Exam 2 NURS 660 (100% correct answers)

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