Final pharm exam (1).docx

Wellbutrin bupropion weak inhibitor of neuronal

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Wellbutrin (Bupropion) Weak inhibitor of neuronal uptake of dopamine, norepinephrine, serotonin Helpful for smoking cessation Can be used for extended periods Other Depression Treatments Atypical antipsychotics- Abilify (aripiprazole) Selective Serotonin Reuptake Inhibitors Actions Potently and selectively inhibit serotonin uptake pump on presynaptic neuron Increase concentration of 5HT in synapse by inhibiting reuptake Weak effect on dopamine, norepinephrine reuptake Indications Frequently first choice among antidepressants Often effective in treating anxiety that sometimes complicates depression as well as anxiety disorder itself Very useful in treating obsessive compulsive disorder (OCD) Varieties of SSRIs Zoloft (sertraline) Paxil (paroxetine) Celexa (citalopram) Lexapro (escitalopram) Luvox (fluvoxamine) Prozac (fluoxetine) Oldest SSRI, still very useful Pharmacokinetics of SSRIs Widely distributed Highly protein bound Metabolism: Interference with cytochrome P450 (CYP) enzymes Beware potentially harmful interactions with other meds Renal excretion Half-lives vary: Fluoxetine: longest; 4–6 days Fluvoxamine: shortest; 15–26 hours Two weeks required for SSRIs to reach full therapeutic strength Major Side Effects of SSRIs Nausea, loose stools Sexual dysfunction Weight gain Before prescribing, consider how side effects are likely to effect patient's mental state Serotonin Syndrome Symptoms Rigidity Hyperthermia Autonomic instability Tremors Confusion Delirium Coma Causes of Serotonin Syndrome Interaction of SSRIs with certain cardiac medications Dosage too high Interaction with MAOIs Interaction with St. John's wort Always inquire about patient's use of herbal preparations SSRI Withdrawal Syndrome Symptoms F lu-like L ightheadedness or dizziness U neasiness or restlessness S leepiness or sensory disturbances H eadaches Symptoms typically remit within 24 hours of restarting SSRI Reduce SSRI gradually Example: Patient taking Paxil 40 mg should reduce dose in 10-mg stages (30 mg, 20 mg, 10 mg, 0 mg)
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SSRIs: Monitoring Concerns Assess for depression, suicidal ideation Black-box warning affixed to all SSRIs since 2006, due to increase in suicidal thoughts in users ages 24 and under Assess for sexual dysfunction Assess for weight gain Assess for substance use Caffeine, Alcohol, Ecstacy SSRIs: Monitoring Concerns (cont.) Perform rigorous medication inventory Of particular concern are substances metabolized by P450 system Be alert to possible drug-to-drug interactions Warfarin Any substance that might prolong QT interval, as SSRIs do Use cautiously with angina patients Be mindful of recent research on risks to pregnant women Data suggests SSRIs might cause pulmonary hypertension in newborns Initial Stage of Monitoring SSRIs Should be very close Watch for signs of Serotonin syndrome Myoclonus Hyperthermia Autonomic instability Be particularly vigilant when treating elderly patients.
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  • Summer '17
  • Selective serotonin reuptake inhibitor, Serotonin Syndrome, cimetidine, griseofulvin

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