

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40
Q

Labs to monitor for paroxetine

A

creatinine and LDL

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41
Q

pregnancy risk for paroxetine

A

teratogenic

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42
Q

which antidepressant has the highest anticholinergic and sexual side effects

A

paroxetine

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43
Q

dosage range for sertraline

A

50-200mg qd with food

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44
Q

labs to monitor with sertraline

A

cholesterol

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45
Q

pregnancy risk for sertraline

A

low

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46
Q

sertraline effects on drug tests

A

can cause false positive for benzodiazepines

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47
Q

dosage range for vortioxetine

A

5-20mg daily

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48
Q

which SSRI is especially effective in the elderly

A

vortioxetine

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49
Q

pregnancy risk of vortioxetine

A

low

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50
Q

which SSRI is great for severe GAD

A

vorioxetine

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51
Q

which SSRI has the least sexual dysfunction side effects

A

vortioxetine

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52
Q

which SSRI has the potential for more drug interactions and why

A

fluoxetine as it has a marked effect on many CYP enzymes

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53
Q

which 2 SSRIs interfere w/ efficacy of opioids

A

fluoxetine and paroxetine

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54
Q

which SSRIs are the most selective inhibitors

A

citalopram
escitalopram

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55
Q

which 2 meds when administered together increases brain concentrations of norepinephrine

A

fluoxetine/olanzapine combo

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56
Q

which SSRI is not approved as an antidepressant and what is it approved for

A

fluvoxamine treats OCD

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57
Q

when is the period pf maximum risk and and why should you monitor closely

A

first few days-weeks after starting antidepressant and risk is higher for paradoxical suicide

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58
Q

congenital risks of SSRIs

A

none significant except with paroxetine

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59
Q

which SSRI can cause discontinuation syndrome in an infant

A

paroxetine

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60
Q

why are SSRIs good for elderly and chronically ill patients

A

little to no cardiotoxic, anticholinergic, antihistaminergic, or a-adrenergic adverse effects

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61
Q

Which SSRI has anticholinergic effects

A

paroxetine

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62
Q

which class of meds is particularly effective for post CVA depression

A

SSRIs

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63
Q

which SSRI is consistently effective in youths

A

fluoxetine

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64
Q

which 4 SSRIs are approved for OCD in patients 18+

A

fluvoxamine, paroxetine, sertraline, and fluoxetine

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65
Q

which 3 SSRIs are approved for OCD in youths

A

fluvoxamine, fluoxetine, and sertraline

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66
Q

are dosages for OCD typically higher or lower than depression

A

higher

67
Q

which 3 SSRIs are approved for panic disorder

A

paroxetine, fluoxetine, sertraline

68
Q

why must fluoxetine be initiated at a low dose when used in panic disorder

A

risk of initial anxiety

69
Q

what 4 clusters of symptoms are targeted for treatment in PTSD

A

re-experiencing
avoidance behavior
negative changes in mood/thinking
arousal

70
Q

which PTSD sx are markedly improved w/ SSRIs

A

intrusive and avoidant sx

71
Q

which SSRI is approved to tx bulimia

A

fluoxetine

72
Q

what sx of anorexia are targeted by SSRIs

A

associated mood disturbance and OCD

73
Q

SSRI that is modestly effective for weight in concert w/ behavior modification program

