escitalopram prescribing information FDA interactions contraindications dose

escitalopram AND pharmacokinetics

selective serotonin reuptake inhibitor synapse serotonin transporter mechanism diagram

major depressive disorder illustration clinical depression

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https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?set…

serotonin transporter SERT inhibitor synapse diagram selective serotonin reuptake inhibitor

https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?set…

mkdir -p "/tmp/workspace/escitalopram-ppt/src" "/tmp/workspace/escitalopram-ppt/output" "/tmp/workspace/escitalopram-ppt/assets" && python /tmp/skills/shared/scripts/fetch_images.py "https://cdn.orris.care/cdss_images/pmc_clinical_VQA_2d3dc138ca15f1a2ce46feee132635089001570a23227710c1d7fda8471a0ae9.jpg" > "/tmp/workspace/escitalopram-ppt/assets/fetched.json" && python -c "import json,base64; x=json.load(open('/tmp/workspace/escitalopram-ppt/assets/fetched.json'))[0]; open('/tmp/workspace/escitalopram-ppt/assets/brain.jpg','wb').write(base64.b64decode(x['base64'].split(',',1)[1])); print(x.get('error'),len(x['base64']))"

python - <<'PY' from pathlib import Path p=Path('/tmp/workspace/escitalopram-ppt/src/create_deck.py') p.write_text(r'''from pptx import Presentation from pptx.util import Inches, Pt from pptx.dml.color import RGBColor from pptx.enum.shapes import MSO_SHAPE, MSO_CONNECTOR from pptx.enum.text import PP_ALIGN, MSO_ANCHOR from pptx.enum.dml import MSO_THEME_COLOR from pptx.enum.shapes import MSO_AUTO_SHAPE_TYPE OUT='/tmp/workspace/escitalopram-ppt/output/Escitalopram_Presentation.pptx' BRAIN='/tmp/workspace/escitalopram-ppt/assets/brain.jpg' prs=Presentation(); prs.slide_width=Inches(13.333); prs.slide_height=Inches(7.5) blank=prs.slide_layouts[6] # palette NAVY=RGBColor(19,36,64); TEAL=RGBColor(16,137,143); MINT=RGBColor(207,240,235); SKY=RGBColor(231,244,249); ORANGE=RGBColor(238,140,74); RED=RGBColor(190,67,72); INK=RGBColor(38,49,62); GREY=RGBColor(101,112,125); WHITE=RGBColor(255,255,255); PALE=RGBColor(246,249,251) def bg(slide, color=WHITE): sh=slide.background.fill; sh.solid(); sh.fore_color.rgb=color def rect(slide,x,y,w,h,color, radius=False, line=None): shape=slide.shapes.add_shape(MSO_SHAPE.ROUNDED_RECTANGLE if radius else MSO_SHAPE.RECTANGLE, Inches(x), Inches(y), Inches(w), Inches(h)) shape.fill.solid(); shape.fill.fore_color.rgb=color shape.line.color.rgb = line if line else color if radius: shape.adjustments[0]=0.12 return shape def text(slide,txt,x,y,w,h,size=20,color=INK,bold=False,align=PP_ALIGN.LEFT,font='Aptos',margin=.05): box=slide.shapes.add_textbox(Inches(x),Inches(y),Inches(w),Inches(h)) tf=box.text_frame; tf.clear(); tf.word_wrap=True; tf.margin_left=tf.margin_right=Inches(margin); tf.margin_top=tf.margin_bottom=Inches(margin); tf.vertical_anchor=MSO_ANCHOR.MIDDLE p=tf.paragraphs[0]; p.alignment=align; r=p.add_run(); r.text=txt; r.font.name=font; r.font.size=Pt(size); r.font.bold=bold; r.font.color.rgb=color return box def title(slide,head,sub=None,n=None): text(slide,head,.65,.42,10.8,.48,28,NAVY,True) if sub: text(slide,sub,.67,.93,10.8,.3,11,GREY) rect(slide,.65,1.28,1.05,.06,TEAL) if n: text(slide,f'{n:02d}',12.15,.47,.52,.3,13,TEAL,True,PP_ALIGN.RIGHT) def footer(slide,src='Kaplan & Sadock’s Synopsis of Psychiatry; DailyMed Escitalopram label'): rect(slide,.0,7.18,13.333,.32,NAVY) text(slide,src,.65,7.20,11.8,.18,8,WHITE) def bullets(slide,items,x,y,w,h,size=18, color=INK, leading=1.05): box=slide.shapes.add_textbox(Inches(x),Inches(y),Inches(w),Inches(h)); tf=box.text_frame; tf.clear(); tf.word_wrap=True tf.margin_left=tf.margin_right=Inches(.05); tf.margin_top=tf.margin_bottom=Inches(.02) for i,it in enumerate(items): p=tf.paragraphs[0] if i==0 else tf.add_paragraph(); p.text=it; p.font.name='Aptos'; p.font.size=Pt(size); p.font.color.rgb=color; p.space_after=Pt(9); p.level=0; p.bullet=True return box def label(slide,txt,x,y,w,color=TEAL): r=rect(slide,x,y,w,.32,color,True); text(slide,txt,x+.08,y+.02,w-.16,.25,10,WHITE,True,PP_ALIGN.CENTER); return r def circle(slide,x,y,d,color,txt='',ts=16): s=slide.shapes.add_shape(MSO_SHAPE.OVAL, Inches(x), Inches(y), Inches(d), Inches(d)); s.fill.solid(); s.fill.fore_color.rgb=color; s.line.color.rgb=color