NURS 660 Exam 2 with precise |! |! |! |! |! |!
detailed solutions |!
Fluoxetine (Prozac) Major Side Effects SSRI - Correct answer ✔-Sexual
|! |! |! |! |! |! |! |! |! |!
dysfunction (men: delayed ejaculation, erectile dysfunction; men and women:
|! |! |! |! |! |! |! |!
decreased sexual desire, anorgasmia)
|! |! |! |!
-Gastrointestinal (decreased appetite, nausea, diarrhea, constipation, dry |! |! |! |! |! |! |!
mouth)
-Mostly CNS (insomnia but also sedation, agitation, tremors, headache,
|! |! |! |! |! |! |! |! |!
dizziness)
Note: patients with diagnosed or undiagnosed bipolar or psychotic disorders
|! |! |! |! |! |! |! |! |! |!
may be more vulnerable to CNS-activating actions of SSRIs
|! |! |! |! |! |! |! |!
-Autonomic (sweating) |!
-Bruising and rare bleeding |! |! |!
SIADH (syndrome of inappropriate antidiuretic hormone secretion)
|! |! |! |! |! |!
-Fluoxetine's unique 5HT2C antagonist properties could contribute to
|! |! |! |! |! |! |! |!
agitation, anxiety, and undesirable activation, especially early in dosing
|! |! |! |! |! |! |! |!
Fluoxetine major adverse effects - Correct answer ✔Rare seizures
|! |! |! |! |! |! |! |!
Rare induction of mania
|! |! |!
Rare activation of suicidal ideation and behavior (suicidality) (short-term
|! |! |! |! |! |! |! |! |!
studies did not show an increase in the risk of suicidality with
|! |! |! |! |! |! |! |! |! |! |! |!
antidepressants compared to placebo beyond age 24) |! |! |! |! |! |!
,Fluoxetine major drug interactions - Correct answer ✔-Tramadol increases
|! |! |! |! |! |! |! |! |!
the risk of seizures in patients taking an antidepressant
|! |! |! |! |! |! |! |!
-Can increase TCA levels; use with caution with TCAs or when switching
|! |! |! |! |! |! |! |! |! |! |! |!
from a TCA to fluoxetine
|! |! |! |!
-Can cause a fatal "serotonin syndrome" when combined with MAOIs, so do
|! |! |! |! |! |! |! |! |! |! |! |!
not use with MAOIs or for at least 14 days after MAOIs are stopped,Do not
|! |! |! |! |! |! |! |! |! |! |! |! |! |! |!
start an MAOI for at least 5 weeks after discontinuing fluoxetine
|! |! |! |! |! |! |! |! |! |!
-May displace highly protein bound drugs (e.g., warfarin)
|! |! |! |! |! |! |!
-Can rarely cause weakness, hyperreflexia, and incoordination when
|! |! |! |! |! |! |! |!
combined with sumatriptan, or possibly with other triptans, requiring careful
|! |! |! |! |! |! |! |! |! |!
monitoring of patient |! |!
-Possible increased risk of bleeding, especially when combined with
|! |! |! |! |! |! |! |! |!
anticoagulants (e.g.,warfarin, NSAIDs) |! |!
NSAIDs may impair effectiveness of SSRIs |! |! |! |! |!
-Via CYP450 2D6 inhibition, could theoretically interfere with the analgesic
|! |! |! |! |! |! |! |! |! |!
actions of codeine, and increase the plasma levels of some beta blockers and
|! |! |! |! |! |! |! |! |! |! |! |! |!
of atomoxetine
|!
-Via CYP450 2D6 inhibition, fluoxetine could theoretically increase
|! |! |! |! |! |! |! |!
concentrations of thioridazine and cause dangerous cardiac arrhythmias |! |! |! |! |! |! |!
-May reduce the clearance of diazepam or trazodone, thus increasing their
|! |! |! |! |! |! |! |! |! |! |!
levels
-Via CYP450 3A4 inhibition, may increase the levels of alprazolam,
|! |! |! |! |! |! |! |! |! |!
buspirone, and triazolam |! |!
