Board Review: SSRIs

Practice Quiz, Content Review, & Patient scenario

This week’s review questions will cover the utilization of SSRIs. Afterwards there is a brief review followed by a patient scenario which is meant to help tie everything together.

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DISCLAIMER

The content provided in this Substack post is for entertainment and informational purposes only and is not intended to serve as medical advice. The views and opinions expressed herein are those of the writer and should not be taken as definitive or authoritative. Readers should not rely solely on the information provided in this post to make decisions about patient care. Instead, use this content as a starting point for further research and consult a qualified healthcare professional before making any changes to treatment or medication regimens.

1. What is the mechanism of action of SSRIs in the treatment of depression?

   1. Inhibiting dopamine reuptake

   2. Inhibiting norepinephrine reuptake

   3. Inhibiting serotonin reuptake

   4. Inhibiting GABA receptors

2. Which of the following SSRIs has the longest half-life?

   1. Fluoxetine

   2. Sertraline

   3. Escitalopram

   4. Paroxetine

3. Which of the following is a potential side effect of SSRIs?

   1. Hypertension

   2. Hyperglycemia

   3. Hypoglycemia

   4. Hyponatremia

4. A patient is taking an SSRI for depression and presents with sexual dysfunction as a side effect. Which of the following may be a potential management strategy?

   1. Adding bupropion

   2. Adding lithium

   3. Adding buspirone

   4. Adding gabapentin

5. Which of the following SSRIs is associated with the greatest risk of QTc prolongation?

   1. Fluoxetine

   2. Sertraline

   3. Escitalopram

   4. Citalopram

6. Which of the following SSRIs is most likely to cause weight gain?

   1. Fluoxetine

   2. Sertraline

   3. Escitalopram

   4. Paroxetine

7. Which of the following SSRIs is most likely to cause sexual dysfunction as a side effect?

   1. Fluoxetine

   2. Sertraline

   3. Citalopram

   4. Escitalopram

8. Which of the following medications may interact with SSRIs and increase the risk of bleeding?

   1. Aspirin

   2. Warfarin

   3. Clozapine

   4. Lithium

9. A patient taking an SSRI for depression presents with hyponatremia as a side effect. Which of the following should be initial management strategy?

   1. Discontinuing the SSRI

   2. Adding a diuretic

   3. Increasing the SSRI dose

   4. Adding a sodium supplement

10. A patient taking an SSRI for depression presents with akathisia as a side effect. Which of the following may be a potential management strategy?

    1. Adding a beta-blocker

    2. Adding a benzodiazepine

    3. Switching to a different SSRI

    4. Discontinuing the SSRI

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1. What is the mechanism of action of SSRIs in the treatment of depression?

   1. Inhibiting dopamine reuptake

   2. Inhibiting norepinephrine reuptake

   3. Inhibiting serotonin reuptake

   4. Inhibiting GABA receptors

Correct answer: c) Inhibiting serotonin reuptake

Rationale: SSRIs work by selectively inhibiting the reuptake of serotonin at the presynaptic neuron, increasing the availability of serotonin in the synaptic cleft and promoting neurotransmission.

2. Which of the following SSRIs has the longest half-life?

   1. Fluoxetine

   2. Sertraline

   3. Escitalopram

   4. Paroxetine

Correct answer: a) Fluoxetine

Rationale: Fluoxetine has a long half-life of up to several days, making it a good option for adolescents or others who may have difficulty remembering to take their medications. Other SSRIs like sertraline, escitalopram, and paroxetine have shorter half-lives.

3. Which of the following is a potential side effect of SSRIs?

   1. Hypertension

   2. Hyperglycemia

   3. Hypoglycemia

   4. Hyponatremia

Correct answer: d) Hyponatremia

Rationale: SSRIs can cause hyponatremia by increasing antidiuretic hormone (ADH) secretion, leading to dilutional hyponatremia. This can cause symptoms like headache, nausea, seizures, and confusion.

4. A patient is taking an SSRI for depression and presents with sexual dysfunction as a side effect. Which of the following may be a potential management strategy?

   1. Adding bupropion

   2. Adding lithium

   3. Adding buspirone

   4. Adding gabapentin

Correct answer: a) Adding bupropion

Rationale: Bupropion can be added to an SSRI to manage sexual dysfunction, as it has minimal sexual side effects and can also enhance antidepressant response. Lithium, buspirone, and gabapentin are not typically used to manage sexual dysfunction.

5. Which of the following SSRIs is associated with the greatest risk of QTc prolongation?

   1. Fluoxetine

   2. Sertraline

   3. Escitalopram

   4. Citalopram

Correct answer: d) Citalopram

Rationale: Citalopram is associated with the greatest risk of QTc prolongation among SSRIs. It is recommended to limit the dose of citalopram to 20 mg/day in patients over 60 years of age or with cardiac comorbidities to reduce the risk of QTc prolongation and torsades de pointes.

