NURS 660 EXAM 2 QUESTIONS WITH THE LATEST SCORE

NURS 660 EXAM 2 QUESTIONS WITH THE LATEST SCORE.


SSRIs -- Answer ✔✔ selective serotonin reuptake inhibitors
t t t t t t t




Seriously Prepare Cities for the Flu Vaccine -- Answer ✔✔ -Sertraline (Zoloft)
t t t t t t t t t t t




--Paroxetine (Paxil) t t




-Citolpram(Celexa)
-Escitalopram (Lexapro) t




-Fluoxetine HCl (Prozac) t t




--Fluvoxamine (Luvox) t




-(Viibryd)Citol

SSRI mechanism of action -- Answer ✔✔ Blocks the reuptake of serotonin (only
t t t t t t t t t t t t t




serotonin) thus increasing it's effects t t t t




All inhibit the serotonin transporter SERT
t t t t t




SSRI side effects -- Answer ✔✔ Gastrointestinal disturbances
t t t t t t t




Sexual dysfunction t




Drowsiness / insomnia t t




Serotonin Syndrome (rare) t t




SSRI discontinuation -- Answer ✔✔ sx
t t t t t




Most common side effects include GI upset, sexual dysfunction (30%+!), anxiety,
t t t t t t t t t t t




restlessness, nervousness, insomnia, fatigue or sedation, dizziness t t t t t t




Very little risk of cardiotoxicity in overdose
t t t t t t




Can develop a discontinuation syndrome with agitation, nausea, disequilibrium and
t t t t t t t t t t




dysphoria

SSRIs treat -- Answer ✔✔ anxiety
t t t t t t




depression

SSRI discontinuation syndrome -- Answer ✔✔ A drug withdrawal syndrome associated
t t t t t t t t t t t




with the use of at least some of the SSRI and SNRI antidepressants.
t t t t t t t t t t t t

,SSRI discontinuation syndrome symptoms -- Answer ✔✔ flu-like symptoms, dizziness,
t t t t t t t t t t




weakness, nausea, fatigue, feelings of "unreality," loss of balance, light-headedness,
t t t t t t t t t t




"electric-shock" sensations, and other symptoms. t t t t




Paroxetine (Paxil) Pros -- Answer ✔✔ Short half-life with no active metabolite means no
t t t t t t t t t t t t t t




build-up (which is good if hypomania develops)
t t t t t t




Sedating properties (dose at night) offers good initial relief from anxiety and insomnia
t t t t t t t t t t t t




Paroxetine (Paxil) Cons -- Answer ✔✔ Significant CYP2D6 inhibition
t t t t t t t t




Sedating, wt gain, more anticholinergic effects
t t t t t




sexual side effects t t




Notorious for discontinuation syndrome t t t




Sertraline (Zoloft) Pros -- Answer ✔✔ Very weak P450 interactions (only slight CYP2D6)
t t t t t t t t t t t t




Short half life with lower build-up of metabolites
t t t t t t t




Less sedating when compared to paroxetine
t t t t t




Sertraline (Zoloft) Cons -- Answer ✔✔ Max absorption requires a full stomach
t t t t t t t t t t t




Increased number of GI adverse drug reactions
t t t t t t




Fluoxetine (Prozac) Pros -- Answer ✔✔ Long half-life (2 weeks) improve compliance
t t t t t t t t t t t




decreased incidence of discontinuation syndromes. t t t t t




Good for pts with medication noncompliance issues
t t t t t t




Initially activating so may provide increased energy
t t t t t t




Secondary to long half life, can give one 20mg tab to taper someone off SSRI when trying to
t t t t t t t t t t t t t t t t t




tprevent SSRI Discontinuation Syndrome
t t t




Fluoxetine (Prozac) Cons -- Answer ✔✔ Long half life and active metabolite may build up
t t t t t t t t t t t t t t t




(e.g. not a good choice in patients with hepatic illness)
t t t t t t t t t




Significant P450 interactions so this may not be a good choice in pts already on a number of
t t t t t t t t t t t t t t t t t




tmeds
Initial activation may increase anxiety and insomnia
t t t t t t




More likely to induce mania than some of the other SSRIs
t t t t t t t t t t

, Citalopram (Celexa) Pro -- Answer ✔✔ Low inhibition of P450 enzymes so fewer drug-
t t t t t t t t t t t t t




drug interactions t




Intermediate ½ life t t




Citalopram (Celexa) Con -- Answer ✔✔ Dose-dependent QT interval prolongation with
t t t t t t t t t t t




doses of 10-30mg daily t t t




doses of >40mg/day not recommended!
t t t t




Can be sedating (has mild antagonism at H1 histamine receptor)
t t t t t t t t t




GI side effects (less than sertraline)
t t t t t




Excitalopram (Lexapro) Pro -- Answer ✔✔ Low overall inhibition of P450s enzymes sot t t t t t t t t t t t t




fewer drug-drug interactions
t t




Intermediate 1/2 life t t




More effective than Citalopram in acute response and remission
t t t t t t t t




Excitalopram (Lexapro) Con -- Answer ✔✔ Dose-dependent QT interval prolongation t t t t t t t t t t




with doses of 10-30mg daily
t t t t




Nausea, headache t




Fluvoxamine (Luvox) Pro -- Answer ✔✔ Shortest ½ life t t t t t t t t




Found to possess some analgesic properties
t t t t t




Fluvoxamine (Luvox) Con -- Answer ✔✔ Shortest ½ life t t t t t t t t




GI distress, headaches, sedation, weakness
t t t t




Strong inhibitor of CYP1A2 and CYP2C19
t t t t t




No FDA approval for depression
t t t t




anoxilytic properties / psychotic depression t t t t




SNRIs -- Answer ✔✔ serotonin and norepinephrine reuptake inhibitors
t t t t t t t t




SNRIs mechanism of action -- Answer ✔✔ Inhibit SERT-blocks serotonin
t t t t t t t t t




Inhibit NET-norepinephrine transport to some degree
t t t t t




Act on dopamine in prefrontal cortex without affecting DAT-dopamine transporter
t t t t t t t t t




Blocking NE enhances dopamine in the prefrontal cortex
t t t t t t t




No antihistamine, antiadrenergic or anticholinergic s.e.
t t t t t