NURS 660 EXAM 4 CERTIFICATION
EVALUATION EXAMS 2026 COMPLETE
QUESTIONS AND ANSWERS GUARANTEED TO
PASS
◉ Fluoxetine mechanism of action.
Answer: -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.
Answer: -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.
Answer: -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)
◉ Escitalopram major drug interactions.
Answer: -Tramadol increases the risk of seizures in patients taking
an antidepressant
-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 half-lives (5 to 7 days for most
drugs) after discontinuing escitalopram
,-Could theoretically cause weakness, hyperreflexia, and
incoordination when combined with sumatriptan or possibly 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
-Few known adverse drug interactions
◉ Escitalopram lab tests.
Answer: none in healthy individuals
◉ Escitalopram neurotransmitters and mechanism of action.
Answer: -Boosts neurotransmitter serotonin
-Blocks serotonin reuptake pump (serotonin transporter)
-Desensitizes serotonin receptors, especially serotonin 1A
autoreceptors
-Presumably increases serotonergic neurotransmission
◉ Escitalopram pregnancy risks.
Answer: -Not generally recommended for use during pregnancy,
especially during first trimester
-Nonetheless, continuous treatment during pregnancy may be
necessary and has not been proven to be harmful to the fetus
, -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
◉ Sertraline (Zoloft) Major side effects SSRI
*Sertraline also has some ability to block dopamine reuptake pump
(dopamine transporter), which could increase dopamine
neurotransmission and contribute to its therapeutic actions.
Answer: -Sexual dysfunction (dose-dependent; 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
Rare hyponatremia (mostly in elderly patients and generally
reversible on discontinuation of sertraline)
EVALUATION EXAMS 2026 COMPLETE
QUESTIONS AND ANSWERS GUARANTEED TO
PASS
◉ Fluoxetine mechanism of action.
Answer: -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.
Answer: -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.
Answer: -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)
◉ Escitalopram major drug interactions.
Answer: -Tramadol increases the risk of seizures in patients taking
an antidepressant
-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 half-lives (5 to 7 days for most
drugs) after discontinuing escitalopram
,-Could theoretically cause weakness, hyperreflexia, and
incoordination when combined with sumatriptan or possibly 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
-Few known adverse drug interactions
◉ Escitalopram lab tests.
Answer: none in healthy individuals
◉ Escitalopram neurotransmitters and mechanism of action.
Answer: -Boosts neurotransmitter serotonin
-Blocks serotonin reuptake pump (serotonin transporter)
-Desensitizes serotonin receptors, especially serotonin 1A
autoreceptors
-Presumably increases serotonergic neurotransmission
◉ Escitalopram pregnancy risks.
Answer: -Not generally recommended for use during pregnancy,
especially during first trimester
-Nonetheless, continuous treatment during pregnancy may be
necessary and has not been proven to be harmful to the fetus
, -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
◉ Sertraline (Zoloft) Major side effects SSRI
*Sertraline also has some ability to block dopamine reuptake pump
(dopamine transporter), which could increase dopamine
neurotransmission and contribute to its therapeutic actions.
Answer: -Sexual dysfunction (dose-dependent; 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
Rare hyponatremia (mostly in elderly patients and generally
reversible on discontinuation of sertraline)
