Exam (elaborations)
Maryville Nurs 660 Exam 2 2024/2025
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Maryville Nurs 660 Exam 2SSRIs - selective serotonin reuptake inhibitors
Seriously Prepare Cities for the Flu Vaccine - -Sertaline (Zoloft)
--Paroxetine (Paxil)
-Citolpram(Celexa)
-Escitalopram (Lexapro)
-Fluoxetine HCl (Prozac)
--Fluvoxamine (Luvox)
-(Viibryd)Citol
SSRI mechanism of action - Blocks the reuptake of serotonin (only serotonin) thus increasing it's effects
All inhibit the serotonin transporter SERT
SSRI side effects - Gastrointestinal disturbances
Sexual dysfunction
Drowsiness / insomnia
Serotonin Syndrome (rare)
SSRI discontinuation - sx
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 - anxiety
depression
SSRI discontinuation syndrome - A drug withdrawal syndrome associated with the use of at least some
of the SSRI and SNRI antidepressants.
SSRI discontinuation syndrome symptoms - flu-like symptoms, dizziness, weakness, nausea, fatigue,
feelings of "unreality," loss of balance, light-headedness, "electric-shock" sensations, and other
symptoms.
Paroxitine (Paxil) Pros - Short 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 - Significant CYP2D6 inhibition
Sedating, wt gain, more anticholinergic effects
sexual side effects
Notorious for discontinuation syndrome
Sertraline (Zoloft) Pros - Very weak P450 interactions (only slight CYP2D6)
Short half life with lower build-up of metabolites
Less sedating when compared to paroxetine
Sertraline (Zoloft) Cons - Max absorption requires a full stomach
Increased number of GI adverse drug reactions
Fluoxetine (Prozac) Pros - Long 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 - Long 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 - Low inhibition of P450 enzymes so fewer drug-drug interactions
Intermediate ½ life
Citalpram (Celexa) Con - Dose-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 - Low 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 - Dose-dependent QT interval prolongation with doses of 10-30mg daily
Nausea, headache
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