if txt: text(slide,txt,x,y,d,d,ts,WHITE,True,PP_ALIGN.CENTER) return s def arrow(slide,x1,y1,x2,y2,color=TEAL,width=2): ln=slide.shapes.add_connector(MSO_CONNECTOR.STRAIGHT, Inches(x1), Inches(y1), Inches(x2), Inches(y2)); ln.line.color.rgb=color; ln.line.width=Pt(width); ln.line.end_arrowhead=True; return ln # 1 s=prs.slides.add_slide(blank); bg(s,NAVY) # visual shapes for x,y,d,c in [(9.4,.7,.4,TEAL),(10.2,1.25,.22,ORANGE),(11.1,.65,.3,MINT),(10.7,2.0,.42,TEAL),(9.1,2.1,.18,ORANGE)]: circle(s,x,y,d,c) # stylized capsule pill=rect(s,8.7,3.0,3.7,1.25,WHITE,True); rect(s,8.7,3.0,1.85,1.25,TEAL,True); rect(s,10.50,3.0,.08,1.25,WHITE); text(s,'ESC',8.95,3.34,1.2,.42,22,WHITE,True,PP_ALIGN.CENTER); text(s,'SSRI',10.73,3.34,1.25,.42,22,TEAL,True,PP_ALIGN.CENTER) text(s,'ESCITALOPRAM',.72,1.18,7.7,.7,42,WHITE,True) text(s,'Selective serotonin reuptake inhibitor',.77,1.95,6.8,.35,19,MINT) rect(s,.75,2.55,2.0,.06,ORANGE) text(s,'Clinical pharmacology overview',.77,2.83,5.8,.35,21,WHITE) text(s,'Introduction • mechanism • pharmacokinetics • use • safety • dosing',.78,3.43,6.4,.55,15,RGBColor(205,220,231)) text(s,'Prepared from Kaplan & Sadock’s Synopsis of Psychiatry and current product labeling',.78,6.55,7.2,.3,10,RGBColor(183,205,218)) #2 s=prs.slides.add_slide(blank); bg(s); title(s,'At a glance','A highly selective SSRI',2) rect(s,.7,1.7,4.0,4.65,SKY,True); text(s,'WHAT IT IS',.98,2.00,3.3,.35,14,TEAL,True) text(s,'The active S-enantiomer of citalopram',.98,2.48,3.15,.85,26,NAVY,True) text(s,'Selective blockade of the serotonin transporter (SERT).',.98,3.55,3.12,.7,17,INK) label(s,'Once-daily oral SSRI',1.0,5.34,2.65,NAVY) # stat cards for x,num,cap,col in [(5.25,'~27-32 h','terminal half-life',TEAL),(7.78,'~1 week','to steady state',ORANGE),(10.31,'~5 h','to peak level',NAVY)]: rect(s,x,2.13,2.15,2.5,PALE,True); text(s,num,x+.12,2.63,1.91,.5,24,col,True,PP_ALIGN.CENTER); text(s,cap,x+.14,3.38,1.88,.4,13,GREY,False,PP_ALIGN.CENTER) text(s,'Kaplan & Sadock’s Synopsis lists escitalopram among SSRIs. SSRI effects are mediated through inhibition of serotonin reuptake.',5.3,5.2,6.6,.7,16,INK) footer(s) #3 mechanism s=prs.slides.add_slide(blank); bg(s); title(s,'Mechanism of action','Escitalopram increases serotonin signaling in the synaptic cleft',3) # synapse rect(s,.85,2.1,3.55,3.5,SKY,True); text(s,'Presynaptic neuron',1.05,2.35,2.8,.3,16,NAVY,True) rect(s,8.95,2.1,3.55,3.5,MINT,True); text(s,'Postsynaptic neuron',9.15,2.35,2.8,.3,16,NAVY,True) rect(s,4.75,2.1,3.82,3.5,PALE,True); text(s,'Synaptic cleft',5.55,2.35,2.2,.3,16,GREY,True,PP_ALIGN.CENTER) # vesicle, transporter and 5HT for x,y in [(1.35,3.15),(2.15,4.15),(3.15,3.35)]: circle(s,x,y,.56,TEAL,'5-HT',9) # arrows release arrow(s,3.7,3.5,5.35,3.5,TEAL); arrow(s,6.45,3.5,8.75,3.5,TEAL) for x,y in [(5.48,3.23),(6.12,3.85),(7.08,3.18),(7.65,4.0)]: circle(s,x,y,.42,ORANGE,'5-HT',7) # receptors for y in [3.15,4.05]: rect(s,9.0,y,.25,.55,NAVY,True); text(s,'5-HT receptor',9.42,y+.03,1.65,.2,11,NAVY) # SERT blocked rect(s,4.40,4.45,.45,.85,NAVY,True); text(s,'SERT',3.86,5.36,1.5,.22,11,NAVY,True) circle(s,4.25,4.1,.72,RED,'ESC',11); text(s,'blocks reuptake',4.92,4.65,1.5,.25,12,RED,True) text(s,'Net result: more 5-HT remains available in the cleft. Clinical benefit typically develops over weeks, reflecting downstream adaptation.',.95,6.07,11.6,.46,16,INK,False,PP_ALIGN.CENTER) footer(s,'Kaplan & Sadock’s Synopsis of Psychiatry, Antidepressants; DailyMed') #4 PK s=prs.slides.add_slide(blank); bg(s); title(s,'Pharmacokinetics','Predictable, linear exposure with once-daily administration',4) steps=[('Absorption','Oral tablet or solution\nFood does not alter absorption\nPeak: ~5 hours',TEAL),('Distribution','~56% protein bound\nData from labeling',ORANGE),('Metabolism','Hepatic biotransformation\nCYP2C19 and CYP3A4 primary',NAVY),('Elimination','t½ ~27-32 h\n~7% renal clearance\nSteady state ~1 week',TEAL)] for i,(h,b,c) in enumerate(steps): x=.68+i*3.15; rect(s,x,2.2,2.7,2.85,PALE if i%2 else SKY,True); circle(s,x+.18,2.43,.43,c,str(i+1),12); text(s,h,x+.72,2.40,1.68,.3,16,c,True); text(s,b,x+.25,3.10,2.18,1.35,14,INK) if