CMN 548 Unit 5 Exam Questions and
Answers
what medications are irreversible MAOIs (MAOA&B and MAOB MAOB)? - Correct
Answers -Isocarboxazid (Marplan), Phenelzine (Nardil), Tranylcypromine (Parnate),
Selegiline Transdermal (Emasam)
A single dose of irreversible MAOIs may persist in its inhibition of MAO for how long? -
Correct Answers -2 weeks
What are the most frequent adverse effects of irreversible MAOIs? - Correct Answers -
MAOA&B: dizziness, drowsiness, fatigue, headache (without increased BP),
hyperreflexia, & sleep disturbances
Reversible MAOIs (RIMAs) Include what medication? - Correct Answers -Maclobemide
(Manerix)
How long will it take to recover MAO activity after a final dose of RIMA? - Correct
Answers -24-48 hours
What are the most frequent adverse effects of RIMAs? - Correct Answers -orthostatic
hypotension, insomnia, weight gain, edema & sexual dysfunction, insomnia
tx by dividing doses, not giving after dinner, and using trazodone
MAOIs are used to treat what conditions? - Correct Answers -Depression, bipolar
depression, panic disorder, social phobia, bulimia, PTSD, angina pain, atypical face
pain, migraine, ADHD, idiopathic orthostatic HTN, & depression r/t brain injury
Reversible MAO-A (RIMA) used to treat: - Correct Answers -MDD, dysthymic, chronic
Irreversible MAOA&B used to treat: - Correct Answers -Depression, atypical
MDD, unresponsive to other antidepressants
Irreversible MAO-B used to treat: - Correct Answers -MDD in adults
What is the treatment for MAOI induced orthostatic hypotension? - Correct Answers -
•Avoidance of caffeine, intake of 2L of fluid/day, addition of dietary salt, adjustment of
HTN meds, support stockings
•fludrocortisone 0.1-0.2mg/day for severe cases
,•Advise pts to get out of bed slowly
How long should the Psychiatric Nurse Practitioner wait to begin another treatment for
depression when stopping an MAOI to begin either another MAOI or an SSRI? - Correct
Answers -When changing from one MAOI to another taper and stop use of the first drug
for 10-14 days before beginning the second drug
How long should the PNP wait to begin an MAOI after discontinuing a patient from
fluoxetine (Prozac)? - Correct Answers -Don't use within 5 weeks of prozac
Describe potential complications for using MAOIs for patients who have Bipolar I and
Schizophrenia. - Correct Answers -Induction of mania in persons in the depressed
phase of BPI & triggering psychotic decompensating in persons w/ schizophrenia
What are the symptoms of a tyramine-induced hypertensive crisis? - Correct Answers -
Results from inactive GI metabolism of dietary Tyramine due to the MAOI's
Sxs: HA usually 1st sx, severe HTN, stiff neck, diaphoresis, nausea, vomiting
Management: a-adrenergic antagonists such as phentolamine (regitine) or
chlorpromazine (thorazine) they will lower BP w/in 5 minutes. IV furosemide (Lasix) to
reduce fluid load, and B-adrenergic receptor agonists for tachycardia. SL nifedipine
(Procardia) can be given.
Tyramine containing foods should be avoided for how long after discontinuing an
irreversible MAOI? - Correct Answers -2 weeks
Tyramine containing foods should be avoided for how long after discontinuing an
reversible MAOI? - Correct Answers -High concentrated tyramine foods should be
avoided for 3 days after last dose
List the symptoms of the discontinuation syndrome associated with abrupt withdrawal of
MAOIs. How would the PNP prevent this? - Correct Answers -IRREVERSIBLE MAOI's:
can occur 1-4 days after discontinuation
•sxs: self limiting consisting of arousal, mood disturbances, & somatic symptoms
•To aovid: D/c gradually tapered over several weeks
List the symptoms of the discontinuation syndrome associated with abrupt withdrawal of
MAOIs. How would the PNP prevent this? - Correct Answers -REVERSABLE MAOI's:
No discontinuation syndrome evident
How long would it be before symptoms appear in a patient with an overdose from an
MAOI? What are the symptoms that would appear? - Correct Answers -Often
asymptomatic for 1-6 hours after OD
-Sxs: agitation that progresses to a coma with hyperthermia, HTN, tachypnea,
tachycardia, dilated pupils, and hyperactive DTRs. Invol. Movements may be present in
face/jaw.
