Let's move on to some questions. Which of the following
statements about SSRI's is false. A, SSRI's may take up to
2 weeks to have an effect. B, combining them with MAO
inhibitors may lead to a serotonin syndrome. C, they are
competitive inhibitors of the serotonin receptor in nerve
endings. And D, they work well as tricyclic antidepressants
but have fewer side effects. The answer is C. So let's take
a look at the answers. SSRI's may actually take up to 2 weeks
to have an effect. They do cause a serotonin syndrome when
they are combined with MAO inhibitors or you are at risk of
developing serotonin syndrome. And yes, they do work as well
as tricyclic antidepressants and the nice thing is, is that they
have fewer side effects. Okay, let's go on to the next question.
Pick the correct statement. Citalopram has a large number of
drug interactions compared to other SSRI's. MAO inhibitors
will have reduced activity when consumed with tyramine.
Fluoxetine will interact with multiple medications including
tamoxifen. D, tricyclic antidepressants will increase the seizure
threshold, imparting partial protection in epilepsy. So right,
fluoxetine will interact with multiple medications including
tamoxifen. Let's go on to question 3. A 66 year old senator
presents to the emergency room with a rapid heart rate.
He is tremelous, diaphoretic, agitated, and combative.
His blood pressure is 166 systolic. His heart rate is 130.
He is hyperreflexic. He has peripheral clonus with exaggeration
in the lower extremities. He was recently placed on sertraline
for his depression. He has a history of Parkinson's disease,
high blood pressure, high cholesterol. His medications
are sertraline, rosuvastatin, bisoprolol, valsartan, and
selegiline. Pick the true statement. A, the sertraline
has interacted with the bisoprolol, rendering it inactive.
B, the sertraline has interacted with the rosuvastatin causing
toxicity and rhabdomyolysis. C, the sertraline has interacted
with his antiparkinsonian medication, selegiline. And D,
the sertraline has interacted with his valsartan precipitating
a hypertensive crisis. Which one is true? Right, the answer is C.
The sertraline has interacted with his antiparkinsonian
medication, selegiline. He is in serotonin syndrome.
Let's look at the other answers to try and figure out why
they are wrong and this answer is right. A, The sertraline has
interacted with his bisoprolol, rendering it inactive. That
would cause tachycardia and perhaps a rise in blood pressure
but it would have no neurological side effects like we are
describing here. So that answer is wrong. B is wrong.
Rhabdomyolysis does not result in blood pressures like this.
He will have altered urine so it will be a dark urine and
he may complain of severe pain, but he won't have peripheral
clonus and he won't have all of these other syndromes.
And D is wrong, because hypertensive crisis will not
give you the neurological symptoms that you see here.
So this is clearly serotonin syndrome.