NR 572 ADVANCED ACUTE CARE
MANAGEMENT FINAL EXAM 2026 PRACTICE
QUESTIONS AND ANSWERS DETAILED REVIEW
◉ SSRIs
dose should start at 1/3 to 1/2 of normal dose
ABSOLUTE CONTRAINDICATION- do not combine with MAOI
take at least 4 weeks to achieve response
-Fluoxetine 5-10 mg, paroxetine 10mg, sertraline 25-50 mg
SNRI
-venlafaxine 37.5 mg (contraindicated with MAOIs)
helps reduce anticpatory anxiety, fear and avoidance
MAOIs
beneficial if the patient has comorbid atypical depression
-maintain a low-tyramine diet
no cheese or wine
Benzos
-helpful early in the course of treatment and sporadically throughout
(limit to 4-6 weeks and discontinue by week 7)
,-don't use as monotherapy
alprazalam and clonazepam
Can use aripiprazole, divalproex sodium or pindolol for short-term
augmentation for treatment-resistant cases
Psychotherapy for panic disorder
-Breathing techniques, stop smoking, aerobic exercise (walking for 60
minutes or running for 20-30 minutes, 4 days/week), CBT, self-help
books Answer: Panic disorder treatment
◉ drowsiness, fatigue
-avoid operating heavy machineray
retrograde amnesia/memory impairment
-risk worsens with use of alcohol
withdrawl symptoms
-taper dose on discontinuation
paradoxical disinhibition
-can increase anxiety, irritability or agitation especially wit hchildren
and old people
,Patients with hx of multiple substance use are at greatest risk for
sedative, hypnotic or anxiolytic use disorder.
Patients with GAD and panic disorder have highest risk for devloping
physical dependence
-get abstinence syndrome (withdrawl)
causes acute decrease in GABA neurotransmission
symptoms include anxiety, insomnia, resetlessnes, diaphoresis, nausa,
coryza, blurred vision, depression, hyperreflexia, ataxia, depression
reduce dose by 25% per week for no more than 8 weeks
longterm use requires 2 -4 month taper
can use pregablin to when tapering
avoid alcohol and stimu,ants Answer: Side effects and precautions of
prescribing benzodiazepines
◉ AVOID PAROXETINE during pregancy
- tetratogenic
-can cause cardiovascular malformations
, Hypnaatremia
-baseline BMP and monitor preriodically especially 65 and older pts
Thrombocytopenia with citalopram
-get CBC
QT prolongation
--EEG before starting citalopram and in patients with cardiac disease
avoid abrupt discontinuation in all expcept fluoxetine Answer: SSRIs
◉ Concurrent use of medications that inhibit CYP3A4 (eg,
ketoconazole, nefazodone, and ritonavir) can increase the blood levels of
alprazolam and diazepam
Medications that induce cytochrome CYP3A4 (eg, carbamazepine, St.
John's wort) can reduce benzodiazepine levels
Medications that inhibit or induce CYP2C19 (eg, fluoxetine,
fluvoxamine, omeprazole) or N-acetyltransferase 2 activity can alter
diazepam and clonazepam metabolism, respectively Answer: Benzos
◉ Depression
MANAGEMENT FINAL EXAM 2026 PRACTICE
QUESTIONS AND ANSWERS DETAILED REVIEW
◉ SSRIs
dose should start at 1/3 to 1/2 of normal dose
ABSOLUTE CONTRAINDICATION- do not combine with MAOI
take at least 4 weeks to achieve response
-Fluoxetine 5-10 mg, paroxetine 10mg, sertraline 25-50 mg
SNRI
-venlafaxine 37.5 mg (contraindicated with MAOIs)
helps reduce anticpatory anxiety, fear and avoidance
MAOIs
beneficial if the patient has comorbid atypical depression
-maintain a low-tyramine diet
no cheese or wine
Benzos
-helpful early in the course of treatment and sporadically throughout
(limit to 4-6 weeks and discontinue by week 7)
,-don't use as monotherapy
alprazalam and clonazepam
Can use aripiprazole, divalproex sodium or pindolol for short-term
augmentation for treatment-resistant cases
Psychotherapy for panic disorder
-Breathing techniques, stop smoking, aerobic exercise (walking for 60
minutes or running for 20-30 minutes, 4 days/week), CBT, self-help
books Answer: Panic disorder treatment
◉ drowsiness, fatigue
-avoid operating heavy machineray
retrograde amnesia/memory impairment
-risk worsens with use of alcohol
withdrawl symptoms
-taper dose on discontinuation
paradoxical disinhibition
-can increase anxiety, irritability or agitation especially wit hchildren
and old people
,Patients with hx of multiple substance use are at greatest risk for
sedative, hypnotic or anxiolytic use disorder.
Patients with GAD and panic disorder have highest risk for devloping
physical dependence
-get abstinence syndrome (withdrawl)
causes acute decrease in GABA neurotransmission
symptoms include anxiety, insomnia, resetlessnes, diaphoresis, nausa,
coryza, blurred vision, depression, hyperreflexia, ataxia, depression
reduce dose by 25% per week for no more than 8 weeks
longterm use requires 2 -4 month taper
can use pregablin to when tapering
avoid alcohol and stimu,ants Answer: Side effects and precautions of
prescribing benzodiazepines
◉ AVOID PAROXETINE during pregancy
- tetratogenic
-can cause cardiovascular malformations
, Hypnaatremia
-baseline BMP and monitor preriodically especially 65 and older pts
Thrombocytopenia with citalopram
-get CBC
QT prolongation
--EEG before starting citalopram and in patients with cardiac disease
avoid abrupt discontinuation in all expcept fluoxetine Answer: SSRIs
◉ Concurrent use of medications that inhibit CYP3A4 (eg,
ketoconazole, nefazodone, and ritonavir) can increase the blood levels of
alprazolam and diazepam
Medications that induce cytochrome CYP3A4 (eg, carbamazepine, St.
John's wort) can reduce benzodiazepine levels
Medications that inhibit or induce CYP2C19 (eg, fluoxetine,
fluvoxamine, omeprazole) or N-acetyltransferase 2 activity can alter
diazepam and clonazepam metabolism, respectively Answer: Benzos
◉ Depression
