Maryville Exam 3 Psychopharmacology (NURS 660) QUESTIONS WITH COMPLETE SOLUTIONS

Sertraline (Zoloft) Major Side Effects correct answer: insomnia, somnolence, HA, dry mouth, sex dysfunction, nausea & diarrhea Fluoxetine (Prozac) Major Side Effect correct answer: Activating (UPPER); AGITATION, INSOMNIA, nausea, vomiting, sex dysfunction, GI, serotonin syndrome Paraoxetine (Paxil) Major Side Effects correct answer: Anticholinergic (can't see, can't sleep, can't shit, can't spit), CYP2D6 inhibitor, increases TCA, phenothiazines, Type 1C antiarrhythmics, weight gain, GI, sex dysfunction, insomnia, serotonin syndrome Lithium Major Side Effects correct answer: increased thirst & urination, impaired concentration/memory, fatigue, tremor, weight gain. Toxicity: cramps, v/d, kidney dysfunction, coarse tremor, confusion, irritability. Severe toxicity: seizures, coma, death. Fluvoxamine (Luvox) Major Side Effects correct answer: nausea, vomiting, weight gain, sex dysfunction; BIG BBW for SI on this drug Major side effects for sertraline, fluoxetine, paroxetine, and fluvoxamine (generals for all) •Most side effects are immediate and go away with time correct answer: sexual dysfunction (dose dependent- men: delayed ejaculation, ED; men and women: decreased sexual desire, anorgasmia) GI: decreased appetite, nausea, diarrhea, constipation, dry mouth Mostly CNS: insomnia, sedation, agitation, tremors, headache, dizziness Autonomic: sweating Bruising and rare bleeding Rare hyponatremia (mostly in elderly) Rare hypotension SIADH Weight gain Rare: seizures, induction of mania, activation of suicidal ideation and behavior Major side effects for sertraline, fluoxetine, paroxetine, and fluvoxamine (generals for all) r/t to increased serotonin correct answer: concentrations at serotonin receptors in parts of brain and body other than those that cause therapeutic actions (e.g. unwanted actions of serotonin in sleep centers causing insomnia or in gut causing diarrhea) can cause diminished dopamine release and might contribute to emotional flattening, cognitive slowing, and apathy in some patients Major side effects for sertraline, fluoxetine, paroxetine, and fluvoxamine (generals for all) Patients with diagnosed or undiagnosed bipolar or psychotic disorders correct answer: may be more vulnerable to CNS-activating actions of SSRIs Know major side effects for lithium (typically dose related) correct answer: Ataxia, dysarthria, delirium, tremor, memory problems Polyuria, polydipsia (nephrogenic diabetes insipidus) Diarrhea, nausea Weight gain Euthyroid goiter or hypothyroid goiter, possibly with increased TSH and reduced thyroxine levels Acne, rash, alopecia Leukocytosis Life Threatening: TOXICITY: TREMOR, ATAXIA, N/V/D, SEDATION, DI, INTESTINAL NEPHRITIS, T WAVE FLATTENING, SEIZURES Atomoxetine (Strattera) correct answer: - SNRI - inhibits NET, increases DA and NE in prefrontal cortex (pg 493 Stahl) *no potential for abuse *ADHD medication in US Trazodone - correct answer: 5-HT2 -A&C antagonist, increases serotonin release Duloxetine (Cymbalta) correct answer: - inhibits neuronal serotonin and NE reuptake, weak DA reuptake inhibitor - SNRI Carbamazepine (Tegretol) correct answer: - VSSG binding, enhances GABA inhibitory actions, depresses thalamus & temporal activity Lithium correct answer: - promotes neuroprotection and long-term plasticity - enhances 5-HT actions, reduces catecholamine activity - inhibits GSK-3, affects signal transduction through inhibiting inositol monophosphatase and modulating G proteins or interaction with downstream signal transduction cascades, regulates gene expression for growth factors Lamotrigine (Lamictal) correct answer: Anticonvulsant First line treatment for bipolar depression and is approved for acute and maintenance therapy. A potential life-threatening rash may occur. inhibits VSSG binding, inhibits release of glutamate (an excitatory neurotransmitter). Weak 5HT3 inhibition. Know how to discontinue fluoxetine correct answer: Fluoxetine (Prozac) - no taper needed, long half life Know how to discontinue lamotrigine correct answer: Lamot