i<3: arrow(s,x+2.72,3.62,x+3.1,3.62,GREY,1.5) text(s,'Special populations: in older adults, half-life is increased by about 50%; use 10 mg/day. Hepatic impairment: recommended 10 mg/day.',.85,5.70,11.6,.45,16,NAVY,True,PP_ALIGN.CENTER) footer(s,'DailyMed Escitalopram label, Clinical Pharmacology 12.3') #5 uses s=prs.slides.add_slide(blank); bg(s); title(s,'Therapeutic uses','Match treatment to a confirmed diagnosis and individual patient context',5) rect(s,.7,1.65,5.85,4.95,SKY,True); text(s,'FDA-LABELED USES (US)',1.02,1.98,4.5,.3,15,TEAL,True) for i,(h,b) in enumerate([('Major depressive disorder','Adults and adolescents aged 12 years and older.'),('Generalized anxiety disorder','Adults.')]): circle(s,1.06,2.65+i*1.42,.44,TEAL,str(i+1),12); text(s,h,1.64,2.61+i*1.42,3.9,.28,18,NAVY,True); text(s,b,1.64,2.95+i*1.42,3.95,.38,14,INK) rect(s,6.85,1.65,5.8,4.95,MINT,True); text(s,'CLINICAL PRINCIPLES',7.16,1.98,4.5,.3,15,NAVY,True) bullets(s,['SSRIs are core pharmacologic treatments for depressive and anxiety disorders.','Assess suicide risk, bipolar disorder history, comorbidity, medicines, and psychotherapy needs.','Individual indications and approved ages vary across countries and labels.'],7.15,2.58,4.95,2.8,16) text(s,'Not a medication for immediate symptomatic relief.',7.18,5.72,4.8,.36,15,RED,True,PP_ALIGN.CENTER) footer(s,'Kaplan & Sadock’s Synopsis of Psychiatry, Antidepressants; DailyMed') #6 adverse s=prs.slides.add_slide(blank); bg(s); title(s,'Adverse reactions and monitoring','Distinguish common tolerability effects from urgent safety signals',6) rect(s,.7,1.6,5.95,4.98,SKY,True); text(s,'COMMON / DOSE-RELATED',1.02,1.93,4.4,.3,15,TEAL,True) bullets(s,['Nausea, diarrhea or constipation, dry mouth','Headache, dizziness, fatigue, sweating','Insomnia or somnolence','Sexual dysfunction: reduced libido, delayed ejaculation, anorgasmia'],1.00,2.42,5.1,2.85,17) rect(s,6.88,1.6,5.75,4.98,RGBColor(254,241,241),True); text(s,'IMPORTANT WARNINGS',7.20,1.93,4.4,.3,15,RED,True) bullets(s,['Suicidal thoughts/behavior: monitor especially early and after dose changes','Serotonin syndrome: agitation, autonomic instability, neuromuscular findings','Hyponatremia/SIADH, particularly in older adults','Mania/hypomania activation; abnormal bleeding with antiplatelet/NSAID use','QT prolongation risk: consider patient and co-medication factors'],7.18,2.37,4.85,3.35,15) footer(s,'DailyMed Escitalopram label, Warnings and Precautions; Adverse Reactions') #7 interactions s=prs.slides.add_slide(blank); bg(s); title(s,'Drug interactions','Screen medicines, OTC products, and supplements before prescribing',7) items=[('MAOIs / linezolid / IV methylene blue','Contraindicated: serotonin syndrome risk. Observe 14-day washout for psychiatric MAOIs.',RED),('Other serotonergic agents','Triptans, tramadol, lithium, tryptophan, St John’s wort: monitor for serotonin syndrome.',ORANGE),('NSAIDs, aspirin, anticoagulants','May increase bleeding risk. Monitor clinically.',TEAL),('CYP2C19/CYP3A4 inhibitors and CYP2C19 poor metabolizers','May increase escitalopram exposure. Review dose and adverse effects.',NAVY),('Pimozide','Contraindicated. QT-related risk.',RED)] for i,(h,b,c) in enumerate(items): y=1.55+i*1.04; rect(s,.78,y,11.82,.82,PALE,True); rect(s,.79,y,.13,.82,c); text(s,h,1.10,y+.12,4.25,.25,15,c,True); text(s,b,5.35,y+.10,6.75,.42,13,INK) footer(s,'DailyMed Escitalopram label, Drug Interactions and Contraindications') #8 contraindications s=prs.slides.add_slide(blank); bg(s); title(s,'Contraindications and key precautions','Contraindication is not the same as a situation requiring caution',8) rect(s,.7,1.65,5.88,4.85,RGBColor(254,241,241),True); text(s,'CONTRAINDICATIONS',1.03,1.97,4.7,.3,16,RED,True) for i,t in enumerate(['Concomitant MAOI use, or use within 14 days of stopping a psychiatric MAOI','Pimozide coadministration','Known hypersensitivity to escitalopram, citalopram, or formulation components']): circle(s,1.05,2.65+i*1.0,.38,RED,'!',14); text(s,t,1.62,2.57+i*1.0,4.35,.55,15,INK) rect(s,6.9,1.65,5.72,4.85,SKY,True); text(s,'USE CAUTION / ASSESS',7.22,1.97,4.7,.3,16,TEAL,True) bullets(s,['Bipolar disorder or past mania/hypomania','Seizure