-Via CYP450 3A4 inhibition, fluoxetine could theoretically increase
|! |! |! |! |! |! |! |!
concentrations of certain cholesterol lowering HMG CoA reductase |! |! |! |! |! |! |! |!
inhibitors, especially simvastatin, atorvastatin, and lovastatin, but not
|! |! |! |! |! |! |! |!
pravastatin or fluvastatin, which would increase the risk of rhabdomyolysis;
|! |! |! |! |! |! |! |! |! |!
,thus, coadministration of fluoxetine with certain ----HMG CoA reductase
|! |! |! |! |! |! |! |! |!
inhibitors should proceed with caution |! |! |! |!
Via CYP450 3A4 inhibition, fluoxetine could theoretically increase the
|! |! |! |! |! |! |! |! |!
concentrations of pimozide, and cause QTc prolongation and dangerous |! |! |! |! |! |! |! |! |!
cardiac arrhythmias |!
Fluoxetine lab tests |! |!
*Don't have to taper! - Correct answer ✔none in healthy individuals
|! |! |! |! |! |! |! |! |! |!
Fluoxetine neurotransmitters - Correct answer ✔-serotonin
|! |! |! |! |!
-norepinephrine (bc of antagonistic properties5HT2C receptors) |! |! |! |! |!
-dopamine (bc of antagonistic properties at 5HT2C receptors)
|! |! |! |! |! |! |!
Fluoxetine pregnancy risk - Correct answer ✔not recommended, especially in
|! |! |! |! |! |! |! |! |!
first trimester
|! |!
-may need to continue @ 3rd trimester if depressive disorder increased
|! |! |! |! |! |! |! |! |! |! |!
postpartum depression |!
-Neonates exposed to SSRIs or SNRIs late in the third trimester have
|! |! |! |! |! |! |! |! |! |! |! |!
developed complications requiring prolonged hospitalization, respiratory
|! |! |! |! |! |!
support, and tube feeding; reported symptoms are consistent with either a
|! |! |! |! |! |! |! |! |! |! |!
direct toxic effect of SSRIs and SNRIs or, possibly, a drug discontinuation
|! |! |! |! |! |! |! |! |! |! |! |!
syndrome, and include respiratory distress, cyanosis, apnea, seizures,
|! |! |! |! |! |! |! |!
temperature instability, feeding difficulty, vomiting, hypoglycemia, hypotonia,
|! |! |! |! |! |! |!
hypertonia, hyperreflexia, tremor, jitteriness, irritability, and constant crying
|! |! |! |! |! |! |!
, Fluoxetine mechanism of action - Correct answer ✔-Boosts neurotransmitter
|! |! |! |! |! |! |! |! |!
serotonin
-Blocks serotonin reuptake pump (serotonin transporter)
|! |! |! |! |!
-Desensitizes serotonin receptors, especially serotonin 1A receptors
|! |! |! |! |! |!
-Presumably increases serotonergic neurotransmission
|! |! |!
-Fluoxetine also has antagonist properties at 5HT2C receptors, which could
|! |! |! |! |! |! |! |! |! |!
increase norepinephrine and dopamine neurotransmission
|! |! |! |!
Escitalopram (Lexapro) Major Side Effects SSRI |! |! |! |! |!
*May be best tolerated anti-depressants
|! |! |! |!
*may be assoc w/ less sexual dysfunction
|! |! |! |! |! |!
*least interaction w/ CYP 2D6 and 3A4 - Correct answer ✔-Sexual
|! |! |! |! |! |! |! |! |! |! |!
dysfunction
-GI (dry mouth, constipation, nausea, diarrhea, decreased appetite)
|! |! |! |! |! |! |!
-Mostly central nervous system (insomnia but also sedation, agitation,
|! |! |! |! |! |! |! |! |!
tremors, headache, dizziness)
|! |!
Note: patients with diagnosed or undiagnosed bipolar or psychotic disorders
|! |! |! |! |! |! |! |! |! |!
may be more vulnerable to CNS-activating actions of SSRIs
|! |! |! |! |! |! |! |!
-Autonomic (sweating) |!
-Bruising and rare bleeding |! |! |!
-Rare hyponatremia (mostly in elderly patients and generally reversible on
|! |! |! |! |! |! |! |! |! |!
discontinuation of escitalopram |! |!
-SIADH (syndrome of inappropriate antidiuretic hormone secretion)
|! |! |! |! |! |!
Escitalopram major adverse effects - Correct answer ✔-Rare seizures
|! |! |! |! |! |! |! |!
detailed solutions |!
