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Pharm blk4- SSRI

what is the prototype SSRI sertraline (zoloft)
what is the first group of depressive symptoms to subside, and how long does this take neurovegetative symptoms - about two weeks
what symptoms were mentioned to be in this group (4) 1) sleep disturbances; 2) altered appetite; 3) decreased energy; 4) increased anxiety
what group of symptoms subsides next, and how long after treatment begins cognitive symptoms - 4-6 weeks
what symptoms were mentioned to be in this group (3) 1) sadness; 2) hopelessness; 3) poor concentration
how do SSRI side effects compare to TCAs and MAOIs milder
what are the main categories of adverse effects that occur with SSRIs (4) 1) GI; 2) CNS; 3) sexual; 4) weight change
what are the most common GI side effects with SSRI 1) nausea; 2) diarrhea
why does nausea occur 5-HT-3 receptor is in the CTZ
what SSRI may have fewer GI side effects paroxetine
what group of side effects does paroxetine have more of than other SSRIs mild anticholinergic effects
what three were mentioned 1) constipation; 2) urinary retention; 3) dry mouth
who should paroxetine be avoided in patients taking other anticholinergic medication
what SSRI is the most activating in the CNS fluoxetine
what are four common CNS side effects of SSRIs 1) anxiety; 2) tremors; 3) insomnia; 4) extrapyramidal
what AE are activating SSRIs especially likely to cause insomnia
what coincides with lessening of sleep disturbances/insomnia sleep improves when depression subsides
in what patients are activating SSRIs desirable (1) and undesirable (2) desirable in patients without energy, undesirable in patients complaining of: 1) too much anxiety; 2) lack of sleep
what SSRI has the highest propensity for extrapyramidal side effects paroxetine
what is the incidence of sexual dysfunction with SSRIs, and in what sex is this most common 30-50%, most common in men
what sexual side effects happen in males (2) 1) delayed ejaculation; 2) lack of orgasm
what sexual side effects happen in females (3) 1) decreased libido; 2) orgasm trouble; 3) lack of lubricaiton
what SSRI causes the most sexual dysfunction paroxetine
what other sexual adverse effect can happen in both sexes emotional blunting of feelings of romance
what may be the mechanism for this excess 5-HT nonselectively taken up into DA terminals - 5-HT hijacking DA signaling in the brain
what other feelings are affected by emotional blunting (3) 1) less ability to become angry; 2) less ability to care about others feelings; 3) less ability to feel pleasure
what generally happens to weight with SSRIs, and how does this compare to TCAs and MAOIs weight is gained, but less than with TCA or MAOI
what SSRI causes the most weight gain paroxetine
so, what side effects does paroxetine cause more than other SSRIs (4) 1) GI; 2) extrapyramidal; 3) sexual dysfunction; 4) weight gain
what is the leading cause of noncompliance with SSRIs sexual dysfunction
what are the underlying mechanisms that cause sexual dysfunction (2) 1) postsynaptic stimulation of 5-HT2 receptors; 2) decreased sympathetic stimulation
is sexual dysfunction generally transient or does it persist typically transient, but can persist
what SSRI has the least sexual side effects escitalopram (lexapro)
what other drugs have low sexual side effects, and what MOA is each 1) bupropion (SDRI); 2) mirtazapine (blocks presynaptic alpha-2 receptors); 3) nefazadone (blocks postsynaptic 5-HT2A receptors
what are the three stages in antidepressant therapy 1) acute; 2) continuation; 3) maintenance
how long is the acute phase, and what is the goal about 12 weeks, goal to induce remission
what is the goal of step two (continuation), and how long does it last (range) keep in remission - lasts 4-9 months
what is the minimum duration for stages 1 + 2 7 months
how long must stage 3 last stage 3 is not for all patients
what happens to the risk for depression in pregnancy, and what % of women have depression during pregnancy risk increases, 10% of women have depression during pregnancy
what % of women who stop therapy early in pregnancy suffer relapse by the third trimester 50%; 68% total relapse rate given in next slide for women who discontinue treatment
what is the relapse rate during pregnancy for women who maintain meds 26%
does SSRI cross into the fetus, or into breast milk yes
what is SSRI concentration in fetal brain compared to mother 85%
what is SSRI use in pregnancy associated with 1) lower birth weight (0.5 lb); 2) persistent pulmonary hypertension of the newborn (associated with late/3rd trimester use)
what are the long term developmental consequences unknown
so, which groups of ADs were mentioned to be safe and effective in pregnancy (2), but with what caveat 1) TCAs; 2) SSRIs - although increased short-term neonatal adverse effects after exposure to ADs in 3rd trimester can occur
which class (SSRIs or TCAs) has a more favorable side-effect profile SSRIs
what should be done during discontinuation of antidepressants (what reduction per time, and how long between reductions) slow taper - reduce dose by 25% per week
what exception is there, and why unnecessary for fluoxetine - long half life
when is there tolerance or drug-seeking behavior there is not
what symptoms were listed under "discontinuation syndrome" (list) dizziness, vertigo, ataxia, parasthesia, numbness, electric-shock-like sensations, lethargy, headache, tremor, sweating, anorexia, insomnia, nightmares, excessive dreaming, nausea, vomiting, diarrhea, irritability, anxiety/axitation, low mood
what type of drug interactions do SSRIs have P-450
what P450 enzymes were mentioned (3) 1) 3A4; 2) 2D6; 3) 2C9
what SSRI was mentioned to have the greatest effect on P450s fluoxetine
what SSRI has the least effect on P450s sertraline (zoloft)
what drugs were SSRIs specifically said to be able to result in elevated levels of (2 classes, 1 example from each) 1) benzodiazepenes (diazepam/valium); 2) anti-seizure (phenytoin)
what should SSRIs never be used with, and why MAOIs - can precipitate 5-HT syndrome
what four symptoms were mentioned in this lecture for 5-HT (serotonin) syndrome 1) agitation; 2) hypertension; 3) confusion; 4) fever
what are the two options for switching medications (and trying to avoid serotonin syndrome) 1) immediate substitution; 2) cross-taper (introduction of new drug while tapering dosage of the first)
when switching medications, for what kinds of medications is it typically ok to use immediate substitution one SSRI for another
what exception is there, and why should stop fluoxetine for a few days to a week before introducing another SSRI, because of its long half life
Created by: mcafej02