Maryville NURS 660 Exam 2
SSRIs - answer selective serotonin reuptake inhibitors
Seriously Prepare Cities for the Flu Vaccine - answer-Sertaline (Zoloft)
--Paroxetine (Paxil)
-Citalopram (Celexa)
-Escitalopram (Lexapro)
-Fluoxetine HCl (Prozac)
--Fluvoxamine (Luvox)
-(Viibryd)Citol
SSRI mechanism of action - answer Blocks the reuptake of serotonin (only serotonin)
thus increasing it's effects
All inhibit the serotonin transporter SERT
SSRI side effects - answer Gastrointestinal disturbances
Sexual dysfunction
Drowsiness / insomnia
Serotonin Syndrome (rare)
SSRI discontinuation - answersx
uMost common side effects include GI upset, sexual dysfunction (30%+!), anxiety,
restlessness, nervousness, insomnia, fatigue or sedation, dizziness
uVery little risk of cardiotoxicity in overdose
uCan develop a discontinuation syndrome with agitation, nausea, disequilibrium and
dysphoria
SSRIs treat - answeranxiety
depression
SSRI discontinuation syndrome - answerA drug withdrawal syndrome associated with
the use of at least some of the SSRI and SNRI antidepressants.
SSRI discontinuation syndrome symptoms - answerflu-like symptoms, dizziness,
weakness, nausea, fatigue, feelings of "unreality," loss of balance, light-headedness,
"electric-shock" sensations, and other symptoms.
Paroxitine (Paxil) Pros - answerShort half life with no active metabolite means no build-
up (which is good if hypomania develops)
Sedating properties (dose at night) offers good initial relief from anxiety and insomnia
Paroxitine (Paxil) Cons - answerSignificant CYP2D6 inhibition
,Sedating, wt gain, more anticholinergic effects
sexual side effects
Notorious for discontinuation syndrome
Sertraline (Zoloft) Pros - answerVery weak P450 interactions (only slight CYP2D6)
Short half life with lower build-up of metabolites
Less sedating when compared to paroxetine
Sertraline (Zoloft) Cons - answerMax absorption requires a full stomach
Increased number of GI adverse drug reactions
Fluoxetine (Prozac) Pros - answerLong half-life (2 weeks) improve compliance
decreased incidence of discontinuation syndromes.
Good for pts with medication noncompliance issues
Initially activating so may provide increased energy
Secondary to long half life, can give one 20mg tab to taper someone off SSRI when
trying to prevent SSRI Discontinuation Syndrome
Fluoxetine (Prozac) Cons - answerLong half life and active metabolite may build up
(e.g. not a good choice in patients with hepatic illness)
Significant P450 interactions so this may not be a good choice in pts already on a
number of meds
Initial activation may increase anxiety and insomnia
More likely to induce mania than some of the other SSRIs
Citalpram (Celexa) Pro - answerLow inhibition of P450 enzymes so fewer drug-drug
interactions
Intermediate ½ life
Citalpram (Celexa) Con - answerDose-dependent QT interval prolongation with doses
of 10-30mg daily
doses of >40mg/day not recommended!
Can be sedating (has mild antagonism at H1 histamine receptor)
GI side effects (less than sertraline)
Excitalopram (Lexapro) Pro - answerLow overall inhibition of P450s enzymes so fewer
drug-drug interactions
Intermediate 1/2 life
More effective than Citalopram in acute response and remission
Excitalopram (Lexapro) Con - answerDose-dependent QT interval prolongation with
doses of 10-30mg daily
Nausea, headache
Fluvoxamine (Luvox) Pro - answerShortest ½ life
Found to possess some analgesic properties
, Fluvoxamine (Luvox) Con - answerShortest ½ life
GI distress, headaches, sedation, weakness
Strong inhibitor of CYP1A2 and CYP2C19
No FDA approval for depression
anoxilytic properties / psychotic depression
SNRIs - answerserotonin and norepinephrine reuptake inhibitors
SNRIs mechanism of action - answerInhibit SERT-blocks serotonin
Inhibit NET-norepinephrine transport to some degree
Act on dopanmine in prefrontal cortex without affecting DAT-dopamine transporter
Blocking NE enhances dopamine in the prefrontal cortex
No antihistamine, antiadrenergic or anticholinergic s.e.
SNRI drugs - answerVenlafaxine
Desvenlafaxine
Duloxetine
Levomilnacipran
SNRI side effects - answermore weight gain
may increase blood pressure
cause sweating and urinary retention
more discontinuation syndrome than SSRI
SNRIs treat - answerUsed for depression, anxiety and possibly neuropathic pain
Venalfaxine (Effexor) Pros - answerMinimal drug interactions and almost no P450
activity
Short half life and fast renal clearance avoids build-up (good for geriatric populations)
Venalfaxine (Effexor) Cons - answer10-15 mmHG dose dependent increase in diastolic
BP.
