antidepressivi ssri ppt slides

Posted on 15 Дек 201810

Ssri ppt 2013 - slideshare

Ssri ppt 2013 - slideshare
Contents:› General concepts for SSRI › Mechanism of action › Indications › Side effects › Drug-drug interactions (DDI) › Conclusion.

Clipping is a handy way to collect important slides you want to go back to later. Drug-drug interactions (DDI) › Luvox > Prozac > Paxil > Zoloft > Celexa > Lexapro › Interacting effects may be dose dependent (Zoloft) › SSRI levels tend not to be altered by other drugs but can potentially increase levels (inhibit metabolism) of certain drugs › Examples: –paroxetine > ↑ risperidone –fluoxetine > ↑ buspirone –fluvoxamine > ↑ olanzapine Conclusion SSRIs have fewer antimuscarinic side-effects than the older tricyclics and they are also less cardiotoxic in overdosage SSRIs are also preferred to tricyclic antidepressants for depression in patients with diabetes. Stroke can be embolic or haemorrhagic –SSRIs may protect against the former and provoke the latter. It is manufactured by Eli Lilly and Company. Try to avoid SSRIs in patients receiving NSAIDs, aspirin or oral anticoagulants or with history of cerebral or GI bleeds.

Contents:› General concepts for SSRI › Mechanism of action › Indications › Side effects › Drug-drug interactions (DDI) › Conclusion General concepts for SSRI › A class of drugs, such as fluoxetine or sertraline, that inhibit the uptake of serotonin by neurons of the central nervous system and are primarily used in the treatment of depression and obsessive compulsive disorder. Dose-dependent QT interval prolongation with doses of 10-30mg daily (doses of >30mg/day needs monitoring of QT interval). Seropram) › escitalopram (Cipralex, Esertia) › fluoxetine (Prozac, Evorex) › fluvoxamin (Luvox, Faverin, Dumyrox) › paroxetine (Paxil, Seroxat, Aropax) › sertraline (Zoloft, Lustral, Serlain) › zimelidine (Zelmid, Normud) Mechanism of action › Inhibit serotonin reuptake so increase synaptic serotonin levels › Many SSRIs affect other receptors especially at high doses › Clinical effect usually takes weeks so mechanism goes beyond simply increasing synaptic serotonin levels › Several serotonin (5-HT) receptor subtypes › Serotonin receptors are located throughout the body (especially GI tract) Indications The main indication for SSRIs is clinical depression. NE DA ACH H1 potency Summary of pharmacodynamic differences • Dose-response curves – Citalopram is linear • Selectivity – Citalopram and Escitalopram is the most selective • Serotonergic reuptake blockade• Serotonergic reuptake blockade – paroxetine is the most potent • Dopamine reuptake blockade – Sertraline is the most potent • Anticholinergic effect – paroxetine is the most potent drug-drug interactions  The SSRIs are potent inhibitors of the CYP450. No clear evidence of increased risk of arrhythmia at any licensed dose Special patient groups Pregnancy  All SSRIs are rated pregnancy category C, with the exception of paroxetine, which is a category D.

Side-effect profile is relatively worse (GI distress, headaches, sedation, weakness). SSRIs and bleeding  SSRI + ASPIRIN, NSAIDs increases the risk of GIT bleeding. Absorption of Sertraline may be slightly increased by food. More effective than Citalopram in acute response and remission. YEARSSRI YEAR Fluoxetine 1987 Sertraline 1992 Paroxetine 1993 Fluvoxamine 1994 Citalopram 1998 Escitalopram 2002 Chemical Structure • These compounds are structurally unrelated. Special patient groups Parkinson’s Disease  SSRIs are considered to be first-line treatment. Special patient groups Cancer Pts  Sertraline, Escitalopram are preferred due to least risk of drug interaction. Special patient groups Renal Impairment  No agent clearly preferred to another. SSRIs have little affinity for cholinergic, β-adrenergic or histamine receptors.

Selective serotonin reuptake inhibitors 2016 - slideshare
Mohamed sedky Selective Serotonin Reuptake Inhibitors (SSRIs) Psychiatric . This may account for the differential response we see in some .

Anxiety and Depression Comparison of the Serotonergic Antidepressants Douglas L.

Fluvoxamine (Faverin) Pros  Short ½ life + No active metabolite  No build-up of metabolites. Stroke Depression  Fluoxetine, Citalopram are the most studied and seem to be effective and safe and widely recommended for post-stroke depression. SSRIs increase the risk of GIT, cerebral and perioperative bleeding (those undergoing orthopaedic or breast surgery may be at greatest risk). Special patient groups Geriatric • SSRIs are Safe & well tolerated in geriatric population. Lower potential for drug-drug interactions (very weak P450 interactions).

June 1996 Fluoxetine (Prozac) 6 7 8 9 0 1 2 3 4 5 6 5-HT NE DA ACH H1 potency Richelson E, Synaptic Effects of Antidepressants, Journal of Clinical Psychopharmacology, Vol. Escitalopram (Cipralex) Pros  Low overall inhibition of P450s enzymes so fewer drug-drug interactions. Dose-dependent QT interval prolongation with doses of 10-30mg daily (doses of >30mg/day needs monitoring of QT interval). Rationale for differential response may be related to different morphology of the serotonin transport protein. Adding adjunctive or ‘antidote’ drugs: Bupropion, Mirtazapine, Trazodone, Sildenafil (Viagra) and Tadalafil (Snafi).

SSRIs Affect all phases of the sexual response  Sexual Dysfunctions occurring in male includes:  Decreased libido  Erectile dysfunction  Delayed orgasm  Penile anaesthesia  Painful ejaculation  Priapism  Sexual Dysfunctions occurring in female includes  Decreased libido  Delayed orgasm  Decreased vaginal lubrication  Vaginal anaesthesia  Dyspareunia ‘strategies for managing sexual dysfunction induced by antidepressant medication’  Reduce the dose  Delayed dosing  Drug ‘holidays’ Drug ‘holidays’  Switch to a different antidepressant that is less likely to cause the specific sexual problem experienced (e. If you continue browsing the site, you agree to the use of cookies on this website. NE DA ACH H1 potency Summary of pharmacodynamic differences • Dose-response curves – Citalopram is linear • Selectivity – Citalopram and Escitalopram is the most selective • Serotonergic reuptake blockade• Serotonergic reuptake blockade – paroxetine is the most potent • Dopamine reuptake blockade – Sertraline is the most potent • Anticholinergic effect – paroxetine is the most potent drug-drug interactions  The SSRIs are potent inhibitors of the CYP450. More effective than Citalopram in acute response and remission. So, Fluoxetine  lowest risk for discontinuation syndrome. Minimal cardiotoxic, anticholinergic, antihistaminic or α adrenergic adverse effects except for Paroxetine which has some anticholinergic activity. SSRIs and bleeding  SSRIs will deplete platelet serotonin, leading to a reduced ability to form clots and a subsequent increase in the risk of bleeding. Clinical effect usually takes weeks so mechanism goes beyond simply increasing synaptic serotonin levels. Cardiac effects of SSRIs SSRIs are generally safe in cardiac disease. Clipping is a handy way to collect important slides you want to go back to later.

Antidepressants 2008 ppt

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