SSRIs by Abdelali Agouni https://padlet.com/aagouni78/ltaunlg9y5rm Made with whimsy en-us 2016-11-28 08:09:00 UTC 2016-11-28 08:30:01 UTC hello@padlet.com SABA's group https://padlet.com/aagouni78/ltaunlg9y5rm/wish/140101173 Q1) A. Central nervous system: 
ataxia, sedation, and coma. Respiratory depression may occur, especially with co-ingestion of alcohol. restlessness, anxiety, and agitation. Tremor and seizures are common with bupropion 
B. Cardiovascular effects :trazodone can cause
hypotension and orthostatic hypotension, bupropion can cause sinus tachy- cardia, and fluoxetine may cause minor ST-T wave changes.
C. Serotonin syndrome: confusion, hypomania,
restlessness, myoclonus, hyperreflexia, diaphoresis, shivering, tremor, inco- ordination, and hyperthermia. 
Q2)Compare and contrast the toxicity and safety profile of SSRIs with TCAs
A) Non-cyclic: 
S/E: serotonin syndrome and seizures (they do not affect cardiac conduction)

B) Cyclic (TCA): 
S/E: anticolinergic effect, hypotension and QRS prolongation-significant and distinguish TCAs from SSRI (some drugs seizures) ---- they mainly affect CVS and CNS. 

Q3)cyproheptadine (Periactin), 4 mg orally every hour for 3 doses, or methysergide (Sansert), 2 mg orally every 6 hours for 3 doses, presumably because of the serotonin antagonist effects of these drugs.
Q4)  Treatment
 A. Emergency and supportive measures 
1. Maintain an open airway --> supplemental oxygen. 2. Treat coma , hypotension, and seizures if they occur. 
B. Specific drugs and antidotes. cyproheptadine (Periactin), , or methysergide (Sansert), 
C. Decontamination
1. Prehospital.  activated charcoal if available. Do not induce emesis.
2. Hospital. Administer activated charcoal. Gastric emptying is not necessary if activated charcoal can be given promptly.
 D. Enhanced elimination. Owing to extensive protein binding and large volumes of distribution, dialysis, hemoperfusion, peritoneal dialysis, and repeatdose charcoal are not effective. 

SSRI rare relatively safe when compared to TCAs  
but they cause more probs (heart probs like QT prolongation)
]]> 2016-11-28 08:21:06 UTC https://padlet.com/aagouni78/ltaunlg9y5rm/wish/140101173 Group SSRI: https://padlet.com/aagouni78/ltaunlg9y5rm/wish/140101533 1-  Clinical presentation A. Central nervous system. The usual presentation after overdose includes ataxia, sedation, and coma. Respiratory depression may occur, especially with co-ingestion of alcohol or other drugs. These agents, particularly bupropion, can cause restlessness, anxiety, and agitation. Tremor and seizures are common with bupropion but occur occasionally after overdose with an SSRI. B. Cardiovascular effects are usually minimal, although trazodone can cause hypotension and orthostatic hypotension, bupropion can cause sinus tachycardia, and fluoxetine may cause minor ST-T wave changes. C. Serotonin syndrome (see p 21) is characterized by confusion, hypomania, restlessness, myoclonus, hyperreflexia, diaphoresis, shivering, tremor, incoordination, and hyperthermia. This reaction may be seen when a patient taking an MAO inhibitor (p 269) ingests a serotonin uptake blocker. Because of the long duration of effects of MAO inhibitors and most of the serotonin uptake blockers, this reaction can occur up to several days to weeks after either treatment regimen has been discontinued. The syndrome has also been described in patients taking an overdose of an SSRI or combinations of various SSRIs without concomitant MAO inhibitor use. 

2- 
3-  cyproheptadine (Periactin), 4 mg orally every hour for 3 doses, or methysergide (Sansert), 2 mg orally every 6 hours for 3 doses, presumably because of the serotonin antagonist effects of these drugs. 

4- A. Emergency and supportive measures 1. Maintain an open airway and assist ventilation if necessary (see pp 1–7). Caution: Respiratory arrest can occur abruptly and without warning. 2. Treat coma (see p 19), seizures (p 22), hyperthermia (p 21), hypotension (p 16), and arrhythmias (pp 13–15) if they occur. Note: Do not use procainamide or other type Ia or Ic antiarrhythmic agents for ventricular tachycardia, because these drugs may aggravate cardiotoxicity. 3. Consider cardiac pacing for bradyarrhythmias and high-degree AV block, and overdrive pacing for torsade de pointes. 4. Mechanical support of the circulation (eg, cardiopulmonary bypass) may be useful (based on anecdotal reports) to stabilize patients with refractory shock, allowing time for the body to eliminate some of the drug. 5. If seizures are not immediately controlled with usual anticonvulsants, paralyze the patient with a neuromuscular blocker such as pancuronium (see p 472) to prevent hyperthermia, which may induce further seizures, and lactic acidosis, which aggravates cardiotoxicity. Note: Paralysis abolishes the muscular manifestations of seizures, but has no effect on brain seizure activity. After paralysis, ECG monitoring is necessary to determine the efficacy of anticonvulsant therapy. 6. Continuously monitor the temperature, other vital signs, and ECG in asymptomatic patients for a minimum of 6 hours, and admit patients to an intensive care setting for at least 24 hours if there are any signs of toxicity.  ]]> 2016-11-28 08:23:07 UTC https://padlet.com/aagouni78/ltaunlg9y5rm/wish/140101533