May cause significant nausea, primarily with immediate-release (IR) tabs
Can cause a bad discontinuation syndrome, and taper recommended after 2 weeks of
administration
Noted to cause QT prolongation
Sexual side effects in >30%
Desvanlafaxine (Pristiq) Pro - answerMinimal drug interactions
Short half life and fast renal clearance avoids build-up (good for geriatric populations)
Desvanlafaxine (Pristiq) - answerGI distress in 20%+
Dose related increase in total cholesterol, LDL and triglycerides
Dose related increase in BP
SSRIs - answer selective serotonin reuptake inhibitors
Seriously Prepare Cities for the Flu Vaccine - answer-Sertaline (Zoloft)
--Paroxetine (Paxil)
-Citalopram (Celexa)
-Escitalopram (Lexapro)
-Fluoxetine HCl (Prozac)
--Fluvoxamine (Luvox)
-(Viibryd)Citol
SSRI mechanism of action - answer Blocks the reuptake of serotonin (only serotonin)
thus increasing it's effects
All inhibit the serotonin transporter SERT
SSRI side effects - answer Gastrointestinal disturbances
Sexual dysfunction
Drowsiness / insomnia
Serotonin Syndrome (rare)
SSRI discontinuation - answersx
uMost common side effects include GI upset, sexual dysfunction (30%+!), anxiety,
restlessness, nervousness, insomnia, fatigue or sedation, dizziness
uVery little risk of cardiotoxicity in overdose
uCan develop a discontinuation syndrome with agitation, nausea, disequilibrium and
dysphoria
SSRIs treat - answeranxiety
depression
SSRI discontinuation syndrome - answerA drug withdrawal syndrome associated with
the use of at least some of the SSRI and SNRI antidepressants.
SSRI discontinuation syndrome symptoms - answerflu-like symptoms, dizziness,
weakness, nausea, fatigue, feelings of "unreality," loss of balance, light-headedness,
"electric-shock" sensations, and other symptoms.
Paroxitine (Paxil) Pros - answerShort half life with no active metabolite means no build-
up (which is good if hypomania develops)
Sedating properties (dose at night) offers good initial relief from anxiety and insomnia
Paroxitine (Paxil) Cons - answerSignificant CYP2D6 inhibition
,Sedating, wt gain, more anticholinergic effects
sexual side effects
Notorious for discontinuation syndrome
Sertraline (Zoloft) Pros - answerVery weak P450 interactions (only slight CYP2D6)
Short half life with lower build-up of metabolites
Less sedating when compared to paroxetine
Sertraline (Zoloft) Cons - answerMax absorption requires a full stomach
Increased number of GI adverse drug reactions
Fluoxetine (Prozac) Pros - answerLong half-life (2 weeks) improve compliance
decreased incidence of discontinuation syndromes.
Good for pts with medication noncompliance issues
Initially activating so may provide increased energy
Secondary to long half life, can give one 20mg tab to taper someone off SSRI when
trying to prevent SSRI Discontinuation Syndrome
Fluoxetine (Prozac) Cons - answerLong half life and active metabolite may build up
(e.g. not a good choice in patients with hepatic illness)
Significant P450 interactions so this may not be a good choice in pts already on a
number of meds
Initial activation may increase anxiety and insomnia
More likely to induce mania than some of the other SSRIs
Citalpram (Celexa) Pro - answerLow inhibition of P450 enzymes so fewer drug-drug
interactions
Intermediate ½ life
Citalpram (Celexa) Con - answerDose-dependent QT interval prolongation with doses
of 10-30mg daily
doses of >40mg/day not recommended!
Can be sedating (has mild antagonism at H1 histamine receptor)
GI side effects (less than sertraline)
Excitalopram (Lexapro) Pro - answerLow overall inhibition of P450s enzymes so fewer
drug-drug interactions
Intermediate 1/2 life
More effective than Citalopram in acute response and remission
Excitalopram (Lexapro) Con - answerDose-dependent QT interval prolongation with
doses of 10-30mg daily
Nausea, headache
Fluvoxamine (Luvox) Pro - answerShortest ½ life
Found to possess some analgesic properties
, Fluvoxamine (Luvox) Con - answerShortest ½ life
GI distress, headaches, sedation, weakness
Strong inhibitor of CYP1A2 and CYP2C19
No FDA approval for depression
anoxilytic properties / psychotic depression
SNRIs - answerserotonin and norepinephrine reuptake inhibitors
SNRIs mechanism of action - answerInhibit SERT-blocks serotonin
Inhibit NET-norepinephrine transport to some degree
Act on dopanmine in prefrontal cortex without affecting DAT-dopamine transporter
Blocking NE enhances dopamine in the prefrontal cortex
No antihistamine, antiadrenergic or anticholinergic s.e.
SNRI drugs - answerVenlafaxine
Desvenlafaxine
Duloxetine
Levomilnacipran
SNRI side effects - answermore weight gain
may increase blood pressure
cause sweating and urinary retention
more discontinuation syndrome than SSRI
SNRIs treat - answerUsed for depression, anxiety and possibly neuropathic pain
Venalfaxine (Effexor) Pros - answerMinimal drug interactions and almost no P450
activity
Short half life and fast renal clearance avoids build-up (good for geriatric populations)
Venalfaxine (Effexor) Cons - answer10-15 mmHG dose dependent increase in diastolic
BP.
May cause significant nausea, primarily with immediate-release (IR) tabs
Can cause a bad discontinuation syndrome, and taper recommended after 2 weeks of
administration
Noted to cause QT prolongation
Sexual side effects in >30%
Desvanlafaxine (Pristiq) Pro - answerMinimal drug interactions
Short half life and fast renal clearance avoids build-up (good for geriatric populations)
Desvanlafaxine (Pristiq) - answerGI distress in 20%+
Dose related increase in total cholesterol, LDL and triglycerides
Dose related increase in BP
