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Maryville NURS 660 Exam 2 2026/2027 – Psychopharmacology
and Advanced Mental Health | Verified Questions & Detailed
Rationales | Grade A Prep Guide
1. What are the major side effects of fluoxetine (Prozac)? (Select all that apply.)
A. Sexual dysfunction (delayed ejaculation, erectile dysfunction, decreased sexual
desire, anorgasmia)
B. Gastrointestinal effects (decreased appetite, nausea, diarrhea, constipation, dry
mouth)
C. CNS effects (insomnia, sedation, agitation, tremors, headache, dizziness)
D. SIADH (syndrome of inappropriate antidiuretic hormone secretion)
Correct Answer: A, B, C, D
Rationale: Fluoxetine causes sexual dysfunction, GI effects, CNS activation/sedation,
autonomic effects (sweating), bruising, and SIADH. Its 5HT2C antagonist properties may
contribute to agitation and activation early in dosing.
2. What are the major adverse effects of fluoxetine? (Select all that apply.)
A. Rare seizures
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B. Rare induction of mania
C. Rare activation of suicidal ideation and behavior (suicidality) (short-term studies did
not show an increase in risk beyond age 24)
D. Weight loss
Correct Answer: A, B, C
Rationale: Fluoxetine can cause rare seizures, induction of mania, and activation of
suicidal ideation and behavior (suicidality) in younger patients.
3. What are the major drug interactions with fluoxetine? (Select all that apply.)
A. Tramadol increases risk of seizures
B. Can cause fatal serotonin syndrome when combined with MAOIs; 5-week washout
required after fluoxetine before starting MAOI
C. May increase TCA levels
D. May increase risk of bleeding with anticoagulants (warfarin, NSAIDs)
Correct Answer: A, B, C, D
Rationale: Fluoxetine interacts with tramadol (seizure risk), MAOIs (serotonin
syndrome, 5-week washout), TCAs (increased levels), and anticoagulants (bleeding risk).
It also inhibits CYP2D6 and CYP3A4.
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4. Does fluoxetine require tapering when discontinuing?
A. Yes, must taper slowly over 2-4 weeks
B. No, fluoxetine has a long half-life and does not require tapering
C. Only if the patient is elderly
D. Only if the patient is on a high dose
Correct Answer: B
Rationale: Fluoxetine has a long half-life (approximately 4-6 days) and self-tapers, so it
does not require gradual discontinuation.
5. What neurotransmitters does fluoxetine affect? (Select all that apply.)
A. Serotonin
B. Norepinephrine (via 5HT2C antagonism)
C. Dopamine (via 5HT2C antagonism)
D. GABA
Correct Answer: A, B, C
Rationale: Fluoxetine boosts serotonin through reuptake inhibition and increases
norepinephrine and dopamine through 5HT2C receptor antagonism.
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6. What are the major side effects of escitalopram (Lexapro)? (Select all that apply.)
A. May be best tolerated antidepressant with less sexual dysfunction
B. Least interaction with CYP2D6 and CYP3A4
C. Sexual dysfunction, GI effects, CNS effects, autonomic effects, bruising
D. Rare hyponatremia (mostly in elderly)
Correct Answer: A, B, C, D
Rationale: Escitalopram is well tolerated with fewer drug interactions. Side effects
include sexual dysfunction, GI effects, CNS effects, autonomic effects, bruising, and rare
hyponatremia.
7. What is the washout period required before starting an MAOI after discontinuing
escitalopram?
A. 2 weeks
B. 5-7 days (5 half-lives)
C. 4 weeks
D. 6-8 weeks
Correct Answer: B
Rationale: Escitalopram requires a washout of 5 half-lives (5-7 days for most drugs)
before starting an MAOI to prevent serotonin syndrome.
Maryville NURS 660 Exam 2 2026/2027 – Psychopharmacology
and Advanced Mental Health | Verified Questions & Detailed
Rationales | Grade A Prep Guide
1. What are the major side effects of fluoxetine (Prozac)? (Select all that apply.)
A. Sexual dysfunction (delayed ejaculation, erectile dysfunction, decreased sexual
desire, anorgasmia)
B. Gastrointestinal effects (decreased appetite, nausea, diarrhea, constipation, dry
mouth)
C. CNS effects (insomnia, sedation, agitation, tremors, headache, dizziness)
D. SIADH (syndrome of inappropriate antidiuretic hormone secretion)
Correct Answer: A, B, C, D
Rationale: Fluoxetine causes sexual dysfunction, GI effects, CNS activation/sedation,
autonomic effects (sweating), bruising, and SIADH. Its 5HT2C antagonist properties may
contribute to agitation and activation early in dosing.
2. What are the major adverse effects of fluoxetine? (Select all that apply.)
A. Rare seizures
,2|Page
B. Rare induction of mania
C. Rare activation of suicidal ideation and behavior (suicidality) (short-term studies did
not show an increase in risk beyond age 24)
D. Weight loss
Correct Answer: A, B, C
Rationale: Fluoxetine can cause rare seizures, induction of mania, and activation of
suicidal ideation and behavior (suicidality) in younger patients.
3. What are the major drug interactions with fluoxetine? (Select all that apply.)
A. Tramadol increases risk of seizures
B. Can cause fatal serotonin syndrome when combined with MAOIs; 5-week washout
required after fluoxetine before starting MAOI
C. May increase TCA levels
D. May increase risk of bleeding with anticoagulants (warfarin, NSAIDs)
Correct Answer: A, B, C, D
Rationale: Fluoxetine interacts with tramadol (seizure risk), MAOIs (serotonin
syndrome, 5-week washout), TCAs (increased levels), and anticoagulants (bleeding risk).
It also inhibits CYP2D6 and CYP3A4.
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4. Does fluoxetine require tapering when discontinuing?
A. Yes, must taper slowly over 2-4 weeks
B. No, fluoxetine has a long half-life and does not require tapering
C. Only if the patient is elderly
D. Only if the patient is on a high dose
Correct Answer: B
Rationale: Fluoxetine has a long half-life (approximately 4-6 days) and self-tapers, so it
does not require gradual discontinuation.
5. What neurotransmitters does fluoxetine affect? (Select all that apply.)
A. Serotonin
B. Norepinephrine (via 5HT2C antagonism)
C. Dopamine (via 5HT2C antagonism)
D. GABA
Correct Answer: A, B, C
Rationale: Fluoxetine boosts serotonin through reuptake inhibition and increases
norepinephrine and dopamine through 5HT2C receptor antagonism.
, 4|Page
6. What are the major side effects of escitalopram (Lexapro)? (Select all that apply.)
A. May be best tolerated antidepressant with less sexual dysfunction
B. Least interaction with CYP2D6 and CYP3A4
C. Sexual dysfunction, GI effects, CNS effects, autonomic effects, bruising
D. Rare hyponatremia (mostly in elderly)
Correct Answer: A, B, C, D
Rationale: Escitalopram is well tolerated with fewer drug interactions. Side effects
include sexual dysfunction, GI effects, CNS effects, autonomic effects, bruising, and rare
hyponatremia.
7. What is the washout period required before starting an MAOI after discontinuing
escitalopram?
A. 2 weeks
B. 5-7 days (5 half-lives)
C. 4 weeks
D. 6-8 weeks
Correct Answer: B
Rationale: Escitalopram requires a washout of 5 half-lives (5-7 days for most drugs)
before starting an MAOI to prevent serotonin syndrome.
