SSRIs

Question 1

citalopram

Answer 1

celexa

Question 2

escitalopram

Answer 2

lexapro

Question 3

fluoxetine

Answer 3

prozac

Question 4

fluvoxamine

Answer 4

luvox

Question 5

paroxetine

Answer 5

paxil

Question 6

sertraline

Answer 6

zoloft

Question 7

MOA of SSRIs

Answer 7

increase serotonin activity by decreasing action of the presynaptic serotonin uptake pump

Question 8

indications for SSRIs

Answer 8

• anxiety d/o (OCD, panic, SAD, PTSD, GAD)
• anorexia/bulimia nervosa
• premenstrual dysphroic disorder
• MDD, dysthymia
• with a mood stabilizer for bipolar depression
• some efficacy in pain syndromes (migraine or chronic pain)
• may be effective in impulse control d/o and emotional physical symptoms of menopause

Question 9

dosing of SSRIs

Answer 9

QDaily

Question 10

is there a linear relationship between SSRI dose and response?

Answer 10

NO, don’t have to max out dose before switching drugs

Question 11

which disorders require high dosing of SSRIs?

Answer 11

OCD, anorexia/bulimia nervosa (may even be BID)

Question 12

which disorders only need low dosing of SSRIs?

Answer 12

panic

Question 13

metabolism of SSRIs

Answer 13

CYP450 in the liver EXCEPT celexa and lexapro

Question 14

time to steady state for SSRI?

Answer 14

5 days for everything but prozac (over a month)

Question 15

how long until symptoms are alleviated from SSRIs?

Answer 15

2-4 weeks

Question 16

how long should SSRI treatment be continued before it is considered refractory?

Answer 16

6-8 weeks

Question 17

is the lack of a response to one SSRI predictive of effectiveness of another?

Answer 17

NOPE

Question 18

is measuring plasma levels indicated for SSRIs?

Answer 18

NOPE

Question 19

are SSRIs safe in overdose

Answer 19

YUP

Question 20

can SSRIs induce mania or rapid cycline in bipolar patients?

Answer 20

YUP, just like all other antidepressants

Question 21

what do SSRIs have on TCAs and MAIOs int he side effects category?

Answer 21

• NO orthostatic hypotension (not blocking adrenergic receptors)
• LESS sedation (minimal action on histamine)
• NO dry mouth, constipation, blurred vision, urinary retention (minimal muscarinic cholinertic recepto action)
• LOWER seizure rate than TCAs

Question 22

time-limited side effects of SSRIs?

Answer 22

nausea, jitteriness

Question 23

sexual dysfunction side effects of SSIRs?

Answer 23

usually not time limited, most common SE (loss of libido, inability/delayed orgasm, nonsustaining erection)

Question 24

GI side effects of SSIRs?

Answer 24

diarrhea and nausea, usually resolves in a few days, food may help, may cause a decreased appetite

Question 25

CV side effects of SSIRs?

Answer 25

main issue is QT prolongation

Question 26

which SSRI has an FDA warning about CV effects?

Answer 26

citalopram

Question 27

are headaches a side effect of SSIRs?

Answer 27

usually transient and occur at the start of treatment but can persist in some

Question 28

worst SSRI offender for headaches?

Answer 28

prozac

Question 29

CNS side effects of SSIRs?

Answer 29

anxiety, insomnia, sedation, somnolence, emotional blunting, yawning

Question 30

worst SSRI offender for anxiety?

Answer 30

prozac (time limited)

Question 31

worst SSRI offenders for insomnia?

Answer 31

prozac and zoloft (take in the AM, duh)

Question 32

worst SSRI offenders for sedation?

Answer 32

paxil and luvox (take at night)

Question 33

why can people yawn when on SSRIs?

Answer 33

effect on hypothalamus, not related to being tired

Question 34

hematologic side effect of SSIRs?

Answer 34

platelet dysfunction, not reduction in the number (remember that serotonin is in platelets too) -> they bleed

Question 35

pregnancy category of SSIRs

Answer 35

C = teratogenic and should be avoided if possible

Question 36

can patients breast feed while on SSRIs?

Answer 36

NO, SSRIs are secreted in breast milk

Question 37

is there a difference in drugs within the SSRI class?

Answer 37

NOPE, but may be patient specific

Question 38

what meds should patients taking SSRIs avoid?

Answer 38

other meds that effect serotonin (SEROTONIN SYNDROME) - triptans and tramadol

Question 39

who is at greatest risk for serotonin syndrome?

Answer 39

drug-drug interactions

Question 40

presentation of serotonin syndrome

Answer 40

nausea, diarrhea, restlessness, extreme agitation, hyperreflexia, autonomic instability (fluctuations in vitals), myclonus, seizures, coma, CV collapse

Question 41

treatment of serotonin syndrome

Answer 41

benzos for agitation | cyrohepadine for serotonin antagonism

Question 42

SSRI discontinuation syndrome

Answer 42

some patients may experience transient dizziness, lethargy, nausea, irritabilitiy and headache

Question 43

worst offenders for SSRI discontinuation syndrome

Answer 43

paxil and luvox

Question 44

how can SSRI discontinuation syndrome be prevented?

Answer 44

slowly tapering over several weeks

Question 45

considerations when selecting an SSRI

Answer 45

patient response to prior antidepressants, comorbid illness, family history of response to antidepressants

Question 46

which SSRIs can be used in kids?

Answer 46

prozac (MDD/OCD) and zoloft (OCD)

Question 47

FDA black box warning for SSRIs

Answer 47

SUICIDE in kids and young adults - lower risk as age rises

Question 48

Worst SSRI offender of GI disturbance

Answer 48

Zoloft

Question 49

Only SSRI approved for OCD

Answer 49

Luvox