The first time that you fill an antidepressant, you should ask the patient what?
- “Are you thinking about harming or killing yourself?”
- If the risk is significant, the patient should be referred immediately to an appropriate health care professional.
- You can continue to ask in future situations
- Document interactions
What are the SSRIs?
- Citalopram (Celexa®)
- Escitalopram (Lexapro®)
- Fluoxetine (Prozac®)
- Paroxetine (Paxil®)
- Sertraline (Zoloft®)
How should you instruct patients about antidepressant use?
- 4 weeks or longer for effect
- Continue taking even if not feeling better right away
- Watch for worsening or changes in feelings
- Do not suddenly stop – talk to doc first
- Drowsiness or dizziness
- Avoid alcohol
- Black Box Warning and Med Guide
How do SSRIs compare to TCAs?
When given with what other drugs can SSRIs cause Seratonin Syndrome?
- St. John's Wort
- MAO inhibitors
- Taking SSRIs alongside many similar drugs can make new bad listeners
What are the general Disadvantages of SSRIs?
- Serotonin Syndrome
- CYP interactions
- HA/ Tremor
- (Last two are transient)
What are the dosages forms available for Zoloft?
- 25, 50, 100 mg
- 20 mg/mL oral concentrate
How many active metabolites does Zoloft have?
One less active metabolite
What DDIs does Zoloft have?
2D6 (less than Fluoxetine or Paroxetine)
What is Zoloft approved to treat?
- Major Depression
- Panic disorder
- Social anxiety
What special information should you tell a patient about Zoloft?
- Take w/ food to decrease GI upset
- Oral solution: dilute right before admin in >4 oz beverage
- Beverage must be: Ginger ale, water, lemon lime soda, lemonade, orange juice
What should you know about the pharmacokinetics of Zoloft?
- Elderly clear it 40% less
- Dose reduce in liver failure due lengthened t1/2
- Unchanged kinetics in moderate – severe renal impairment
What are the dosage forms available for Celexa?
- 10, 20, 40 mg tabs
- Oral solution 10mg/5 mL
How/When should Celexa be given?
Morning or evening w/ or without food
What are the dosage forms available for Lexapro
5,10,20 mg, 5mg/5ml solution
How/When should Lexapro be given?
- with or without food
- morning or night
- Nausea is problematic = take after a meal
- Take with a full glass of water
What special information should you counsel a patient on regarding Lexapro?
Tablets are scored and may be cut in half if needed