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SSRI Drugs all questions solved 100 accurately latest version
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SSRI: DrugsFluoxetine (Prozac)
•Indications: MDD (8+), OCD, Panic, Bulimia, PMDD, fluox+olanzapine for
bipolar depression
•Dosage forms: capsules, tablets, oral solution, delayed release (1x/weekly)
•Dosing: start 10-20mg in AM, Max 60mg/day (OCD often needs 80mg daily)
•Side Effects: agitation/insomnia most common, weight gain not common
•PK:
•Potent inhibitor of 2D6 and 2C19
•Longest half-life of all SSRIs- 24-72 hours
•Has an active metabolite, which lengthens half life with repeated
administration to 2-3 weeks!
•Also inhibits its own metabolism (both 2db substrate and inhibitor) which
contributes to long half-life
•Clinical Pearls: good choice for patient with neurovegetative sxs, wants to
avoid weight gain, bad with adherence. Bad for patients on a complicated
medication regimen (because of high potential for interaction)
Sertraline (Zoloft)
•Indications: MDD, OCD, PD, PTSD, PMDD, SAD
•Dosage forms: tablets, capsules, oral solution
•Dosing: Start 25-50mg daily, can increase by 50mg increments until 200mg
max mg/day
•SE: Most common is GI
, •PK:
• Potent inhibitor of 2d6 at doses >150mg/day
•Half-life 26 hours
•Clinical Pearls:
•Good first-line SSRI due to tolerability, flexible dosing, low drug interaction
potential
•You will see it rx often in pregnancy/breastfeeding because we have the most
research regarding its use and safety in this population
Paroxetine (Paxil)
•Indications: MDD, OCD, PD, SAD, GAD, PTSD, PMDD, vasomotor sxs of
menopause
•Dosing forms: tablets, capsules, oral suspension, ER tablets
•Dosing 10-20mg daily (12.5-25mg CR) and increase by 10mg (12.5mg CR)
increments until max dose 50mg/day (62.5mgCR)
•Notice both immediate and extended release are daily dosing. CR may help
with SE. Coating on pill allows it to bypass absorption in stomach where 5HT
receptors are. Evidence is weak
•SE: Most likely of SSRIs to cause sexual SE, weight gain, sedation,
constipation, anticholinergic
•PK:
•Potent inhibitor of 2D6
•Also a substrate of 2D6 so inhibits its own metabolism (this + short half life is
how it causes discontinuation syndrome)
•Shortest half-life: <20 hrs
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