CMN 548 UNIT 5 EXAM CORE
INTERPERSONAL AND ORGANIZATIONAL
COMMUNICATION CONCEPTS REVIEW 2026
◉ How long should the NP wait to begin another tx for depression
when stopping an MAOI to begin another MAOI or SSRI?.
Answer: irreversible MAOI-wait 14 days
MAO activity recovers completely 24-48 hrs after last dose of RIMA
◉ How long should the NP wait to begin an MAOI after d/c a pt from
fluoxetine (Prozac)?.
Answer: when switching from an antidepressant to an irreversible
MAOI-should wait 10-14 days (or 5 weeks for fluoxetine (Prozac)
before starting use of MAOI to avoid drug interactions
◉ Complications for using MAOIs for pts who have bipolar I and
schizophrenia?.
Answer: induction of mania in the depressed phase of bipolar I
disorder and triggering of a psychotic decompensation in persons
with schizophrenia
◉ Symptoms of tyramine-induced hypertensive crisis?.
Answer: Severe HTN
,HA
Stiff neck
diaphoresis
N/V
◉ Tyramine-containing foods should be avoided for how long after
d/c an irreversible MAOI? A reversible MAOI?.
Answer: irreversible MAOI-2 weeks after last dose
reversible-3 days after last dose of RIMA
◉ s/s of the discontinuation syndrome associated with abrupt
withdrawal of MAOIs? How would the NP prevent this?.
Answer: arousal, mood disturbances, and somatic symptoms
To avoid: dosage should be gradually tapered over several weeks
◉ How long would it be before symptoms appear in a patient with
an OD from an MAOI? symptoms?.
Answer: pts may appear symptom free up to 6 hrs, then progress to:
restlessness
coma-hyperthermia, HTN, tachypnea, tachycardia, dilated pupils,
hyperactive deep tendon reflexes
involuntary movements in face & jaw
death
,close medical supervision is indicated for 48 hrs following an OD
◉ Symptoms of MAOI toxicity?.
Answer: CNS (dizzy, drowsy, fatigue, HA, hyperreflexia, sleep
disturbance)
Anticholinergic effects (constipation, dry mouth, urinary retention)
Cardio (weakness, orthostatic hypotension, edema in lower
extremities)
Hematologic (anemia, neutropenia, thrombocytopenia,
agranulocytosis)
Endocrine (hyponatremia, SIADH, increased appetite, weight gain)
GI (anorexia, N/V)
Urogenital (urinary retention/freq/incontinence, decreased libido,
impotence, diminished sperm count, priaprism)
Elevated transaminase levels
hair loss
◉ What hepatic enzyme in the CYP450 enzyme system can have a
dramatic difference in plasma concentrations of TCAs?.
Answer: Poor metabolizer (CYP2D6) may experience an up to 8 fold
increase in plasma concentrations, resulting in increased AE
◉ What are the indications for use for TCAs?.
, Answer: MDD
Panic disorder w/agoraphobia
GAD
OCD
pain
childhood enuresis
peptic ulcer disease
narcolepsy
nightmare disorder
PTSD
children and adolescents with ADHD, sleepwalking disorder,
premature ejaculation
*b/c TCAs have caused sudden death in several children &
adolescents, they should NOT be used in children
◉ Why is it not recommended to use TCAs in pts with bipolar I and
bipolar II?.
Answer: May induce manic reactions in up to 50% of pts with
bipolar disorder; risk of increased cycling, bipolar disorder is a
relative CI
◉ Why is it important to titrate TCAs slowly in pts with panic &
anxiety disorder?.
INTERPERSONAL AND ORGANIZATIONAL
COMMUNICATION CONCEPTS REVIEW 2026
◉ How long should the NP wait to begin another tx for depression
when stopping an MAOI to begin another MAOI or SSRI?.
Answer: irreversible MAOI-wait 14 days
MAO activity recovers completely 24-48 hrs after last dose of RIMA
◉ How long should the NP wait to begin an MAOI after d/c a pt from
fluoxetine (Prozac)?.
Answer: when switching from an antidepressant to an irreversible
MAOI-should wait 10-14 days (or 5 weeks for fluoxetine (Prozac)
before starting use of MAOI to avoid drug interactions
◉ Complications for using MAOIs for pts who have bipolar I and
schizophrenia?.
Answer: induction of mania in the depressed phase of bipolar I
disorder and triggering of a psychotic decompensation in persons
with schizophrenia
◉ Symptoms of tyramine-induced hypertensive crisis?.
Answer: Severe HTN
,HA
Stiff neck
diaphoresis
N/V
◉ Tyramine-containing foods should be avoided for how long after
d/c an irreversible MAOI? A reversible MAOI?.
Answer: irreversible MAOI-2 weeks after last dose
reversible-3 days after last dose of RIMA
◉ s/s of the discontinuation syndrome associated with abrupt
withdrawal of MAOIs? How would the NP prevent this?.
Answer: arousal, mood disturbances, and somatic symptoms
To avoid: dosage should be gradually tapered over several weeks
◉ How long would it be before symptoms appear in a patient with
an OD from an MAOI? symptoms?.
Answer: pts may appear symptom free up to 6 hrs, then progress to:
restlessness
coma-hyperthermia, HTN, tachypnea, tachycardia, dilated pupils,
hyperactive deep tendon reflexes
involuntary movements in face & jaw
death
,close medical supervision is indicated for 48 hrs following an OD
◉ Symptoms of MAOI toxicity?.
Answer: CNS (dizzy, drowsy, fatigue, HA, hyperreflexia, sleep
disturbance)
Anticholinergic effects (constipation, dry mouth, urinary retention)
Cardio (weakness, orthostatic hypotension, edema in lower
extremities)
Hematologic (anemia, neutropenia, thrombocytopenia,
agranulocytosis)
Endocrine (hyponatremia, SIADH, increased appetite, weight gain)
GI (anorexia, N/V)
Urogenital (urinary retention/freq/incontinence, decreased libido,
impotence, diminished sperm count, priaprism)
Elevated transaminase levels
hair loss
◉ What hepatic enzyme in the CYP450 enzyme system can have a
dramatic difference in plasma concentrations of TCAs?.
Answer: Poor metabolizer (CYP2D6) may experience an up to 8 fold
increase in plasma concentrations, resulting in increased AE
◉ What are the indications for use for TCAs?.
, Answer: MDD
Panic disorder w/agoraphobia
GAD
OCD
pain
childhood enuresis
peptic ulcer disease
narcolepsy
nightmare disorder
PTSD
children and adolescents with ADHD, sleepwalking disorder,
premature ejaculation
*b/c TCAs have caused sudden death in several children &
adolescents, they should NOT be used in children
◉ Why is it not recommended to use TCAs in pts with bipolar I and
bipolar II?.
Answer: May induce manic reactions in up to 50% of pts with
bipolar disorder; risk of increased cycling, bipolar disorder is a
relative CI
◉ Why is it important to titrate TCAs slowly in pts with panic &
anxiety disorder?.