6. Which of the following SSRIs is most likely to cause weight gain?

   1. Fluoxetine

   2. Sertraline

   3. Escitalopram

   4. Paroxetine

Correct answer: d) Paroxetine

Rationale: Paroxetine is associated with the greatest risk of weight gain among SSRIs. Fluoxetine and sertraline may cause weight loss, while escitalopram has a neutral effect on weight.

7. Which of the following SSRIs is most likely to cause sexual dysfunction as a side effect?

   1. Fluoxetine

   2. Sertraline

   3. Citalopram

   4. Escitalopram

Correct answer: b) Sertraline

Rationale: Sertraline is associated with the greatest risk of sexual dysfunction among the SSRIs. Fluoxetine, citalopram, and escitalopram have lower rates of sexual side effects.

8. Which of the following medications may interact with SSRIs and increase the risk of bleeding?

   1. Aspirin

   2. Warfarin

   3. Clozapine

   4. Lithium

Correct answer: b) Warfarin

Rationale: Warfarin is a medication used as an anticoagulant that can interact with SSRIs and increase the risk of bleeding. Aspirin, clozapine, and lithium do not have significant interactions with SSRIs.

9. A patient taking an SSRI for depression presents with hyponatremia as a side effect. Which of the following may be a potential management strategy?

   1. Discontinuing the SSRI

   2. Adding a diuretic

   3. Increasing the SSRI dose

   4. Adding a sodium supplement

Correct answer: a) Discontinuing the SSRI

Rationale: Hyponatremia can be a side effect of SSRIs, and discontinuing the SSRI may alleviate this symptom. Adding a diuretic or increasing the SSRI dose can exacerbate hyponatremia. Adding a sodium supplement may be considered in certain cases but is not a first-line management strategy.

10. A patient taking an SSRI for depression presents with akathisia as a side effect. Which of the following should be initial management strategy?

    1. Adding a beta-blocker

    2. Adding a benzodiazepine

    3. Switching to a different SSRI

    4. Discontinuing the SSRI

Correct answer: c) Switching to a different SSRI

Rationale: Akathisia can be a side effect of SSRIs, and switching to a different SSRI may alleviate this symptom. Adding a beta-blocker or benzodiazepine may be considered in certain cases, but switching SSRIs is often the first-line management strategy. Discontinuing the SSRI should be avoided if possible to prevent withdrawal symptoms.

PDF File:

Board Review SSRI Practice Questions

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SSRI Content Review

SSRIs (Selective Serotonin Reuptake Inhibitors) are a class of medications commonly used for the treatment of depression, anxiety disorders, and other mental health conditions.

Mechanism of action: SSRIs work by selectively inhibiting the reuptake of serotonin at the presynaptic neuron, increasing the availability of serotonin in the synaptic cleft and promoting neurotransmission.

Common SSRIs: Some of the commonly used SSRIs include fluoxetine, sertraline, citalopram, escitalopram, and paroxetine.

Dosage: The starting dose of SSRIs is typically low and gradually increased over time to reduce the risk of adverse effects. The dose of SSRIs may need to be adjusted based on individual patient response.

Adverse effects: Common side effects of SSRIs include nausea, headache, insomnia, sexual dysfunction, and weight changes. In rare cases, SSRIs may cause serotonin syndrome, which can be life-threatening.

Interactions: SSRIs may interact with other medications, including MAO inhibitors, warfarin, and some antipsychotics, and increase the risk of adverse effects.

Monitoring: Patients taking SSRIs should be monitored regularly for adverse effects, including hyponatremia, bleeding risk, and QTc prolongation.

Discontinuation: SSRIs should be discontinued gradually to prevent withdrawal symptoms, which may include headache, nausea, dizziness, and flu-like symptoms.

Overall, SSRIs are a safe and effective treatment option for many mental health conditions, and healthcare providers should carefully monitor patients for adverse effects and adjust treatment as necessary.

Patient Scenario:

Consider education, side effects, and adjustments when reviewing scenarios. These scenarios are intended to integrate multiple aspects of the review.

Mrs. Smith is a 38-year-old woman who presents to the psychiatric-mental health nurse practitioner (PMHNP) clinic with symptoms of depression, including persistent low mood, anhedonia (inability to experience pleasure), fatigue, sleep disturbances, and feelings of guilt. She reports a past history of depression and anxiety, but has not taken any medications in the past. She also mentions difficulties in her marriage and problems at work, which have exacerbated her depressive symptoms.