disorder, bleeding risk, hyponatremia risk','Severe renal impairment: limited data','Pregnancy, lactation, older age, hepatic impairment','QT-risk factors or concomitant QT-prolonging medicines'],7.22,2.55,4.82,2.9,16) text(s,'Caution prompts a risk-benefit assessment and monitoring.',7.25,5.80,4.76,.28,14,NAVY,True,PP_ALIGN.CENTER) footer(s,'DailyMed Escitalopram label') #9 dose s=prs.slides.add_slide(blank); bg(s); title(s,'Dose and administration','Typical US label dosing. Prescribe and adjust only under clinician supervision.',9) headers=['Population / indication','Initial & recommended','Maximum / note'] xs=[.75,5.1,8.65]; ws=[4.15,3.3,3.95] for x,w,h in zip(xs,ws,headers): rect(s,x,1.62,w,.55,NAVY,True); text(s,h,x+.12,1.74,w-.24,.2,14,WHITE,True,PP_ALIGN.CENTER) rows=[('Adults with MDD','10 mg once daily','20 mg/day. No added benefit seen at 20 mg/day for some patients.'),('Adolescents 12+ with MDD','10 mg once daily','May increase to 20 mg/day after at least 3 weeks.'),('Adults with GAD','10 mg once daily','20 mg/day maximum.'),('Older adults / hepatic impairment','10 mg once daily','Recommended dose 10 mg/day.'),('Discontinuation','Taper gradually','Avoid abrupt stopping when possible.')] for i,row in enumerate(rows): y=2.18+i*.79 for x,w,tx in zip(xs,ws,row): rect(s,x,y,w,.72,SKY if i%2==0 else PALE,False); text(s,tx,x+.13,y+.10,w-.26,.5,13,INK, i==0 and x==xs[0]) text(s,'May be taken morning or evening, with or without food. Reassess response, adverse effects, adherence, and safety after initiation and each dose change.',.85,6.34,11.4,.35,14,NAVY,True,PP_ALIGN.CENTER) footer(s,'DailyMed Escitalopram label, Dosage and Administration') #10 summary s=prs.slides.add_slide(blank); bg(s,NAVY); title(s,'Summary','Clinical take-home points',10) # title override text color? # headings remain navy invisible so overlay rect(s,.64,.38,8.8,.7,NAVY); text(s,'Summary',.65,.42,7.0,.44,28,WHITE,True); text(s,'Clinical take-home points',.67,.94,7,.24,11,MINT) points=[('1','Selective SSRI','Blocks SERT and increases synaptic serotonin.'),( '2','Predictable PK','Once daily; steady state in about 1 week; hepatic metabolism.'),('3','Evidence-based use','US labeling: MDD and adult GAD.'),('4','Safety first','Avoid MAOIs and pimozide. Screen for serotonergic, bleeding, and QT risks.'),('5','Individualize','Start 10 mg/day in most adults; taper rather than stop abruptly.')] for i,(n,h,b) in enumerate(points): y=1.55+i*.88; circle(s,.92,y,.46,TEAL,n,13); text(s,h,1.62,y-.02,2.3,.24,16,WHITE,True); text(s,b,4.0,y-.02,7.7,.34,14,RGBColor(217,231,238)) text(s,'Medication education and follow-up are part of safe SSRI prescribing.',.9,6.35,10.7,.35,17,MINT,True) #11 refs s=prs.slides.add_slide(blank); bg(s); title(s,'References','Core sources used in this educational presentation',11) refs=["Sadock BJ, Sadock VA, Ruiz P. Kaplan & Sadock’s Synopsis of Psychiatry. Antidepressants and psychopharmacological interventions sections.","DailyMed. Escitalopram tablets/oral solution: US prescribing information. Clinical Pharmacology, Dosage and Administration, Contraindications, Warnings, Adverse Reactions, Drug Interactions. Accessed September 2026.","FDA. Lexapro (escitalopram oxalate) prescribing information. US Food and Drug Administration.","Visual note: original schematic synapse used for mechanism explanation. Brain connectivity figure from image library, used as a contextual depression illustration."] for i,r in enumerate(refs): rect(s,.82,1.70+i*1.0,11.65,.73,PALE if i%2 else SKY,True); text(s,r,1.08,1.83+i*1.0,11.05,.42,14,INK) text(s,'Educational use only. Not a substitute for local prescribing information, clinical assessment, or specialist advice.',.9,6.28,11.4,.35,14,RED,True,PP_ALIGN.CENTER) footer(s,'Sources listed above') prs.save(OUT) print(OUT) ''') PY python "/tmp/workspace/escitalopram-ppt/src/create_deck.py" python - <<'PY' from pptx import Presentation p='/tmp/workspace/escitalopram-ppt/output/Escitalopram_Presentation.pptx' prs=Presentation(p) print('slides:',len(prs.slides)) for i,s in enumerate(prs.slides,1): print(i, ' | '.join(sh.text.replace('\n',' / ')[:60] for sh in s.shapes if getattr(sh,'has_text_frame',False) and sh.text.strip())[:180]) PY

