hey everyone it's sarah with registerednessrn.com and in this video i'm going to cover ssris and as always whenever you get done watching this youtube video you can access the free quiz that will test you on this content so let's get started ssris are selective serotonin reuptake inhibitors and this group of medications inhibit the reuptake of the neurotransmitter serotonin so whenever you're studying medications many times if you just simply look at the name of the drug it's going to tell you how they work in the body so we know that these drugs inhibit the reuptake of serotonin and whenever we talk about the mechanism of action here in a moment that's going to make a lot more sense but because they do that they increase the serotonin levels in the brain which is helpful for many patients who are experiencing like depression so ssris are a common antidepressant that are prescribed also they can treat anxiety slash panic disorders along with compulsion disorders and ptsd now as a nurse how can you recognize on a patient's medication list that they are taking an ssri well you can look at the generic name and some of the generic names will have similar endings some will not but there's only about six to seven main ones used here in the u.s and they include paroxetine and fluoxetine which if you look at the ending of those they are very similar and then we have fluvoxamine and then sertaline and then there's cetalopram and escitalopram which are very similar in their names and then lastly is valazidone now let's talk about the mechanism of action of ssris and how they work in our body to influence the serotonin levels in our brain so the whole goal of these medications is to actually block the reuptake of serotonin by the releasing neuron now we want serotonin levels to be balanced we don't want them too low because that could lead to depression sleep problems etc and we don't want them too high because that could lead to serotonin syndrome which we're going to talk about a little bit later so we've already established the beginning of this lecture that ssris are used as an antidepressant to treat patients who are depressed and there's many theories about what causes depression one of the theories is that there's issues with an imbalance of neurotransmitters and one of those neurotransmitters being serotonin so if we can balance that out maybe we can help a patient with depression so to really help us understand how ssris work we have to review neurons and neurotransmitters so what are neurons well neurons are the functional part of our brain without a working neuron our brain ceases to really function because neurons are responsible for sending and transmitting information to either other neurons or glands or muscles and here we're going to be talking about communication between a neuron and a neuron now in order to send that message that neuron has to have some help through a neurotransmitter and neurotransmitters are chemical agents they are really what gives the details of that message that is being sent and you have many different types of neurotransmitters in your body you have some neurotransmitters that send exciting messages so they're excitatory neurotransmitters and this they will stimulate the brain you have some that send inhibitory messages which will help calm the brain and this is what serotonin is serotonin is an inhibitory neurotransmitter then you can have neurotransmitters that can have both properties so let's talk about serotonin because that's what we really care about for this lecture so serotonin helps you feel calm it is known for giving you happiness now serotonin receptors are mainly found in the brain stem specifically the rafi nucleus and the neurotransmitter serotonin has a major influence on your body for instance it plays a role with your mood it gives you that ability to feel happy and gives you mental stability along with your emotions how you respond to things and your memory and your sleeping schedule your appetite and your digestion therefore in order for us to function properly we have to have this balance of serotonin so now let's look at these serotonin receptors and how they work to release the neurotransmitter serotonin and what happens whenever an ssri is on board and how it actually affects this process so here we have a presynaptic neuron this is going to be the neuron that actually releases the neurotransmitter serotonin and that is represented here with the purple triangles then we have the postsynaptic neuron and this is the neuron that is going to have the special receptors on it that's going to allow the serotonin to lock onto those receptors and it will help carry out that inhibitory message and the space found between the presynaptic and the postsynaptic neuron is known as the synaptic clef so that's just like a fancy word to say the space between the two neurons so whenever the presynaptic neuron receives its signal it is going to release serotonin serotonin is going to enter into the synaptic cleft and then it's going to go down and it's going to find its special receptor site on this postsynaptic neuron now your body doesn't like anything to go to waste so in this space the synaptic cleft there will be some leftover serotonin so either some of that will degrade or it will enter back into this presynaptic neuron for future use so in order to get back into that neuron it needs some help and it gets its help through a special protein transporter called cert so some of the serotonin that's