Maryville Psychopharmacology Exam 3 Study Guide –
Comprehensive Notes
Detailed and organized notes for Maryville University's
Psychopharmacology Exam 3, covering medication classes,
side effects, mechanisms of action, and clinical considerations
Top rated Exam Study Guide latest updated 2025/2026
Sertraline (Zoloft)
Major Side Effects - ansinsomnia, somnolence, HA, dry mouth, sex dysfunction, nausea &
diarrhea
Fluoxetine (Prozac)
Major Side Effect - ansActivating (UPPER); AGITATION, INSOMNIA, nausea, vomiting,
sex dysfunction, GI, serotonin syndrome
Paraoxetine (Paxil)
Major Side Effects - ansAnticholinergic (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 - ansincreased 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 - ansnausea, 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 - anssexual 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
,Maryville Psychopharmacology Exam 3 Study Guide –
Comprehensive Notes
Detailed and organized notes for Maryville University's
Psychopharmacology Exam 3, covering medication classes,
side effects, mechanisms of action, and clinical considerations
Top rated Exam Study Guide latest updated 2025/2026
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 - ansconcentrations 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 - ansmay be more
vulnerable to CNS-activating actions of SSRIs
Know major side effects for lithium (typically dose related) - ansAtaxia, 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) - ans- SNRI
- inhibits NET, increases DA and NE in prefrontal cortex (pg 493 Stahl)
*no potential for abuse
*ADHD medication in US
Trazodone - - ans5-HT2
-A&C antagonist, increases serotonin release
, Maryville Psychopharmacology Exam 3 Study Guide –
Comprehensive Notes
Detailed and organized notes for Maryville University's
Psychopharmacology Exam 3, covering medication classes,
side effects, mechanisms of action, and clinical considerations
Top rated Exam Study Guide latest updated 2025/2026
Duloxetine (Cymbalta) - ans- inhibits neuronal serotonin and NE reuptake, weak DA
reuptake inhibitor
- SNRI
Carbamazepine (Tegretol) - ans- VSSG binding, enhances GABA inhibitory actions,
depresses thalamus & temporal activity
Lithium - ans- 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) - ansAnticonvulsant 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 - ansFluoxetine (Prozac) - no taper needed, long half life
Know how to discontinue lamotrigine - ansLamotrigine (Lamictal) - decrease dose by 50%
per week, over at least 2 weeks (unless there is a safety concern = rash)
Why is L-methylfolate prescribed or augmented to current therapy - ansImportant regulator
of critical cofactor for monoamine neurotransmitter synthesis (mostly tetrahydrobiopterin or
BH4)
It is needed for serotonin and dopamine synthesis
4. Know why L-methylfolate might be prescribed or augmented to current therapy
Two theories: - ans1. Low amounts of L-methylfolate = low synthesis of monoamines =
depression/resistance or unresponsive to antidepressants (because SSRIs/SNRIs need good
synthesis of monamines to work - messes with the reuptake blockade)
2. Methylation of genes silences them. So, if there is low L-methylfolate, the gene silencing
could also be low = increased enzyme activity (COMT) = decreased dopamine levels =
cognitive dysfunction.
So adding L-methylfolate to someone who is deficient can increase dopamine and help with
cognition.
Causes of low L-methylfolate: - ansDietary deficiency
Genetic variations in folate metabolism (you can test for this genetic variation (MTHFR)
through tests like Genesight).
Comprehensive Notes
Detailed and organized notes for Maryville University's
Psychopharmacology Exam 3, covering medication classes,
side effects, mechanisms of action, and clinical considerations
Top rated Exam Study Guide latest updated 2025/2026
Sertraline (Zoloft)
Major Side Effects - ansinsomnia, somnolence, HA, dry mouth, sex dysfunction, nausea &
diarrhea
Fluoxetine (Prozac)
Major Side Effect - ansActivating (UPPER); AGITATION, INSOMNIA, nausea, vomiting,
sex dysfunction, GI, serotonin syndrome
Paraoxetine (Paxil)
Major Side Effects - ansAnticholinergic (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 - ansincreased 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 - ansnausea, 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 - anssexual 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
,Maryville Psychopharmacology Exam 3 Study Guide –
Comprehensive Notes
Detailed and organized notes for Maryville University's
Psychopharmacology Exam 3, covering medication classes,
side effects, mechanisms of action, and clinical considerations
Top rated Exam Study Guide latest updated 2025/2026
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 - ansconcentrations 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 - ansmay be more
vulnerable to CNS-activating actions of SSRIs
Know major side effects for lithium (typically dose related) - ansAtaxia, 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) - ans- SNRI
- inhibits NET, increases DA and NE in prefrontal cortex (pg 493 Stahl)
*no potential for abuse
*ADHD medication in US
Trazodone - - ans5-HT2
-A&C antagonist, increases serotonin release
, Maryville Psychopharmacology Exam 3 Study Guide –
Comprehensive Notes
Detailed and organized notes for Maryville University's
Psychopharmacology Exam 3, covering medication classes,
side effects, mechanisms of action, and clinical considerations
Top rated Exam Study Guide latest updated 2025/2026
Duloxetine (Cymbalta) - ans- inhibits neuronal serotonin and NE reuptake, weak DA
reuptake inhibitor
- SNRI
Carbamazepine (Tegretol) - ans- VSSG binding, enhances GABA inhibitory actions,
depresses thalamus & temporal activity
Lithium - ans- 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) - ansAnticonvulsant 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 - ansFluoxetine (Prozac) - no taper needed, long half life
Know how to discontinue lamotrigine - ansLamotrigine (Lamictal) - decrease dose by 50%
per week, over at least 2 weeks (unless there is a safety concern = rash)
Why is L-methylfolate prescribed or augmented to current therapy - ansImportant regulator
of critical cofactor for monoamine neurotransmitter synthesis (mostly tetrahydrobiopterin or
BH4)
It is needed for serotonin and dopamine synthesis
4. Know why L-methylfolate might be prescribed or augmented to current therapy
Two theories: - ans1. Low amounts of L-methylfolate = low synthesis of monoamines =
depression/resistance or unresponsive to antidepressants (because SSRIs/SNRIs need good
synthesis of monamines to work - messes with the reuptake blockade)
2. Methylation of genes silences them. So, if there is low L-methylfolate, the gene silencing
could also be low = increased enzyme activity (COMT) = decreased dopamine levels =
cognitive dysfunction.
So adding L-methylfolate to someone who is deficient can increase dopamine and help with
cognition.
Causes of low L-methylfolate: - ansDietary deficiency
Genetic variations in folate metabolism (you can test for this genetic variation (MTHFR)
through tests like Genesight).
