NURS 660 EXAM 4 COMPREHENSIVE
EXAMINATION TEST 2026 SOLVED QUESTIONS
ANSWERS GRADED A+
◉ Fluoxetine major adverse effects.
Answer: Rare seizures
Rare induction of mania
Rare activation of suicidal ideation and behavior (suicidality) (short-
term studies did not show an increase in the risk of suicidality with
antidepressants compared to placebo beyond age 24)
◉ Fluoxetine major drug interactions.
Answer: -Tramadol increases the risk of seizures in patients taking
an antidepressant
-Can increase TCA levels; use with caution with TCAs or when
switching from a TCA to fluoxetine
-Can cause a fatal "serotonin syndrome" when combined with
MAOIs, so do not use with MAOIs or for at least 14 days after MAOIs
are stopped,Do not start an MAOI for at least 5 weeks after
discontinuing fluoxetine
-May displace highly protein bound drugs (e.g., warfarin)
,-Can rarely cause weakness, hyperreflexia, and incoordination when
combined with sumatriptan, or possibly with other triptans,
requiring careful monitoring of patient
-Possible increased risk of bleeding, especially when combined with
anticoagulants (e.g.,warfarin, NSAIDs)
NSAIDs may impair effectiveness of SSRIs
-Via CYP450 2D6 inhibition, could theoretically interfere with the
analgesic actions of codeine, and increase the plasma levels of some
beta blockers and of atomoxetine
-Via CYP450 2D6 inhibition, fluoxetine could theoretically increase
concentrations of thioridazine and cause dangerous cardiac
arrhythmias
-May reduce the clearance of diazepam or trazodone, thus increasing
their levels
-Via CYP450 3A4 inhibition, may increase the levels of alprazolam,
buspirone, and triazolam
-Via CYP450 3A4 inhibition, fluoxetine could theoretically increase
concentrations of certain cholesterol lowering HMG CoA reductase
inhibitors, especially simvastatin, atorvastatin, and lovastatin, but
not pravastatin or fluvastatin, which would increase the risk of
rhabdomyolysis; thus, coadministration of fluoxetine with certain ---
-HMG CoA reductase inhibitors should proceed with caution
Via CYP450 3A4 inhibition, fluoxetine could theoretically increase
the concentrations of pimozide, and cause QTc prolongation and
dangerous cardiac arrhythmias
,◉ Fluoxetine lab tests
*Don't have to taper!.
Answer: none in healthy individuals
◉ Fluoxetine neurotransmitters.
Answer: -serotonin
-norepinephrine (bc of antagonistic properties5HT2C receptors)
-dopamine (bc of antagonistic properties at 5HT2C receptors)
◉ Fluoxetine pregnancy risk.
Answer: not recommended, especially in first trimester
-may need to continue @ 3rd trimester if depressive disorder
increased postpartum depression
-Neonates exposed to SSRIs or SNRIs late in the third trimester have
developed complications requiring prolonged hospitalization,
respiratory support, and tube feeding; reported symptoms are
consistent with either a direct toxic effect of SSRIs and SNRIs or,
possibly, a drug discontinuation syndrome, and include respiratory
distress, cyanosis, apnea, seizures, temperature instability, feeding
difficulty, vomiting, hypoglycemia, hypotonia, hypertonia,
hyperreflexia, tremor, jitteriness, irritability, and constant crying
◉ Fluoxetine mechanism of action.
, Answer: -Boosts neurotransmitter serotonin
-Blocks serotonin reuptake pump (serotonin transporter)
-Desensitizes serotonin receptors, especially serotonin 1A receptors
-Presumably increases serotonergic neurotransmission
-Fluoxetine also has antagonist properties at 5HT2C receptors,
which could increase norepinephrine and dopamine
neurotransmission
◉ Escitalopram (Lexapro) Major Side Effects SSRI
*May be best tolerated anti-depressants
*may be assoc w/ less sexual dysfunction
*least interaction w/ CYP 2D6 and 3A4.
Answer: -Sexual dysfunction
-GI (dry mouth, constipation, nausea, diarrhea, decreased appetite)
-Mostly central nervous system (insomnia but also sedation,
agitation, tremors, headache, dizziness)
Note: patients with diagnosed or undiagnosed bipolar or psychotic
disorders may be more vulnerable to CNS-activating actions of SSRIs
-Autonomic (sweating)
-Bruising and rare bleeding
-Rare hyponatremia (mostly in elderly patients and generally
reversible on discontinuation of escitalopram
-SIADH (syndrome of inappropriate antidiuretic hormone secretion)
EXAMINATION TEST 2026 SOLVED QUESTIONS
ANSWERS GRADED A+
◉ Fluoxetine major adverse effects.
