EXAM 2 PSYCHOPHARM: NURS 660
ADVANCED PSYCHOPHARMACOLOGY AND
MENTAL HEALTH, 2025/2026 WITH
CORRECT/ACCURATE ANSWERS
AT MARYVILLE UNIVERSITY
Psychopharmacology Exam 2 builds on foundational concepts and moves
into more advanced topics related to specific drug classes and mental
health disorders. It focuses on applying knowledge to patient care
scenarios, medication management, and understanding drug interactions.
ADVANCED PSYCHOPHARMACOLOGY AND
MENTAL HEALTH
Fluoxetine (Prozac) Major Side Effects SSRI - CORRECT-ANSWERS---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-ANSWERS--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-ANSWERS---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-ANSWERS--none in healthy individuals
Fluoxetine neurotransmitters - CORRECT-ANSWERS---serotonin
-norepinephrine (bc of antagonistic properties5HT2C receptors)
-dopamine (bc of antagonistic properties at 5HT2C receptors)
Fluoxetine pregnancy risk - CORRECT-ANSWERS--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-ANSWERS---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-ANSWERS---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-ANSWERS---Rare seizures
-Rare induction of mania
ADVANCED PSYCHOPHARMACOLOGY AND
MENTAL HEALTH, 2025/2026 WITH
CORRECT/ACCURATE ANSWERS
AT MARYVILLE UNIVERSITY
Psychopharmacology Exam 2 builds on foundational concepts and moves
into more advanced topics related to specific drug classes and mental
health disorders. It focuses on applying knowledge to patient care
scenarios, medication management, and understanding drug interactions.
ADVANCED PSYCHOPHARMACOLOGY AND
MENTAL HEALTH
Fluoxetine (Prozac) Major Side Effects SSRI - CORRECT-ANSWERS---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-ANSWERS--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-ANSWERS---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-ANSWERS--none in healthy individuals
Fluoxetine neurotransmitters - CORRECT-ANSWERS---serotonin
-norepinephrine (bc of antagonistic properties5HT2C receptors)
-dopamine (bc of antagonistic properties at 5HT2C receptors)
Fluoxetine pregnancy risk - CORRECT-ANSWERS--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-ANSWERS---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-ANSWERS---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-ANSWERS---Rare seizures
-Rare induction of mania