A

fluoxetine

74
Q

which 4 SSRIs are used for PMDD

A

sertraline
paroxetine
fluoxetine
fluvoxamine

75
Q

off label uses for SSRIs

A

premature ejaculation
paraphilias
autism

76
Q

which SSRIs are used for premature ejaculation and why

A

fluoxetine and sertraline d/t anorgasmic effects

77
Q

autistic features that may be responsive to SSRIs and clomipramine

A

obsessive-compulsive behaviors
poor social relatedness
aggression

78
Q

2 SSRIs used for aggression, self-injurious and repetitive behaviors of autism

A

sertraline and fluvoxamine

79
Q

most common side effect that leads to discontinuation of SSRIs

A

sexual side effects

80
Q

which 2 SSRIs have the most intense GI side effects

A

sertraline
fluvoxamine

81
Q

which SSRI often causes initial anorexia

A

fluoxetine

82
Q

which SSRI is associated with weight gain

A

paroxetine

83
Q

cardiovascular effect of all SSRIs

A

QT prolongation

84
Q

which SSRI has most significant effect on QT interval

A

citalopram

85
Q

when is 20mg the max dose of citalopram

A

hepatic impairment
>60
CYP2C19 poor metabolizers
taking cimetidine

86
Q

which SSRI has the smallest effect on QT interval

A

vilazodone

87
Q

which SSRI is most likely to cause headaches

A

fluoxetine

88
Q

when are SSRIs used prophylactically

A

migraine and tension headaches

89
Q

which 2 SSRIs are less likely to cause initial anxiety

A

paroxetine
escitalopram

90
Q

which SSRI is the most likely to cause insomnia

A

fluoxetine

91
Q

which 2 SSRIs are more likely to cause somnolence

A

citalopram
paroxetine

92
Q

is citalopram or escitalopram more likely to interfere with sleep

A

escitalopram

93
Q

sleep side effects of SSRIs

A

vivid dreams/nightmares
bruxism
restless legs
nocturnal myoclonus
sweating

94
Q

what is emotional blunting

A

inability to cry
feelings of apathy/indifference
restriction in intensity of emotional experiences

95
Q

which side effect is the result of SSRI effects on the hypothalamus

A

yawning

96
Q

potential hematologic effects of SSRIs

A

functional impairment of platelet aggregation

97
Q

what med increases risk of gastric bleeding when given with SSRI

A

NSAIDs

98
Q

electrolyte and glucose disturbances associated with SSRIs

A

acute decrease in glucose but increased with chronic use
hyponatremia
SIADH

99
Q

potential endocrine and allergic reactions associated with SSRIs

A

increased prolactin levels
rash

100
Q

symptoms of serotonin syndrome in order of appearance

A

-diarrhea
-restlessness
-extreme agitation, hyperreflexia, and autonomic instability (rapid changes in VS)
-myoclonus, seizures, hyperthermia, shivering, rigidity
-delirium, coma, status epilepticus, cardi collapse, and death

101
Q

treatment of serotonin syndrome

A

remove offending agent and provide comprehensive supportive care

102
Q

what is used to treat sweating side effect of SSRIs

A

terazosin 1-2mg is dramatically effective

103
Q

which 2 SSRIs are most likely to cause discontinuation syndrome

A

paroxetine
fluvoxamine

104
Q

which SSRI is least likely to cause discontinuation syndrome

A

fluoxetine d/t long half-life

105
Q

why can’t you use SSRIs with clozapine

A

they increase clozapine’s concentration increasing risk for seizures

106
Q

fluoxetine and warfarin

A

may increase bleeding time

107
Q

sertraline and warfarin

A

may displace warfarin from plasma proteins increasing prothrombin time

108
Q

which SSRIs can increase bleeding risk when given with warfarin

A

paroxetine
sertraline
fluoxetine

109
Q

which pain reliever can increase risk of serotonin syndrome when taken with paroxetine

A

tramadol

110
Q

which SSRI has the highest risk of drug interactions

A

fluvoxamine

111
Q

which medications can have dramatically increased concentrations when administered with escitalopram

A

desipramine
metoprolol

112
Q

effect of food on fluoxetine

A

take with food to minimize nausea

113
Q

sertraline and food

A

food may reduce GI side effects

114
Q

oral concentration of sertraline

A

contains alcohol so it must be diluted

115
Q

initial dose of sertraline when used for panic disorder

A

25mg to reduce risk of provoking a panic attack

116
Q

paroxetine and food

A

may minimize GI upset

117
Q

starting dose of paroxetine for depression and panic disorder

A

25mg for depression
12.5mg for panic disorder

118
Q

fuvoxamine and food

A

take with food

119
Q

max dose of citalopram in elderly or hepatic impairment

A

20mg

120
Q

citalopram and food

A

with or without

121
Q

vilazodone and food

A

take with food or effectiveness may be diminished

122
Q

percentage of SERTs that must be occupied for therapeutic action of SSRIs

A

80-90%

123
Q

is fluoxetine activating? why or why not

A

yes because of 5HT2C antagonism

124
Q

is fluoxetine’s half-life long or short

A

long

125
Q

“well-oft”

