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Maryville Nurs 660 Exam 2 2025 - 2026 WITH COMPLETE QUESTIONS
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PASS EXAM 2025- 2026 / Maryville Nurs 660 Exam 2
SSRIs 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.
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 Fluvoxamine (Luvox) Pro Shortest ½ life Found to possess some analgesic properties Fluvoxamine (Luvox) Con Shortest ½ life GI distress, headaches, sedation, weakness Strong inhibitor of CYP1A2 and CYP2C No FDA approval for depression anoxilytic properties / psychotic depression SNRIs
SNRIs treat Used for depression, anxiety and possibly neuropathic pain Venalfaxine (Effexor) Pros Minimal drug interactions and almost no P450 activity Short half life and fast renal clearance avoids build-up (good for geriatric populations) Venalfaxine (Effexor) Cons 10 - 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 Minimal drug interactions Short half life and fast renal clearance avoids build-up (good for geriatric populations) Desvanlafaxine (Pristiq) GI distress in 20%+ Dose related increase in total cholesterol, LDL and triglycerides
Dose related increase in BP Duloxetine (Cymbalta) Pro Some data to suggest efficacy for the physical symptoms of depression Thus far less BP increase as compared to venlafaxine Duloxetine (Cymbalta) Con CYP2D6 and CYP1A2 inhibitor Cannot break capsule, as active ingredient not stable within the stomach higher drop out rate Novel Antidepressants drugs Mirtazapine (Remeron) Bupropion (Wellbutrin) Mitrazapine (Remeron) Pro Different mechanism of action may provide a good augmentation strategy to SSRIs. Is a 5HT2 and 5HT receptor antagonist Can be utilized as a hypnotic at lower doses secondary to antihistaminic effects Mitrazapine (Remeron) Con
Inhibit the MAO enzyme system in the CNS Amines (dopamine, serotonin, norepinephrine) are not broken down, resulting in higher levels in the brain Result: alleviation of symptoms of depression MAO contains a cysteinyl-linked flavin MAOIs covalently bind to N-5 of the flavin residue of the enzyme MAOI drugs Phenelzine (Nardil) Tranylcypromine (Parnate) Isocarboxazid (Marplan) MAOI food interactions Tyramine - cheese, wine, licorice, raisins MAO breaks down tyramine= too much à intracranial hemorrage (stroke) MAOI side effects The most common side effects of MAOIs include: Dry mouth Nausea, diarrhea or constipation Headache
Drowsiness Insomnia Skin reaction at the patch site Dizziness or lightheadedness Other possible side effects include: Involuntary muscle jerks Low blood pressure Reduced sexual desire or difficulty reaching orgasm Sleep disturbances Weight gain Difficulty starting a urine flow Muscle aches Prickling or tingling sensation in the skin (paresthesia MAOI cheese effect Headaches Large increase in BP without MAO Increase tyramine indirectly acts on sympathetic release of norepi Tricyclics (TCAs) Tricyclics antidepressants are used in numerous applications; mainly indicated for the treatment of clinical depression, neuropathic pain, nocturnal enuresis, and ADHD, but they have also been used successfully for headache (including migraine headache), anxiety, insomnia, smoking cessation, bulimia nervosa, irritable bowel syndrome, narcolepsy, pathological crying or laughing, persistent hiccups,
- Morning depression heightened MAO-B action Breaks down and deaminates Dopamine in mitochondria MAO-B drugs Selegiline (Emsam) Line of treatment for MAOIs Second or third line due to side effects Receptor associated with suicide 5HT-α Receptor Sensitivity Hypothesis Supersensitivity and up-regulation of post-synaptic receptors leads to depression Four major toxic effects of TCAs Anticholinergic
Cardiovascular Seizures Death Main side effects MAOIs Drowsiness/fatigue Decreased sexual function Low blood pressure Weight gain MDD and brain neruoanatomy - Prefrontal cortex Concentration/interest/pleasure Psychomotor fatigue (mental) Guilt./ suidicality/ worthlessness Mood MDD and brain neuroanatomy - Striatum psychomotor fatigue (physical) MDD and brain neroanatomy - nucleus accumbens Pleasure, interest, fatigue, energy
For - fluvoxamine, floxetine Sadness-Sertraline Panic-Paroxetine Conpulsion-Citalopram Side effects SSRIs - SSSS S-Stomach upset S-Sexual dysfunction S-Serotonin syndrome S-Suicidal thoughts H1 histamine receptor side effects sedation drowsiness weight gain DA reuptake inhibition psychomotor activation psychosis 5HT2 agonism
sexual dysfunction activating side effects 5HT3 agonism nausea 5HT reuptake inhibition GI disturbances activating side effects NE reuptake inhibition Dry mouth urinary retention activating effects Tremor CV troubles alpha 2 antagonism postural hypotension dizziness reflex tachycardia
Downside of fluoxetine Long half life (2 weeks) Sertraline (Zoloft) receptor activity Dopamine transport and Sigma 1 receptor binding Drug choice for atypical depressive symptoms of hypersomnia, anergia, and mood reactivity. Sertraline (Zoloft) Action of Sigma 1 (Sertraline) anxiolytic psychotic/delusional depression Agent of choice for pregnant/breastfeeing women Sertraline Paxil (paroxetine) receptor Weak NET inhibitor Inhibits nitrous oxide synthesis mild anticholinergic action
Which SSRI is the worst offender for sexual side effects, weight gain Paxil Fluvozamine (Luvox) enzyme reactions CYP1A2, 3A Avoid caffeine Citalopram (Celexa) receptor action 2 enantiomers (R and S) and mild antihistamine mildly sedating Key factor in dosing Citalopram No higher than 40 mg in persons < No higher than 20 mg in persons > 60 Black Box warning for Citalopram QTc prolongation=arrhthymias Dose restrictions
