NR668 WEEK 1 STUDY GUIDE 2026 TESTED
QUESTIONS AND ANSWERS
◉ Fluoxetine. Answer: -CYP2D6 Metabolism
-More P450 interactions that most antidepressants
-5HT2C Antagonism results in the release of Dopamine & NE which
explains why it can be activating
-Half life of 5 days - 2 weeks!
• This is a concern when starting another agent
◉ Paroxetine. Answer: -CYP2D6 Metabolism
-More P450 interactions that most antidepressants
-Notable effect on anxiety thought related to muscarinic,
anticholinergic action
• Hence, it is less activating
-Short half life contributes to horrible withdrawal
◉ Sertraline. Answer: -SSRI with some dopamine reuptake
inhibition
-Often the cardiologist SSRI of choice given its record of
cardiovascular safety
-Weight neutral although known to cause transient diarrhea
,-Thought relatively safe for breast feeding & pregnancy
◉ Fluvoxamine. Answer: -Not FDA approved for depression
-Approved for OCD
-Known side effect of hyponatremia
◉ Citalopram. Answer: -Supposedly less tolerated than escitalopram
-Persons age 60+ are limited to a QD dose of 20mg given the known
risk of QT prolongation
• associated with Torsade de pointes which can lead to sudden death
◉ Escitalopram. Answer: -The S - stereoisomer of Citalopram
• a purified version with less drug - drug interactions
-QT prolongation remains a possible concern, but less so compared
to Citalopram
◉ QT interval. Answer: Normal QTc is 360 - 440 ms
Abnormal QTc:
QTc > 450 ms males
QTc > 470 ms females
, (Each small box is 40 ms)
◉ Torsade de pointes. Answer: Abnormal parameters
QTc > 450 ms males
QTc > 470 ms females
◉ Antidepressant medications: 5HT1A partial agonist & Multimodal
antidepressants. Answer: -Vilazodone (Viibryd)
-Vortioxetine (Trintellix)
◉ Vilazodone (Viibryd). Answer: -Serotonin Partial Agonist
Reuptake inhibitor
-Dual acting serotonin reuptake inhibitor plus 5HT1A partial agonist
-Side effects:
• N/V/D
• minimal sexual dysfunction
-Metabolism via CYP3A4 (major)
-Bioavailability drop 50% when not given with food
-US boxed warning with suicidal thoughts & behavior
◉ Vortioxetine (Trintellix). Answer: -Multimodal action:
QUESTIONS AND ANSWERS
◉ Fluoxetine. Answer: -CYP2D6 Metabolism
-More P450 interactions that most antidepressants
-5HT2C Antagonism results in the release of Dopamine & NE which
explains why it can be activating
-Half life of 5 days - 2 weeks!
• This is a concern when starting another agent
◉ Paroxetine. Answer: -CYP2D6 Metabolism
-More P450 interactions that most antidepressants
-Notable effect on anxiety thought related to muscarinic,
anticholinergic action
• Hence, it is less activating
-Short half life contributes to horrible withdrawal
◉ Sertraline. Answer: -SSRI with some dopamine reuptake
inhibition
-Often the cardiologist SSRI of choice given its record of
cardiovascular safety
-Weight neutral although known to cause transient diarrhea
,-Thought relatively safe for breast feeding & pregnancy
◉ Fluvoxamine. Answer: -Not FDA approved for depression
-Approved for OCD
-Known side effect of hyponatremia
◉ Citalopram. Answer: -Supposedly less tolerated than escitalopram
-Persons age 60+ are limited to a QD dose of 20mg given the known
risk of QT prolongation
• associated with Torsade de pointes which can lead to sudden death
◉ Escitalopram. Answer: -The S - stereoisomer of Citalopram
• a purified version with less drug - drug interactions
-QT prolongation remains a possible concern, but less so compared
to Citalopram
◉ QT interval. Answer: Normal QTc is 360 - 440 ms
Abnormal QTc:
QTc > 450 ms males
QTc > 470 ms females
, (Each small box is 40 ms)
◉ Torsade de pointes. Answer: Abnormal parameters
QTc > 450 ms males
QTc > 470 ms females
◉ Antidepressant medications: 5HT1A partial agonist & Multimodal
antidepressants. Answer: -Vilazodone (Viibryd)
-Vortioxetine (Trintellix)
◉ Vilazodone (Viibryd). Answer: -Serotonin Partial Agonist
Reuptake inhibitor
-Dual acting serotonin reuptake inhibitor plus 5HT1A partial agonist
-Side effects:
• N/V/D
• minimal sexual dysfunction
-Metabolism via CYP3A4 (major)
-Bioavailability drop 50% when not given with food
-US boxed warning with suicidal thoughts & behavior
◉ Vortioxetine (Trintellix). Answer: -Multimodal action:
