Pharm NS SSRI

追加: 2026-06-06

[00:00:01]all right so now we're moving on to the selective serotonin reuptake inhibitor fluoxetine remember it takes about four to six weeks to work and one of the biggest things uh with that is that there's this increased risk of suicide as this medication begins to work um it kind of makes the person a little bit better um kind of decreasing their inhibitions but it hasn't quite worked on that on that depression yet very increased risk of suicide okay so it is a therapeutic resolution of depression it does block the re-uptake of the neurotransmitter serotonin to allow greater serotonin availability to the next nerve cell we want to be cautious in older adults with liver disease peptic ulcer disease diabetes mellitus hyponatremia cardiac disease and suicidal tendencies we want to con we want to know that there are contraindications um to those who are hypersensitive everybody if they're hypersensitive or has an allergy to anything it's a contraindication uh those on maois and children less than seven we don't give this group of meds to be cautious of serotonin syndrome uh serotonin syndrome is when the seroto selective serotonin reuptake inhibitor might be too high or it's mixing with something else a different drug or something that is making serotonin levels too high serotonin syndrome can include confusion difficulty concentrating fever agitation anxiety hallucinations in coordination hyperreflexia and then diaphoresis and tremors okay so hyperreflexia if the reason why it's got the word kidney behind that is you can cause some breakdown of muscle um and then a clogging up of the kidneys and cause problems with the kidneys that clogging up of the kidneys would be called rhabdomyosis from the um the breakdown of muscle products ssris within two weeks of maois can increase that risk of serotonin syndrome um fluoxetine increases tca levels and lithium increases the risk of bleeding with nsads you want to report any signs or symptoms of serotonin syndrome who do you report to well the provider the doctor the psychiatrist the um nurse practitioner whoever is the provider guiding that care insomnia nervousness increased excretion um so we're dealing with of adh so we're dealing with um possibility of some fluid overload um lower dosages may resolve symptoms um we want to report those though to the provider any of the symptoms if people take them in the morning they can decrease this risk of insomnia okay we want to be watching uh kind of fluid retention this is why we wouldn't um we would be watching it closely if somebody had heart issues or kidney issues uh headaches are common tylenol should be taken rather than ibuprofen because it interferes with ibuprofen hyponatremia we are going to watch for lethargy abdominal cramps diarrhea and nausea and i also tell students watch for confusion with any changes in sodium and so hyponatremia can actually increase the risk of toxicity with other other meds too so if they're taking other meds be watching for that um so sexual dysfunction is another one weight gain um which also interferes with compliance right so we're checking that weight uh weekly the best um the best thing to do to try to avoid that obviously would be uh exercise and diet