Which one of the following is a common early side effect of fluoxetine (Prozac)?
Correct Answer B: Fluoxetine, a selective serotonin reuptake inhibitor, has no effect on the norepinephrine system; therefore, it does not produce the side effects common to the tricyclic antidepressants. These include anticholinergic side effects (dry mouth, constipation), orthostatic hypotension, cardiac conduction disturbances, and drowsiness.
Loss of appetite is often seen in patients who take fluoxetine, and can be especially troublesome in the elderly. Skin rash is uncommon.
A 30 year old white female returns to your office for a 6 week follow-up for depression. Six weeks ago, she started fluoxetine (Prozac) and she now complains that her libido, which was decreased when she started the drug, has become significantly worse.
Which one of the following is appropriate?
Correct Answer D:
Fluoxetine and other SSRIs (e.g. sertraline) can cause or worsen loss of libido. This is also true with tricyclics such as imipramine. Bupropion does not inhibit libido.
Which one of the following is a major advantage of second-generation (atypical) antipsychotics compared with first generation antipsychotics?
Correct Answer A:
A recent expert consensus panel endorsed the use of second-generation antipsychotics rather than first-generation drugs. Tardive dyskinesia is much less common with the use of second-generation antipsychotics. Several of the second generation drugs require monitoring for major side effects, however. For example, clozapine, shown by studies to be the most efficacious of the new class, causes granulocytopenia or agranulocytosis, requiring weekly and later biweekly monitoring of blood counts. Both classes have depot formulations for intramuscular administration every 2-4 weeks. Oral dosing of drugs from both classes varies from 1 to 3 times daily. First-generation antipsychotics cost less than second-generation drugs.
Patients treated with which one of the following require regular hematologic monitoring for the development of granulocytopenia?
Correct Answer C:
Clozapine is one of the so-called second-generation antipsychotics, which are believed to be less likely to cause extrapyramidal side effects than the first-generation drugs such as haloperidol or the phenothiazines (e.g., fluphenazine). A 2003 meta-analysis concluded that clozapine was the most efficacious second-generation antipsychotic, followed by risperidone and olanzapine. However, clozapine use is associated with an approximately 1% incidence of granulocytopenia or agranulocytosis. Early detection by monitoring blood counts every 1-2 weeks has led to a reduction in agranulocytosis-related death, but clozapine is generally considered second-line therapy, to be used in cases unresponsive to other drugs.
Which one of the following side effects induced by traditional neuroleptic agents responds to treatment with beta-blockers?
Rigidity, sialorrhea, and stooped posture are parkinsonian side effects of neuroleptic drugs. These are treated with anticholinergic drugs such as benztropine or amantadine. Dystonia, often manifested as an acute spasm of the muscles of the head and neck, also responds to anticholinergics. Akathisia (motor restlessness and an inability to sit still) can be treated with either anticholinergic drug or beta-blockers.
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