Answer: Rare seizures
Rare induction of mania
Rare activation of suicidal ideation and behavior (suicidality) (short-
term studies did not show an increase in the risk of suicidality with
antidepressants compared to placebo beyond age 24)
◉ Fluoxetine major drug interactions.
Answer: -Tramadol increases the risk of seizures in patients taking
an antidepressant
-Can increase TCA levels; use with caution with TCAs or when
switching from a TCA to fluoxetine
-Can cause a fatal "serotonin syndrome" when combined with
MAOIs, so do not use with MAOIs or for at least 14 days after MAOIs
are stopped,Do not start an MAOI for at least 5 weeks after
discontinuing fluoxetine
-May displace highly protein bound drugs (e.g., warfarin)
,-Can rarely cause weakness, hyperreflexia, and incoordination when
combined with sumatriptan, or possibly with other triptans,
requiring careful monitoring of patient
-Possible increased risk of bleeding, especially when combined with
anticoagulants (e.g.,warfarin, NSAIDs)
NSAIDs may impair effectiveness of SSRIs
-Via CYP450 2D6 inhibition, could theoretically interfere with the
analgesic actions of codeine, and increase the plasma levels of some
beta blockers and of atomoxetine
-Via CYP450 2D6 inhibition, fluoxetine could theoretically increase
concentrations of thioridazine and cause dangerous cardiac
arrhythmias
-May reduce the clearance of diazepam or trazodone, thus increasing
their levels
-Via CYP450 3A4 inhibition, may increase the levels of alprazolam,
buspirone, and triazolam
-Via CYP450 3A4 inhibition, fluoxetine could theoretically increase
concentrations of certain cholesterol lowering HMG CoA reductase
inhibitors, especially simvastatin, atorvastatin, and lovastatin, but
not pravastatin or fluvastatin, which would increase the risk of
rhabdomyolysis; thus, coadministration of fluoxetine with certain ---
-HMG CoA reductase inhibitors should proceed with caution
Via CYP450 3A4 inhibition, fluoxetine could theoretically increase
the concentrations of pimozide, and cause QTc prolongation and
dangerous cardiac arrhythmias
,◉ Fluoxetine lab tests
*Don't have to taper!.
Answer: none in healthy individuals
◉ Fluoxetine neurotransmitters.
Answer: -serotonin
-norepinephrine (bc of antagonistic properties5HT2C receptors)
-dopamine (bc of antagonistic properties at 5HT2C receptors)
◉ Fluoxetine pregnancy risk.
Answer: not recommended, especially in first trimester
-may need to continue @ 3rd trimester if depressive disorder
increased postpartum depression
-Neonates exposed to SSRIs or SNRIs late in the third trimester have
developed complications requiring prolonged hospitalization,
respiratory support, and tube feeding; reported symptoms are
consistent with either a direct toxic effect of SSRIs and SNRIs or,
possibly, a drug discontinuation syndrome, and include respiratory
distress, cyanosis, apnea, seizures, temperature instability, feeding
difficulty, vomiting, hypoglycemia, hypotonia, hypertonia,
hyperreflexia, tremor, jitteriness, irritability, and constant crying
◉ Fluoxetine mechanism of action.
, Answer: -Boosts neurotransmitter serotonin
-Blocks serotonin reuptake pump (serotonin transporter)
-Desensitizes serotonin receptors, especially serotonin 1A receptors
-Presumably increases serotonergic neurotransmission
-Fluoxetine also has antagonist properties at 5HT2C receptors,
which could increase norepinephrine and dopamine
neurotransmission
◉ Escitalopram (Lexapro) Major Side Effects SSRI
*May be best tolerated anti-depressants
*may be assoc w/ less sexual dysfunction
*least interaction w/ CYP 2D6 and 3A4.
Answer: -Sexual dysfunction
-GI (dry mouth, constipation, nausea, diarrhea, decreased appetite)
-Mostly central nervous system (insomnia but also sedation,
agitation, tremors, headache, dizziness)
Note: patients with diagnosed or undiagnosed bipolar or psychotic
disorders may be more vulnerable to CNS-activating actions of SSRIs
-Autonomic (sweating)
-Bruising and rare bleeding
-Rare hyponatremia (mostly in elderly patients and generally
reversible on discontinuation of escitalopram
-SIADH (syndrome of inappropriate antidiuretic hormone secretion)