~/escitalopram-ppt/

python - <<'PY' from pptx import Presentation from pathlib import Path p=Path('/tmp/workspace/escitalopram-ppt/output/Escitalopram_Presentation.pptx') assert p.exists() and p.stat().st_size > 10000 prs=Presentation(str(p)) assert len(prs.slides)==11 checks=['ESCITALOPRAM','Mechanism of action','Pharmacokinetics','Therapeutic uses','Adverse reactions','Drug interactions','Contraindications','Dose and administration','Summary'] alltxt='\n'.join(shape.text for slide in prs.slides for shape in slide.shapes if getattr(shape,'has_text_frame',False)) missing=[x for x in checks if x not in alltxt] assert not missing, missing print(f'Validated: {len(prs.slides)} slides, {p.stat().st_size} bytes') PY

DailyMed escitalopram current prescribing information dosage contraindications interactions pharmacokinetics

escitalopram AND safety

serotonin synapse diagram serotonin transporter SERT reuptake inhibitor SSRI

depression brain illustration serotonin pathway

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Educational medical illustration showing a serotonin synapse in cross-section: presynaptic neuron releasing serotonin molecules into the synaptic cleft, serotonin transporter on presynaptic membrane blocked by an escitalopram molecule, postsynaptic serotonin receptors. Include no labels or text. Scientifically clear, suitable for a pharmacology presentation.

~/escitalopram-ppt/

python /tmp/skills/shared/scripts/fetch_images.py "https://cdn.orris.care/image-gen/d036149daa8e41809f97d955c09e43f8.png" > "/tmp/workspace/escitalopram-ppt/assets/synapse_fetch.json" && python -c "import json,base64; x=json.load(open('/tmp/workspace/escitalopram-ppt/assets/synapse_fetch.json'))[0]; assert not x.get('error'),x.get('error'); open('/tmp/workspace/escitalopram-ppt/assets/synapse.png','wb').write(base64.b64decode(x['base64'].split(',',1)[1])); print('saved')"

python - <<'PY' from pathlib import Path p=Path('/tmp/workspace/escitalopram-ppt/src/rebuild_deck.py') p.write_text('''from pptx import Presentation from pptx.util import Inches, Pt from pptx.dml.color import RGBColor from pptx.enum.shapes import MSO_SHAPE from pptx.enum.text import PP_ALIGN, MSO_ANCHOR from pptx.enum.dml import MSO_LINE_DASH_STYLE from pathlib import Path OUT=Path('/tmp/workspace/escitalopram-ppt/output/Escitalopram_Kaplan_Sadock_Rebuilt.pptx') IMG='/tmp/workspace/escitalopram-ppt/assets/synapse.png' prs=Presentation(); prs.slide_width=Inches(13.333); prs.slide_height=Inches(7.5) BLANK=prs.slide_layouts[6] NAVY=RGBColor(18,40,67); BLUE=RGBColor(31,110,168); TEAL=RGBColor(30,153,145); AQUA=RGBColor(219,242,240); PALE=RGBColor(243,248,251); INK=RGBColor(35,48,64); GREY=RGBColor(93,109,124); WHITE=RGBColor(255,255,255); AMBER=RGBColor(236,155,54); RED=RGBColor(193,67,71) def fill(slide,c): slide.background.fill.solid(); slide.background.fill.fore_color.rgb=c def shape(slide,x,y,w,h,c,rounded=False,stroke=None): s=slide.shapes.add_shape(MSO_SHAPE.ROUNDED_RECTANGLE if rounded else MSO_SHAPE.RECTANGLE,Inches(x),Inches(y),Inches(w),Inches(h)); s.fill.solid(); s.fill.fore_color.rgb=c; s.line.color.rgb=stroke or c; return s def tx(slide,t,x,y,w,h,sz=18,c=INK,b=False,align=PP_ALIGN.LEFT): box=slide.shapes.add_textbox(Inches(x),Inches(y),Inches(w),Inches(h)); f=box.text_frame; f.clear(); f.word_wrap=True; f.margin_left=f.margin_right=Inches(.06); f.margin_top=f.margin_bottom=Inches(.03); f.vertical_anchor=MSO_ANCHOR.MIDDLE; p=f.paragraphs[0]; p.alignment=align; r=p.add_run(); r.text=t; r.font.name='Aptos'; r.font.size=Pt(sz); r.font.bold=b; r.font.color.rgb=c; return box def heading(slide,t,sub,num): tx(slide,t,.65,.38,10.9,.5,27,NAVY,True); tx(slide,sub,.67,.88,10.9,.28,11,GREY); shape(slide,.67,1.22,1.05,.055,TEAL); tx(slide,f'{num:02d}',12.15,.42,.5,.28,13,TEAL,True,PP_ALIGN.RIGHT) def foot(slide,source): shape(slide,0,7.17,13.333,.33,NAVY); tx(slide,source,.62,7.205,12,.16,8,WHITE) def bullet_box(slide,items,x,y,w,h,sz=16): box=slide.shapes.add_textbox(Inches(x), Inches(y), Inches(w), Inches(h)); f=box.text_frame; f.clear(); f.word_wrap=True; f.margin_left=Inches(.12); f.margin_right=Inches(.05); f.margin_top=Inches(.05); f.margin_bottom=Inches(.02) for i,a in enumerate(items): p=f.paragraphs[0] if i==0 else f.add_paragraph(); p.text=a; p.font.name='Aptos'; p.font.size=Pt(sz); p.font.color.rgb=INK; p.level=0; p.space_after=Pt(8); p.bullet=True return box def badge(slide,t,x,y,w,c): shape(slide,x,y,w,.36,c,True); tx(slide,t,x+.05,y+.04,w-.1,.25,10,WHITE,True,PP_ALIGN.CENTER) # 1 s=prs.slides.add_slide(BLANK); fill(s,NAVY) for x,y,d,c in [(8.9,.72,.25,TEAL),(10.3,1.12,.42,AQUA),(11.5,.66,.16,AMBER),(11.1,2.2,.28,TEAL),(9.55,2.1,.16,AMBER)]: o=s.shapes.add_shape(MSO_SHAPE.OVAL,Inches(x),Inches(y),Inches(d),Inches(d)); o.fill.solid(); o.fill.fore_color.rgb=c; o.line.color.rgb=c shape(s,8.55,3.0,3.85,1.22,WHITE,True); shape(s,8.55,3.0,1.92,1.22,TEAL,True); shape(s,10.43,3.0,.08,1.22,WHITE) tx(s,'ESC',8.83,3.35,1.25,.34,22,WHITE,True,PP_ALIGN.CENTER); tx(s,'SSRI',10.72,3.35,1.25,.34,22,TEAL,True,PP_ALIGN.CENTER) tx(s,'ESCITALOPRAM',.7,1.1,7.3,.6,43,WHITE,True); tx(s,'Selective serotonin reuptake inhibitor',.74,1.9,6.9,.34,19,AQUA); shape(s,.75,2.5,2.15,.06,AMBER); tx(s,'Clinical pharmacology presentation',.74,2.82,6.4,.34,20,WHITE); tx(s,'Introduction • mechanism of action • pharmacokinetics • uses • safety • dosing',.74,3.43,6.9,.38,15,RGBColor(204,222,234)); tx(s,'Primary text: Kaplan & Sadock’s Synopsis of Psychiatry',.74,6.52,7.2,.24,10,RGBColor(190,213,226)) # 2 s=prs.slides.add_slide(BLANK); fill(s,WHITE); heading(s,'Introduction','What is escitalopram?',2) shape(s,.72,1.7,4.05,4.85,PALE,True); tx(s,'IDENTITY',1.02,2.03,2.8,.25,14,TEAL,True); tx(s,'The pharmacologically active S-enantiomer of citalopram',1.02,2.48,3.25,1.08,25,NAVY,True); tx(s,'An SSRI that selectively inhibits the serotonin transporter (SERT).',1.02,3.85,3.22,.65,16,INK); badge(s,'Once-daily oral medicine',1.02,5.42,2.65,NAVY) for i,(a,b,c) in enumerate([('Class','SSRI',TEAL),('Core target','SERT',BLUE),('Clinical onset','weeks',AMBER)]): x=5.2+i*2.45; shape(s,x,2.05,2.1,2.4,PALE,True); tx(s,a,x+.15,2.43,1.8,.25,13,GREY,True,PP_ALIGN.CENTER); tx(s,b,x+.13,3.03,1.84,.45,25,c,True,PP_ALIGN.CENTER) tx(s,'Kaplan & Sadock’s Synopsis lists escitalopram among selective serotonin reuptake inhibitors. Low SSRI doses can produce high serotonin-transporter occupancy.',5.25,5.12,6.75,.76,16,INK) foot(s,'Kaplan & Sadock’s Synopsis of Psychiatry, Table 1-25; Antidepressants') # 3 s=prs.slides.add_slide(BLANK); fill(s,WHITE); heading(s,'Mechanism of action','Escitalopram blocks the serotonin transporter',3) shape(s,.75,1.62,5.0,4.95,NAVY,True); s.shapes.add_picture(IMG,Inches(.94),Inches(1.81),width=Inches(4.62),height=Inches(4.55)) shape(s,6.15,1.62,6.45,4.95,PALE,True); tx(s,'WHAT HAPPENS AT THE SYNAPSE',6.5,1.97,4.7,.25,14,TEAL,True) for i,(h,b) in enumerate([('1. SERT blockade','Escitalopram inhibits presynaptic reuptake of serotonin.'),('2. More 5-HT in cleft','Synaptic