A

adds weak DAT inhibition of sertraline with wellbutrin

126
Q

which citalopram enantiomer is in escitalopram

A

S enantiomer

127
Q

benefits of escitalopram over citalopram

A

-no high dose restriction to avoid QTc prolongation
-no antihistaminic properties

128
Q

what is the best tolerated SSRI with the least CYP450 drug interactions

A

escitalopram

129
Q

which SSRI is FDA approved for pediatric depression

A

fluoxetine

130
Q

which 6 SSRIs are FDA-approved for MDD in adults

A

citalopram
escitalopram
fluoxetine
paroxetine
sertraline
vilazodone

131
Q

which 2 SSRIs are approved for GAD in adults

A

escitalopram
paroxetine

132
Q

which 4 SSRIs are approved for OCD in adults

A

fluoxetine
fluvoxamine
paroxetine
sertraline

133
Q

which 3 SSRIs are approved for pediatric OCD

A

fluoxetine
fluvoxamine
sertraline

134
Q

which 3 SSRIs are approved for panic disorder in adults

A

fluoxetine
paroxetine
sertraline

135
Q

which 2 SSRIs are approved for PTSD in adults

A

paroxetine
sertraline

136
Q

which2 SSRIs are approved for social anxiety disorder in adults

A

paroxetine
sertraline

137
Q

which 3 SSRIs are approved for PMDD

A

fluoxetine
paroxetine
sertraline

138
Q

Tramadol increases risk of serotonin syndrome when taken with which SSRI

A

paroxetine

139
Q

symptoms of SSRI withdrawal

A

dizziness/weakness
nausea
HA
rebound mood sx
insomnia
URI sx
migraine sx

140
Q

time frame for SSRI withdrawal sx

A

usually don’t experience until after 6 weeks of tx and typically disappears in 3 weeks

141
Q

which SSRIs increase concentration of TCAs leading to toxicity

A

fluoxetine
sertraline
paroxetine

142
Q

what causes the interaction between some SSRIs and narcotic painkillers and tomoxifen

A

inhibition of 2D6

143
Q

SSRIs and ambien

A

SSRIs may increase duration and severity of ambien

144
Q

cimetidine increases concentration of what 2 SSRIs

A

sertraline
paroxetine

145
Q

paroxetine is an inhibitor of what CYP450 enzyme

A

2D6

146
Q

fluoxetine inhibits what CYP450 enzyme

A

2D6

147
Q

what CYP450 enzyme is potently inhibited by paroxetine

A

2D6

148
Q

which benzodiazepines have an increased half-life when coadministered with fluvoxamine

A

alprazolam
triazolam
diazepam

149
Q

which enzyme metabolizes fluvoxamine

A

3A4

150
Q

citalopram and cimetidine

A

increased concentration of citalopram

151
Q

citalopram and metoprolol

A

increased concentration of metoprolol

152
Q

which CYP enzyme is inhibited by escitalopram

A

2D6

153
Q

how is fluoxetine marketed for PMDD

A

as sarafem

154
Q

initial dose of fluoxetine

A

10-20mg

155
Q

initial dose of sertraline

A

50mg

156
Q

initial dose of paroxetine

A

10-20mg

157
Q

when do you increase the dose of paroxetine

A

if no response is seen in 1-3 weeks raise by 10mg weekly to max dose of 50mg

158
Q

how quickly do you taper paroxetine when dc

A

dosage reduction q2-3 weeks

159
Q

starting dose of fluvoxamine

A

50mg at hs x1 week then adjust based on effectiveness

160
Q

recommended daily dose of escitalopram

A

10mg

161
Q

initiation of vilazodone

A

10mg qd x1 wk
20mg qd x1 wk
then 40mg

162
Q

starting dose of vortioxetine

A

10mg qd

163
Q

side effects of trintellix

A

N/V and constipation

164
Q

what other actions does vortioxetine have besides inhibiting SERT

A

5HT1A agonist
5HT1B partial agonist
5HT3, 5HT1D, and 5HT7 antagonist

Meds (11 decks)

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