been left over in this space will just migrate up and go back into this pre-synaptic neuron and then later on it'll be ucm but let's say a patient is taking an ssri what's going to happen is this ssri is going to block this cert from working the special protein and instead the serotonin will hang out in this space longer which will enhance its availability to these receptors in hope of enhancing the serotonin levels that we need for let's say the patient who's depressed who has low serotonin levels now let's talk about nursing responsibilities patient education and those other important things we need to know about ssris and help guide us with those main concepts let's remember the mnemonic ssris the first s is symptoms start to improve around a month to six weeks so you want to take time to educate the patient that these medications start to work over time they don't work instantly because they have to build up in the system and to not stop taking them because you think they're not working and if you do start experiencing side effects they will usually start to ease off after this time so as a nurse you want to assess the patient's baseline signs and symptoms and then go back and re evaluate the patient signs and symptoms and see if this medication is providing them relief the next s is slowly taper off with assistance of the prescriber so you want to educate the patient that they don't want to suddenly just quit taking the ssri sometimes patients feel better and they don't want to take the medication anymore and others don't like the side effects so they may just quit taking the medication but instead it has to be tapered off and why is this because the body is used to that specific amount of neurotransmitter and the body must slowly be readjusted to the change so what can develop is discontinuation syndrome and this can last for a week or so and be very uncomfortable for the patient so what are some signs and symptoms that your patient may be going through this well remember the word stop because they've just stopped the medication so s is for stomach pain with diarrhea nausea gi symptoms will definitely be presenting t for trouble sleeping o for off balance they'll be dizzy experiencing ataxia and then p for peculiar sensations like they may report electrical shocks or tingling or numbness sensations in their body nexus are for risk for suicidal thoughts in young adults and possible adverse effects in pregnancy and breastfeeding and this depends on the ssri so as a nurse you want to assess the patient for thoughts of suicide or self-harm and if they plan on having a baby if they're pregnant because some ssris have been associated with heart defects and a condition called persistent pulmonary hypertension of the newborn and then also if your patient is breastfeeding assess that as well next is eye interaction with other medications so ssris are known to interact with some over-the-counter medications and prescription medications so one thing you want to remember with this is serotonin syndrome and this occurs when serotonin levels are too high and it typically happens when a patient is taking an ssri and combines it with another type of medication or substance that also increases serotonin levels in the brain so educate the patient to avoid the following medications mao eyes which are monoamine oxidase inhibitors certain opioid medications which are used for pain over-the-counter cold medications such as dextromethorphan which is known as robitussin alcohol migraine medications specifically the triptans and then st john's wort which is an over-the-counter herbal substance now this condition can present with the following signs and symptoms so to help you keep those signs and symptoms straight let's remember the word serotonin and we're talking about high serotonin so s is for sweating they'll be extremely sweaty and shivering e is for elevated temperature and heart rate r rigidity of muscles o for overactive reflexes t for tremors slash twitching seizures oh ophthalmolic changes like pupil dilation in nausea and vomiting diarrhea i irritability confusion in for nervousness and anxiety and then lastly you want to be familiar with the side effects of ssris and these are the main side effects that patients experience and again they tend to ease off over time so some things that they can experience is like gi disturbances because remember whenever we talked about the role of serotonin it played a role with our gi system so they can have nausea and vomiting nausea is a really big thing so maybe to help provide relief they can take their medication with food that might help it also patients have reported experiencing low libido or erectile dysfunction along with weight gain insomnia so if your patient reports to you i'm having insomnia i can't sleep at night because again serotonin is responsible for helping us with her whole sleep schedule um you may can recommend that the patient take the medication in the morning but let's say the patient maybe gets drowsy well they may want to take it at bedtime so just assess how the patient is tolerating it with that also the medications can cause dry mouth so you can recommend that the patient choose sugarless gum and because they are experiencing dry mouth they need to have good dental care so make sure they're brushing their teeth at least twice a day and go into regular dental visits okay so that wraps up this review over ssris and don't forget to access the free quiz that will test you on this material