Fluoxetine (Prozac) Major Side Effects SSRI - Correct answer ✔-Sexual
|! |! |! |! |! |! |! |! |! |!
dysfunction (men: delayed ejaculation, erectile dysfunction; men and women:
|! |! |! |! |! |! |! |!
decreased sexual desire, anorgasmia)
|! |! |! |!
-Gastrointestinal (decreased appetite, nausea, diarrhea, constipation, dry |! |! |! |! |! |! |!
mouth)
-Mostly CNS (insomnia but also sedation, agitation, tremors, headache,
|! |! |! |! |! |! |! |! |!
dizziness)
Note: patients with diagnosed or undiagnosed bipolar or psychotic disorders
|! |! |! |! |! |! |! |! |! |!
may be more vulnerable to CNS-activating actions of SSRIs
|! |! |! |! |! |! |! |!
-Autonomic (sweating) |!
-Bruising and rare bleeding |! |! |!
SIADH (syndrome of inappropriate antidiuretic hormone secretion)
|! |! |! |! |! |!
-Fluoxetine's unique 5HT2C antagonist properties could contribute to
|! |! |! |! |! |! |! |!
agitation, anxiety, and undesirable activation, especially early in dosing
|! |! |! |! |! |! |! |!
Fluoxetine major adverse effects - Correct answer ✔Rare seizures
|! |! |! |! |! |! |! |!
Rare induction of mania
|! |! |!
Rare activation of suicidal ideation and behavior (suicidality) (short-term
|! |! |! |! |! |! |! |! |!
studies did not show an increase in the risk of suicidality with
|! |! |! |! |! |! |! |! |! |! |! |!
antidepressants compared to placebo beyond age 24) |! |! |! |! |! |!
,Fluoxetine major drug interactions - Correct answer ✔-Tramadol increases
|! |! |! |! |! |! |! |! |!
the risk of seizures in patients taking an antidepressant
|! |! |! |! |! |! |! |!
-Can increase TCA levels; use with caution with TCAs or when switching
|! |! |! |! |! |! |! |! |! |! |! |!
from a TCA to fluoxetine
|! |! |! |!
-Can cause a fatal "serotonin syndrome" when combined with MAOIs, so do
|! |! |! |! |! |! |! |! |! |! |! |!
not use with MAOIs or for at least 14 days after MAOIs are stopped,Do not
|! |! |! |! |! |! |! |! |! |! |! |! |! |! |!
start an MAOI for at least 5 weeks after discontinuing fluoxetine
|! |! |! |! |! |! |! |! |! |!
-May displace highly protein bound drugs (e.g., warfarin)
|! |! |! |! |! |! |!
-Can rarely cause weakness, hyperreflexia, and incoordination when
|! |! |! |! |! |! |! |!
combined with sumatriptan, or possibly with other triptans, requiring careful
|! |! |! |! |! |! |! |! |! |!
monitoring of patient |! |!
-Possible increased risk of bleeding, especially when combined with
|! |! |! |! |! |! |! |! |!
anticoagulants (e.g.,warfarin, NSAIDs) |! |!
NSAIDs may impair effectiveness of SSRIs |! |! |! |! |!
-Via CYP450 2D6 inhibition, could theoretically interfere with the analgesic
|! |! |! |! |! |! |! |! |! |!
actions of codeine, and increase the plasma levels of some beta blockers and
|! |! |! |! |! |! |! |! |! |! |! |! |!
of atomoxetine
|!
-Via CYP450 2D6 inhibition, fluoxetine could theoretically increase
|! |! |! |! |! |! |! |!
concentrations of thioridazine and cause dangerous cardiac arrhythmias |! |! |! |! |! |! |!
-May reduce the clearance of diazepam or trazodone, thus increasing their
|! |! |! |! |! |! |! |! |! |! |!
levels
-Via CYP450 3A4 inhibition, may increase the levels of alprazolam,
|! |! |! |! |! |! |! |! |! |!
buspirone, and triazolam |! |!
-Via CYP450 3A4 inhibition, fluoxetine could theoretically increase
|! |! |! |! |! |! |! |!
concentrations of certain cholesterol lowering HMG CoA reductase |! |! |! |! |! |! |! |!
inhibitors, especially simvastatin, atorvastatin, and lovastatin, but not
|! |! |! |! |! |! |! |!
pravastatin or fluvastatin, which would increase the risk of rhabdomyolysis;
|! |! |! |! |! |! |! |! |! |!
