Comprehensive Nursing Pharmacology Q 57
Serotonin release stimulates vomiting following chemotherapy. Therefore, serotonin antagonists are effective in preventing and treating nausea and vomiting related to chemotherapy. An example of an effective serotonin antagonist antiemetic is:
A. ondansetron (Zofran).
B. fluoxetine (Prozac).
C. paroxetine (Paxil).
D. sertraline (Zoloft).
Correct Answer: A. ondansetron (Zofran).
Chemotherapy often induces vomiting centrally by stimulating the chemoreceptor trigger zone (CTZ) and peripherally by stimulating visceral afferent nerves in the GI tract. Ondansetron (Zofran) is a serotonin antagonist that blocks the effects of serotonin and prevents and treats nausea and vomiting. It is especially useful in single-day highly emetogenic cancer chemotherapy (for example, cisplatin). The agents in options 2-4 are selective serotonin reuptake inhibitors. They increase the available levels of serotonin.
Option B: Fluoxetine has FDA-approval for major depressive disorder (age eight and older), obsessive-compulsive disorder (age seven and older), panic disorder, bulimia, binge eating disorder, premenstrual dysphoric disorder, bipolar depression (as an adjunct with olanzapine also known as Symbyax), and treatment-resistant depression when used in combination with olanzapine. Fluoxetine exerts its effects by blocking the reuptake of serotonin into presynaptic serotonin neurons by blocking the reuptake transporter protein located in the presynaptic terminal.
Option C: Paroxetine is a selective serotonin reuptake inhibitor (SSRI), and, as such, is identified as an antidepressant. It is FDA approved for major depressive disorder (MDD), obsessive-compulsive disorder (OCD), social anxiety disorder (SAD), panic disorder, posttraumatic stress disorder (PTSD), generalized anxiety disorder (GAD), and premenstrual dysphoric disorder (PMDD), vasomotor symptoms associated with menopause. As an SSRI class drug, paroxetine’s signature mechanism of action is to block the serotonin reuptake transporter (SERT) and thus increase the concentration of synaptic serotonin.
Option D: Sertraline is an antidepressant used as a first-line treatment of a major depressive disorder. The Food and Drug Administration (FDA) has also approved other indications for sertraline, including the treatment of obsessive-compulsive disorder, panic disorder, post-traumatic stress disorder, premenstrual dysphoric disorder, and social anxiety disorder. Sertraline is an antidepressant medication within the selective serotonin reuptake inhibitors (SSRIs) class. Sertraline is an antidepressant with primarily inhibitory effects on presynaptic serotonin reuptake. This inhibition of serotonin reuptake results in an accumulation of serotonin.