serotonin remains available for longer.'),('3. Downstream adaptation','Clinical response develops over time and is not immediate.')]): y=2.55+i*1.04; shape(s,6.48,y,.38,.38,[TEAL,BLUE,AMBER][i],True); tx(s,str(i+1),6.48,y+.035,.38,.24,11,WHITE,True,PP_ALIGN.CENTER); tx(s,h,7.08,y-.02,2.5,.25,16,NAVY,True); tx(s,b,7.08,y+.30,4.75,.44,14,INK) tx(s,'Functional result: enhanced serotonergic neurotransmission.',6.52,5.88,5.4,.3,15,RED,True,PP_ALIGN.CENTER) foot(s,'Kaplan & Sadock’s Synopsis of Psychiatry; DailyMed Escitalopram label') # 4 s=prs.slides.add_slide(BLANK); fill(s,WHITE); heading(s,'Pharmacokinetics','Linear exposure supports once-daily use',4) items=[('ABSORPTION','Peak plasma concentration: ~5 h\nFood does not affect absorption',TEAL),('DISTRIBUTION','Plasma protein binding: ~56%',BLUE),('METABOLISM','Hepatic; CYP2C19 and CYP3A4 are primary enzymes',AMBER),('ELIMINATION','Terminal half-life: ~27-32 h\nSteady state: ~1 week',TEAL)] for i,(h,b,c) in enumerate(items): x=.72+(i%2)*6.17; y=1.74+(i//2)*2.27; shape(s,x,y,5.72,1.86,PALE if i%2 else AQUA,True); shape(s,x+.22,y+.27,.55,.55,c,True); tx(s,str(i+1),x+.22,y+.35,.55,.2,13,WHITE,True,PP_ALIGN.CENTER); tx(s,h,x+.98,y+.28,4.15,.25,15,c,True); tx(s,b,x+.98,y+.71,4.2,.7,16,INK) shape(s,.75,6.25,11.85,.46,NAVY,True); tx(s,'Older adults: half-life increases by about 50%. Hepatic impairment: recommended dose is 10 mg/day.',.98,6.31,11.3,.26,14,WHITE,True,PP_ALIGN.CENTER) foot(s,'DailyMed Escitalopram label, Clinical Pharmacology 12.3; Kaplan & Sadock’s Comprehensive Textbook of Psychiatry') # 5 s=prs.slides.add_slide(BLANK); fill(s,WHITE); heading(s,'Therapeutic uses','Use within a comprehensive psychiatric treatment plan',5) shape(s,.72,1.68,5.73,4.9,AQUA,True); tx(s,'US FDA-LABELED INDICATIONS',1.04,2.0,4.4,.25,14,TEAL,True) for i,(h,b) in enumerate([('Major depressive disorder','Adults and adolescents aged 12 years and older.'),('Generalized anxiety disorder','Adults.')]): y=2.65+i*1.5; shape(s,1.05,y,.46,.46,TEAL,True); tx(s,str(i+1),1.05,y+.08,.46,.22,12,WHITE,True,PP_ALIGN.CENTER); tx(s,h,1.72,y-.01,3.7,.25,18,NAVY,True); tx(s,b,1.72,y+.37,3.85,.4,14,INK) shape(s,6.83,1.68,5.78,4.9,PALE,True); tx(s,'CLINICAL PRACTICE POINTS',7.14,2.0,4.4,.25,14,BLUE,True); bullet_box(s,['Confirm diagnosis and assess suicide risk before starting treatment.','Screen for previous mania or hypomania and relevant comorbidities.','Combine with psychotherapy and psychosocial interventions when indicated.','Other uses may be off-label and need local guideline support.'],7.1,2.58,4.92,2.95,15) tx(s,'Not intended for rapid relief of acute symptoms.',7.15,5.92,4.7,.25,14,RED,True,PP_ALIGN.CENTER) foot(s,'Kaplan & Sadock’s Synopsis of Psychiatry, Antidepressants; DailyMed Escitalopram label') # 6 s=prs.slides.add_slide(BLANK); fill(s,WHITE); heading(s,'Adverse reactions','Plan monitoring before the first dose',6) shape(s,.72,1.65,5.8,4.95,PALE,True); tx(s,'COMMON EFFECTS',1.02,1.98,4,.25,15,TEAL,True); bullet_box(s,['Nausea, diarrhea or constipation, dry mouth','Headache, dizziness, fatigue, increased sweating','Insomnia or somnolence','Sexual adverse effects: reduced libido, delayed ejaculation, anorgasmia'],1.02,2.48,4.95,2.85,16) shape(s,6.83,1.65,5.78,4.95,RGBColor(255,243,243),True); tx(s,'IMPORTANT SAFETY SIGNALS',7.15,1.98,4.6,.25,15,RED,True); bullet_box(s,['Suicidal thoughts/behaviors, especially early in treatment and after dose changes','Serotonin syndrome','Hyponatremia/SIADH, particularly in older adults','Activation of mania/hypomania','Bleeding risk with NSAIDs, aspirin, or anticoagulants'],7.12,2.42,4.9,3.1,15) foot(s,'DailyMed Escitalopram label, Warnings and Precautions; Adverse Reactions') # 7 s=prs.slides.add_slide(BLANK); fill(s,WHITE); heading(s,'Drug interactions','Ask specifically about prescriptions, OTC medicines, and supplements',7) rows=[('MAOIs, linezolid, IV methylene blue','Contraindicated. Increased serotonin syndrome risk.',RED),('Other serotonergic drugs','Tramadol, triptans, lithium, tryptophan, St John’s wort: monitor for serotonin syndrome.',AMBER),('NSAIDs, aspirin, anticoagulants','May increase bleeding risk.',TEAL),('CYP2C19/CYP3A4 inhibitors','May increase exposure. Review response and adverse effects.',BLUE),('Pimozide','Contraindicated. QT-related risk.',RED)] for i,(a,b,c) in enumerate(rows): y=1.6+i*.98; shape(s,.78,y,11.82,.76,PALE if i%2 else AQUA,True); shape(s,.79,y,.11,.76,c); tx(s,a,1.10,y+.13,4.25,.23,15,c,True); tx(s,b,5.25,y+.10,6.9,.38,13,INK) foot(s,'DailyMed Escitalopram label, Drug Interactions') # 8 s=prs.slides.add_slide(BLANK); fill(s,WHITE); heading(s,'Contraindications','Separate absolute restrictions from situations requiring caution',8) shape(s,.72,1.68,5.82,4.87,RGBColor(255,243,243),True); tx(s,'CONTRAINDICATIONS',1.05,2.0,4.2,.25,16,RED,True) for i,t in enumerate(['MAOIs, or within 14 days of stopping a psychiatric MAOI','Pimozide coadministration','Known hypersensitivity to escitalopram, citalopram, or formulation components']): y=2.65+i*1.03; shape(s,1.07,y,.42,.42,RED,True); tx(s,'!',1.07,y+.06,.42,.2,14,WHITE,True,PP_ALIGN.CENTER); tx(s,t,1.7,y-.04,4.2,.55,15,INK) shape(s,6.85,1.68,5.76,4.87,PALE,True); tx(s,'ASSESS / USE CAUTION',7.17,2.0,4.3,.25,16,TEAL,True); bullet_box(s,['Bipolar disorder or history of mania/hypomania','Seizure disorder, hyponatremia risk, bleeding risk','Severe renal impairment: limited pharmacokinetic data','Pregnancy, lactation, older age, hepatic impairment','QT-risk factors or other QT-prolonging medicines'],7.12,2.54,4.88,3.05,15) foot(s,'DailyMed Escitalopram label, Contraindications and Special Populations') # 9 s=prs.slides.add_slide(BLANK); fill(s,WHITE); heading(s,'Dose and administration','Typical US product-label dosing. Individualize under clinician supervision.',9) cols=[(.74,4.08,'Population / indication'),(4.84,3.25,'Initial / recommended dose'),(8.11,4.48,'Maximum / key note')] for x,w,h in cols: shape(s,x,1.63,w,.52,NAVY,True); tx(s,h,x+.08,1.77,w-.16,.16,13,WHITE,True,PP_ALIGN.CENTER) rows=[('Adults with MDD','10 mg once daily','Maximum 20 mg/day; no added benefit at 20 mg/day for some patients.'),('Adolescents 12+ with MDD','10 mg once daily','May increase to 20 mg/day after at least 3 weeks.'),('Adults with GAD','10 mg once daily','Maximum 20 mg/day.'),('Older adults / hepatic impairment','10 mg once daily','Recommended dose: 10 mg/day.'),('Discontinuation','Taper gradually','Avoid abrupt cessation when possible.')] for i,row in enumerate(rows): y=2.16+i*.78 for (x,w,_),content in zip(cols,row): shape(s,x,y,w,.7,AQUA if i%2==0 else PALE); tx(s,content,x+.11,y+.09,w-.22,.49,12.5,INK, i==0 and x==.74) tx(s,'Administer once daily, morning or evening, with or without food. Reassess benefit, tolerability, adherence, and safety after initiation and dose changes.',.88,6.31,11.5,.34,14,NAVY,True,PP_ALIGN.CENTER) foot(s,'DailyMed Escitalopram label, Dosage and Administration') #10 s=prs.slides.add_slide(BLANK); fill(s,NAVY) tx(s,'Summary',.68,.42,6,.45,28,WHITE,True); tx(s,'Five take-home messages',.7,.92,6,.24,11,AQUA); shape(s,.68,1.22,1.1,.06,TEAL) pts=[('Selective SSRI','Inhibits SERT and increases synaptic serotonin.'),('Predictable pharmacokinetics','Once daily; steady state in about one week.'),('Approved uses','US labeling: MDD and adult GAD.'),('Safety screen is essential','Avoid MAOIs and pimozide; review serotonin, bleeding, and QT risks.'),('Dose thoughtfully','10 mg/day is typical starting dose; taper gradually on discontinuation.')] for i,(a,b) in enumerate(pts): y=1.62+i*.86; shape(s,.84,y,.46,.46,TEAL,True); tx(s,str(i+1),.84,y+.08,.46,.19,12,WHITE,True,PP_ALIGN.CENTER); tx(s,a,1.58,y-.01,3.2,.24,16,WHITE,True); tx(s,b,4.25,y-.01,7.7,.32,14,RGBColor(212,229,236)) tx(s,'Prescribing requires patient-specific clinical assessment and local guidance.',.87,6.28,11.4,.3,15,AQUA,True,PP_ALIGN.CENTER) foot(s,'Educational presentation. Refer to current local product information before prescribing.') #11 s=prs.slides.add_slide(BLANK); fill(s,WHITE); heading(s,'References','Sources used for the presentation',11) refs=["Kaplan & Sadock’s Synopsis of Psychiatry. Antidepressants and psychopharmacological interventions sections.","Kaplan & Sadock’s Comprehensive Textbook of Psychiatry. Pharmacologic Actions: escitalopram metabolism and linear pharmacokinetics.","DailyMed. Escitalopram prescribing information: dosage, pharmacokinetics, contraindications, interactions, warnings, and adverse reactions.","FDA. Lexapro (escitalopram oxalate) prescribing information."] for i,r in enumerate(refs): y=1.68+i*1.06; shape(s,.84,y,11.68,.76,AQUA if i%2==0 else PALE,True); tx(s,r,1.1,y+.14,11.15,.42,14,INK) tx(s,'Educational use only. This deck does not replace clinical judgment, local guidelines, or a current product label.',.9,6.35,11.3,.3,14,RED,True,PP_ALIGN.CENTER) foot(s,'References as listed') prs.save(OUT); print(OUT) ''') PY python "/tmp/workspace/escitalopram-ppt/src/rebuild_deck.py" python - <<'PY' from pptx import Presentation from pathlib import Path p=Path('/tmp/workspace/escitalopram-ppt/output/Escitalopram_Kaplan_Sadock_Rebuilt.pptx') prs=Presentation(p) print('bytes',p.stat().st_size,'slides',len(prs.slides)) for i,s in enumerate(prs.slides,1): print(i, sum(1 for sh in s.shapes if getattr(sh,'has_text_frame',False)), sum(1 for sh in s.shapes if sh.shape_type==13)) assert len(prs.slides)==11 and p.stat().st_size>50000 PY

~/escitalopram-ppt/src/rebuild_deck.py

python "/tmp/workspace/escitalopram-ppt/src/rebuild_deck.py" && python - <<'PY' from pptx import Presentation from pathlib import Path p=Path('/tmp/workspace/escitalopram-ppt/output/Escitalopram_Kaplan_Sadock_Rebuilt.pptx') prs=Presentation(str(p)) assert len(prs.slides)==11 need=['Introduction','Mechanism of action','Pharmacokinetics','Therapeutic uses','Adverse reactions','Drug interactions','Contraindications','Dose and administration','Summary'] all_text='\n'.join(sh.text for sl in prs.slides for sh in sl.shapes if getattr(sh,'has_text_frame',False)) assert not [x for x in need if x not in all_text] pics=sum(1 for sl in prs.slides for sh in sl.shapes if sh.shape_type==13) assert pics>=1 print(f'Validated {len(prs.slides)} slides; {pics} embedded image; {p.stat().st_size} bytes') PY