,thus, coadministration of fluoxetine with certain ----HMG CoA reductase
|! |! |! |! |! |! |! |! |!
inhibitors should proceed with caution |! |! |! |!
Via CYP450 3A4 inhibition, fluoxetine could theoretically increase the
|! |! |! |! |! |! |! |! |!
concentrations of pimozide, and cause QTc prolongation and dangerous |! |! |! |! |! |! |! |! |!
cardiac arrhythmias |!
Fluoxetine lab tests |! |!
*Don't have to taper! - Correct answer ✔none in healthy individuals
|! |! |! |! |! |! |! |! |! |!
Fluoxetine neurotransmitters - Correct answer ✔-serotonin
|! |! |! |! |!
-norepinephrine (bc of antagonistic properties5HT2C receptors) |! |! |! |! |!
-dopamine (bc of antagonistic properties at 5HT2C receptors)
|! |! |! |! |! |! |!
Fluoxetine pregnancy risk - Correct answer ✔not recommended, especially in
|! |! |! |! |! |! |! |! |!
first trimester
|! |!
-may need to continue @ 3rd trimester if depressive disorder increased
|! |! |! |! |! |! |! |! |! |! |!
postpartum depression |!
-Neonates exposed to SSRIs or SNRIs late in the third trimester have
|! |! |! |! |! |! |! |! |! |! |! |!
developed complications requiring prolonged hospitalization, respiratory
|! |! |! |! |! |!
support, and tube feeding; reported symptoms are consistent with either a
|! |! |! |! |! |! |! |! |! |! |!
direct toxic effect of SSRIs and SNRIs or, possibly, a drug discontinuation
|! |! |! |! |! |! |! |! |! |! |! |!
syndrome, and include respiratory distress, cyanosis, apnea, seizures,
|! |! |! |! |! |! |! |!
temperature instability, feeding difficulty, vomiting, hypoglycemia, hypotonia,
|! |! |! |! |! |! |!
hypertonia, hyperreflexia, tremor, jitteriness, irritability, and constant crying
|! |! |! |! |! |! |!
, Fluoxetine mechanism of action - Correct answer ✔-Boosts neurotransmitter
|! |! |! |! |! |! |! |! |!
serotonin
-Blocks serotonin reuptake pump (serotonin transporter)
|! |! |! |! |!
-Desensitizes serotonin receptors, especially serotonin 1A receptors
|! |! |! |! |! |!
-Presumably increases serotonergic neurotransmission
|! |! |!
-Fluoxetine also has antagonist properties at 5HT2C receptors, which could
|! |! |! |! |! |! |! |! |! |!
increase norepinephrine and dopamine neurotransmission
|! |! |! |!
Escitalopram (Lexapro) Major Side Effects SSRI |! |! |! |! |!
*May be best tolerated anti-depressants
|! |! |! |!
*may be assoc w/ less sexual dysfunction
|! |! |! |! |! |!
*least interaction w/ CYP 2D6 and 3A4 - Correct answer ✔-Sexual
|! |! |! |! |! |! |! |! |! |! |!
dysfunction
-GI (dry mouth, constipation, nausea, diarrhea, decreased appetite)
|! |! |! |! |! |! |!
-Mostly central nervous system (insomnia but also sedation, agitation,
|! |! |! |! |! |! |! |! |!
tremors, headache, dizziness)
|! |!
Note: patients with diagnosed or undiagnosed bipolar or psychotic disorders
|! |! |! |! |! |! |! |! |! |!
may be more vulnerable to CNS-activating actions of SSRIs
|! |! |! |! |! |! |! |!
-Autonomic (sweating) |!
-Bruising and rare bleeding |! |! |!
-Rare hyponatremia (mostly in elderly patients and generally reversible on
|! |! |! |! |! |! |! |! |! |!
discontinuation of escitalopram |! |!
-SIADH (syndrome of inappropriate antidiuretic hormone secretion)
|! |! |! |! |! |!
Escitalopram major adverse effects - Correct answer ✔-Rare seizures
|! |! |! |! |! |! |! |!
