DRUG STUDY

Drug Data Classification Mechanism of Action Indication Contraindications Adverse Reaction Nursing Responsibilities
 Generic Name Therapeutic: Selectively inhibits the reuptake  General Indications  CNS: NEUROLEPTIC  Before
fluoxetine antidepressants of serotonin in the CNS.  Hypersensitivity; Concurrent MALIGNANT SYNDROME, 1. Assess patient’s mood.
 Major depressive disorder. use or use within 14 days of SEIZURES, SUICIDAL 2. Assess patient’s mental status.
 Trade Name Pharmacologic  Pharmacokinetics Obsessive compulsive discontinuing MAO inhibitors THOUGHTS, anxiety, 3. Assess if patient had any past
Prozac, Sarafem Selective serotonin A: Well absorbed after oral (fluoxetine should be drowsiness, headache, suicidal tendencies.
disorder (OCD). Bulimia
reuptake inhibitors(SSRIs) administration. discontinued at least 5 wk insomnia, nervousness, 4. Confirm medication from
nervosa. Panic disorder.
D: Crosses the blood-brain Depressive episodes before MAO therapy is abnormal dreams, dizziness, doctor’s orders.
Pregnancy Category barrier. associated with bipolar I initiated); Concurrent use of fatigue, hypomania, mania, 5. Assess patient for sensitivity
 Patients Dose pimozide; Concurrent use of weakness. reaction to medication.
B disorder (when used with
M&E: Converted by the olanzapine). Treatment thioridazine (fluoxetine should  EENT: stuffy nose, visual
liver to norfluoxetine (primarily resistant depression (when be discontinued at least 5 wk disturbances.  During
by CYP2D6 isoenzyme), another used with olanzapine). before thioridazine therapy is  Resp: cough.
antidepressant compound; the initiated).  CV: chest pain, palpitations.
 Minimum Dose  Sarafem: Premenstrual 1. Confirm patient’s identity.
CYP2D6 enzyme system  GI: diarrhea, abdominal pain,
PO:5mg/day dysphoric disorder 2. May administer mediation
exhibits genetic
(PMDD).  Precaution abnormal taste, anorexia,
polymorphism (_7% of  Severe hepatic or renal with food to reduce GI
 Unlabeled Use: Anorexia constipation, dry mouth,
population may be poor impairment (lower/less irritation.
nervosa: ADHD, Diabetic dyspepsia, nausea, vomiting,
metabolizers and may have frequent dose may be 3. Do not go over the
 Maximum Dose neuropathy, Fibromyalgia, weight loss.
significantly increase fluoxetine necessary); History of recommended dose.
PO:80mg/day Obesity, Raynaud’s  GU: sexual dysfunction, 4. Practice aseptic technique.
concentrations and an increased seizures; Debilitated patients urinary frequency.
phenomenon, Social 5. Do not crush or open ER
risk of adverse effects). (increased risk of seizures);  Derm:qsweating, pruritus,
 Contents anxiety disorder (social preparations.
Fluoxetine and norfluoxetine are Diabetes mellitus; Patients erythema nodusum, flushing,
fluoxetine phobia), Post-traumatic
mostly with concurrent chronic illness rashes.
stress disorder (PTSD).
metabolized by the liver; 12% or multiple drug therapy (dose  After
 Endo: dysmenorrhea.
 Availability and excreted by kidneys adjustments may be
 Patients Actual  F and E: hyponatremia.
color as unchanged fluoxetine, 7% as necessary); Patients with
Indication  MS: arthralgia, back pain, 1. Observe proper documentation
 Tablets: 10 mg, 20 unchanged norfluoxetine. impaired hepatic function
myalgia. of administered medication.
mg. ( decrease doses/ increase 2. Ensure that patient has fully
 Onset  Neuro: tremor.
 Capsules: 10 mg, 20 dosing interval may be swallowed oral form of
necessary); May increase risk  Misc: SEROTONIN
mg, 40 mg. medication.
1-4wks of suicide attempt/ideation SYNDROME, allergic
 Delayed- release 3. Observe patient’s behavior
 Peak especially during early reactions, fever, flu-like
capsules (Prozac closely for atleast 15-30
unknown treatment or dose adjustment; syndrome, hot flashes,
Weekly): 90 mg. minutes after administration.
sensitivity reaction.
 Oral solution (mint  OB: Use during third 4. Instruct patient to move
flavor):20 mg/5 mL.  Duration trimester may result in slowly to prevent dizziness.
2wks neonatal serotonin syndrome 5. Instruct patient to rest to
 Routes of requiring prolonged decrease risk of falls.
administration hospitalization, respiratory
 Drug Half Life and nutritional support. May
1-3 days cause sedation in infant;
PO
 Lactation: May cause sedation
in infant; discontinue drug or
bottle-feed;
 Pedi: Risk of suicide ideation
or attempt may be greater in
children or adolescents (safe
use in children < 8 yr not
established);
 Geri: Appears on Beers list.
 Geriatric patients are at high
risk for excessive CNS
stimulation, sleep
disturbances, and agitation.

 .Drug interaction
-drug to drug

 Discontinue use of MAO

inhibitors for 14 days before
fluoxetine therapy; combined
therapy may result in
confusion, agitation, seizures,
hypertension, and
hyperpyrexia (serotonin
syndrome). Fluoxetine should
be discontinued for at least 5
wk before MAO inhibitor
therapy is initiated.
Concurrent use with pimozide
may Increase risk of QT
interval prolongation.
 Increase levels of
thioridazine may increase
risk of QT interval
prolongation
(concurrent use
contraindicated; fluoxetine
should be discontinued for at
least 5 wk before thioridazine
is initiated). Inhibits the
activity of cytochrome P450
2D6 enzyme in the liver and
increase effects of drugs
metabolized by this enzyme
system.
 Medications that inhibit the
P450 enzyme system
(including ritonavir,
saquinavir, and efavirenz)
may increase risk of
developing the serotonin
syndrome).
Source:
Deglin, J. et. Al. 2009. Davis’s Drug Guide for Nurses. 12th ed. F.A. Davis. pp.597-600