AIIMS Rishikesh & Jodhpur NO - 2017
Pharmacology
Hard
Examples of SSRI, except?
Appeared in: AIIMS Rishikesh & Jodhpur NO - 2017
Explanation
- Selegiline is a Monoamine Oxidase Inhibitor (MAOI), a different class of antidepressant from SSRIs.
- The mechanism of action for MAOIs involves inhibiting the monoamine oxidase enzyme, which breaks down neurotransmitters like serotonin, norepinephrine, and dopamine.
- This enzyme inhibition mechanism is fundamentally different from the reuptake inhibition mechanism shared by both SSRIs and SNRIs.
- Because its mechanism is the most distinct from SSRIs, Selegiline is the best answer for a question asking for the exception.
Why Other Options Were Wrong
- Option A: Duloxetine is a Serotonin-Norepinephrine Reuptake Inhibitor (SNRI). Although it is not an SSRI, its mechanism as a reuptake inhibitor is closely related to that of SSRIs, making it a less distinct exception compared to Selegiline.
- Option B: Citalopram is a widely used Selective Serotonin Reuptake Inhibitor (SSRI). It is a correct example of the drug class mentioned in the stem, not an exception.
- Option C: Fluoxetine is one of the most well-known SSRIs. It fits the category perfectly and is therefore not the exception.
Related Visual
Clinical Relevance
- Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Classification of antidepressant medications as background academic context rather than a clinical decision trigger.
- A critical nursing responsibility is educating patients prescribed MAOIs like Selegiline about avoiding tyramine-rich foods (e.g., aged cheeses, cured meats, red wine) to prevent a life-threatening hypertensive crisis.
- Nurses must ensure a 'washout' period of at least 2 weeks is observed when a patient is switching between an MAOI and an SSRI/SNRI to prevent serotonin syndrome, a potentially fatal condition characterized by agitation, fever, and clonus.
- What if? If a patient on Selegiline reports a sudden, severe headache, profuse sweating, and heart palpitations after eating at a party, the nurse's first action should be to assess for a hypertensive crisis by taking their blood pressure immediately and preparing for emergency intervention.
How to Approach the Question
- First, identify the core task from the question stem: you need to find the drug that is an 'except'ion to the SSRI class.
- Review each option and classify it based on your pharmacology knowledge: Citalopram (SSRI), Fluoxetine (SSRI), Duloxetine (SNRI), and Selegiline (MAOI).
- Recognize that two options (Duloxetine and Selegiline) are technically not SSRIs. This indicates you need to find the 'best' or most different exception.
- Compare the mechanisms of action. SSRIs and SNRIs are both 'reuptake inhibitors'. MAOIs are 'enzyme inhibitors'.
- Conclude that the MAOI (Selegiline) is the most fundamentally different drug class from SSRIs, making it the correct answer in this context.
Concept Tested & Keywords
- Concept Tested: Classification of antidepressant medications
- Stem keywords: SSRI, antidepressant
- Lead-in keywords: except
- Negative lead-in flag: The question asks for the option that is an EXCEPTION.
Question ID
QewIzqYF1qMvognQJ76J_s
Reference Book
E6 Robert Boland, Marcia L. Verduin - Kaplan and Sadock's Comprehensive Text of Psychiatry-Wolters Kluwer Health (2024) (pp 1-16525 of 16525) p. 9854-9856
Practise the full AIIMS Rishikesh & Jodhpur NO - 2017
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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