Flashcards
Antidepressants, Selective Serotonin Reuptake Inhibitors (SSRI's)
Flashcards do conjunto (4)
- 1Give eg's of & indications for SSRI's.eg's: citalopram, fluoxetine, sertraline, escitalopram
Indications:
• Moderate-to-severe depression - 1st line Rx
• Mild depression - if psychological Rx has failed
• Panic disorder
• OCD - 2MOA of SSRI's.SSRI's preferentially inhibit neuronal reuptake of serotonin (5-HT) from the synaptic cleft, thereby increasing its availability for neurotransmission. This appears to be the mechanism by which SSRI's improve mood & physical symptoms in depression & relieve Sx of panic & obsessive disorders.
SSRI's differ from tricyclic antidepressants in that they do not inhibit noradrenaline uptake and cause less blockade of other receptors. The efficacy of the two drug classes in the Rx of depression is similar. However, SSRI's are generally preferred as they have fewer adverse effects & are less dangerous in overdose. - 3SE's of SSRI's.• GI upset
• Appetite & weight disturbance
• Hypersensitivity reactions
• Hyponatraemia - especially in the elderly leading to confusion & ↓ LOC
• ↑ suicidal thoughts & behaviour
• Lowered seizure threshold
• Prolonged QT interval (citalopram) - can lead to arrhythmias
• ↑ risk of bleeding
• Serotonin syndrome - in high doses or in combination with other antidepressants classes. Triad of autonomic hyperactivity, altered mental state, neuromuscular excitation.
• Sudden withdrawal can cause GI upset, neurological & flu like symptoms & sleep disturbance - 4CI's, cautions, & important interactions of SSRI's.CI's:
• Shouldn't be co-prescribed with monoamine oxidase inhibitors
Cautions:
• Epilepsy
• Peptic ulcer
• Young people - poor efficacy & associated with an ↑ risk of self harm & suicidal thoughts
• Hepatic impairment - reduce dose
Important interactions:
SSRI's should not be given with monoamine oxidase inhibitors as they both ^synaptic serotonin levels & together may precipitate serotonin syndrome. Gastroprotection should be prescribed for patients taking SSRI's with aspirin or NSAID's due to ^risk of GI bleeding. Bleeding risk is also^ where SSRI's are co-prescribed with anticoagulants. They should not be combined with other drugs that prolong the QT interval, such as antipsychotics.