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26 Cards in this Set
- Front
- Back
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SSRIs list drugs
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Sertraline
Paroxetine Fluoxetine Fluvoxamine Citalopram Escitalopram |
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Treat Bulimia
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Fluoxetine
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Treat PMDD & Panic
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Fluoxetine, Sertraline, Paroxetine
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Treat MDD, all GAD disorders, PMDD, social anxiety
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Sertraline, Fluoxetine, Paroxetine
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Treat MDD, GAD (minus panic), social anxiety
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Citalopram, Escitalopram, Fluvoxamine
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Not optically active
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Paroxetine, Fluvoxamine
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Common SE of all
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*GI upset that titrates out, sexual dysfxn, HA, insomnia.
**5-HT2agonism → Agitation, Akathisia, Anxiety (low doses actually treats), Panicattacks, Insomnia, Sexual dysfxn. **5-HT3agonism → GI effects (n/d), HA. Nausea>take with food. ...weight gain, increased suicidal thoughts |
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Risk of DC syndrome worst
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Sertraline, Paroxetine due to short T1/2
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Strong 2D6 inhibitors
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Fluoxetine, Paroxetine, Sertraline (less..dose dependent)
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3A4 Inhibitors
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Fluvoxamine (potent), Fluoxetine, Sertraline (weak)
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Paroxetine
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highest wt gain, anti-cholinergic SE.
most serotonin specific and activating. |
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Fluvoxamine
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rarely used due to 3A4 inhibition
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Sertraline
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requires higher dose for anxiety than depression
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Fluoxetine- T1/2 & significance
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longest T1/2 so low withdrawal & 5HT syndrome risk, has active metabolite with longer t1/2.
no affinity for ACh, a1, H1. DC 4 weeks from MAOI (as opposed to 2). VERY strong SERT inhibitor. |
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Brand> Generic * Citalopram * Escitalopram * Fluoxetine * Paroxetine * Sertraline * Fluvoxamine |
* Celexa * Lexapro * Prozac * Paxil * Zoloft * Luvox |
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SSRIs MOA |
Primarily just blocks serotonin reuptake |
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1st line use, onset, why prefer use over others, consult |
* Similar to TCAs, but more favorable SE profile * Onsetof 3-8 wks * Less risk of suicide, b/c overdose causes vomiting → less lethal in overdose * Take with full glass of water to prevent heartburn from pill staying in esophagus * Ask about suicidal (or ‘dark’) thoughts |
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Serotonin Syndrome |
*Usually due to excess serotonin due to DDI. * MentalStatus Changes, Myoclonus/Hyperreflexia/Tremor - greater in lower extremities, Diaphoresis,Diarrhea, Incoordination |
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Serotonin Discontinuation Syndrome |
* Must taper SSRIs with short t1/2 or no active metabolites (paroxetine esp). * Sxs:vivid dreams/nightmares, tremors, nausea, dizziness, disorientation. Note: can occur with any class of antidepressants |
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Only one with no active metabolite, and very short t1/2 |
Paxil |
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Paxil admin & use |
d/t short 1/2 & no metabolite.... must taper. Avoid in hypersomnia d/t lots sedation. |
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Most GI upset of the SSRIs also inhibitor of 2D6/3A4 |
Zoloft ... luvox also have significant GI se |
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Least protein binding > good for warfarin pt |
Celexa ...note... Lexapro not highly protein bound & Zoloft high protein binding |
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Lexapro vs Celexa |
100x more potent. Less SEs. Negligible cyp interactions, Celexa is weak 2D6 inhibitor. |
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Similar AE profile |
Fluoxetine, Paroxetine, Sertraline. Light sedation (common to all SSRI) & wt gain. Paxil- most wt gain & some anticholinergic SE. Others have minimal wt gain issue or cholinergic. |
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OCD - only labeled indication |
luvox |