-Acidification of urine markedly hastens the excretion of MAOIs
, What hepatic enzyme in the CYP450 enzyme system can have a dramatic difference in
plasma concentrations of TCAs? - Correct Answers -CYPD2D6
What are the indications for use for TCAs? - Correct Answers -MDD, panic disorder,
GAD, OCD, PTSD, & pain syndromes
Why are TCAs not recommended to use in patients with Bipolar I and Bipolar II? -
Correct Answers -May induce manic episodes in up to 50% of bipolar patients; risk of
cycling more likely to induce mania, hypomania, or cycling than new antidepressants
Why is it important to titrate TCAs slowly in patients with panic or anxiety disorders? -
Correct Answers -Because of the potential initial anxiogenic effects of TCA's
Which TCA is commonly used in the management of pain and in prophylaxis of
migraine headaches? - Correct Answers -Amitriptyline, usually at lower doses
List the indications for use of TCAs in children (keeping in mind that use in this
population is done as a last resort). - Correct Answers -ADHD, sleepwalking disorder,
separation anxiety disorder, sleep terror disorder, compulsive behavior in kids with
autism, movement disorders, premature ejaculation
Enuresis (imipramine), insomnia, and parasomnias, ADHD, MDD, obsessional disorder,
panic disorder, school phobia, separation anxiety disorder, bulimia, & tourette's
syndrome (clomipramine)
What are the prudent diagnostics/labs recommended prior to treatment, during
treatment, and at dosage changes with TCAs? - Correct Answers --Baseline EKG for
children and monitored regularly
-CBC, WBC w/ diff & serum electrolytes
Anticholinergic effects of TCAs at plasma levels above 300 ng/ml can cause what? -
Correct Answers -Delirium (pts w/ dementia are more vulnerable to this)
What symptoms would a patient present with who was experiencing anticholinergic side
effects? - Correct Answers -• Increased frequency (elderly)
• Dry mouth
• Blurred vision
• Dry eyes
• Constipation
• Urinary retention
• Excessive sweating
• Confusion, disorientation, delirium, delusions, & hallucinations
• hyperthermia
What is one of the most common side effects in young persons that causes
discontinuation of TCAs - Correct Answers -Tachycardia
Answers
what medications are irreversible MAOIs (MAOA&B and MAOB MAOB)? - Correct
Answers -Isocarboxazid (Marplan), Phenelzine (Nardil), Tranylcypromine (Parnate),
Selegiline Transdermal (Emasam)
A single dose of irreversible MAOIs may persist in its inhibition of MAO for how long? -
Correct Answers -2 weeks
What are the most frequent adverse effects of irreversible MAOIs? - Correct Answers -
MAOA&B: dizziness, drowsiness, fatigue, headache (without increased BP),
hyperreflexia, & sleep disturbances
Reversible MAOIs (RIMAs) Include what medication? - Correct Answers -Maclobemide
(Manerix)
How long will it take to recover MAO activity after a final dose of RIMA? - Correct
Answers -24-48 hours
What are the most frequent adverse effects of RIMAs? - Correct Answers -orthostatic
hypotension, insomnia, weight gain, edema & sexual dysfunction, insomnia
tx by dividing doses, not giving after dinner, and using trazodone
MAOIs are used to treat what conditions? - Correct Answers -Depression, bipolar
depression, panic disorder, social phobia, bulimia, PTSD, angina pain, atypical face
pain, migraine, ADHD, idiopathic orthostatic HTN, & depression r/t brain injury
Reversible MAO-A (RIMA) used to treat: - Correct Answers -MDD, dysthymic, chronic
Irreversible MAOA&B used to treat: - Correct Answers -Depression, atypical
MDD, unresponsive to other antidepressants
Irreversible MAO-B used to treat: - Correct Answers -MDD in adults
What is the treatment for MAOI induced orthostatic hypotension? - Correct Answers -
•Avoidance of caffeine, intake of 2L of fluid/day, addition of dietary salt, adjustment of
HTN meds, support stockings
•fludrocortisone 0.1-0.2mg/day for severe cases
,•Advise pts to get out of bed slowly
How long should the Psychiatric Nurse Practitioner wait to begin another treatment for
depression when stopping an MAOI to begin either another MAOI or an SSRI? - Correct
Answers -When changing from one MAOI to another taper and stop use of the first drug
for 10-14 days before beginning the second drug
How long should the PNP wait to begin an MAOI after discontinuing a patient from
fluoxetine (Prozac)? - Correct Answers -Don't use within 5 weeks of prozac
Describe potential complications for using MAOIs for patients who have Bipolar I and
Schizophrenia. - Correct Answers -Induction of mania in persons in the depressed
phase of BPI & triggering psychotic decompensating in persons w/ schizophrenia
What are the symptoms of a tyramine-induced hypertensive crisis? - Correct Answers -
Results from inactive GI metabolism of dietary Tyramine due to the MAOI's
Sxs: HA usually 1st sx, severe HTN, stiff neck, diaphoresis, nausea, vomiting
Management: a-adrenergic antagonists such as phentolamine (regitine) or
chlorpromazine (thorazine) they will lower BP w/in 5 minutes. IV furosemide (Lasix) to
reduce fluid load, and B-adrenergic receptor agonists for tachycardia. SL nifedipine
(Procardia) can be given.
Tyramine containing foods should be avoided for how long after discontinuing an
irreversible MAOI? - Correct Answers -2 weeks
Tyramine containing foods should be avoided for how long after discontinuing an
reversible MAOI? - Correct Answers -High concentrated tyramine foods should be
avoided for 3 days after last dose
List the symptoms of the discontinuation syndrome associated with abrupt withdrawal of
MAOIs. How would the PNP prevent this? - Correct Answers -IRREVERSIBLE MAOI's:
can occur 1-4 days after discontinuation
•sxs: self limiting consisting of arousal, mood disturbances, & somatic symptoms
•To aovid: D/c gradually tapered over several weeks
List the symptoms of the discontinuation syndrome associated with abrupt withdrawal of
MAOIs. How would the PNP prevent this? - Correct Answers -REVERSABLE MAOI's:
No discontinuation syndrome evident
How long would it be before symptoms appear in a patient with an overdose from an
MAOI? What are the symptoms that would appear? - Correct Answers -Often
asymptomatic for 1-6 hours after OD
-Sxs: agitation that progresses to a coma with hyperthermia, HTN, tachypnea,
tachycardia, dilated pupils, and hyperactive DTRs. Invol. Movements may be present in
face/jaw.
-Acidification of urine markedly hastens the excretion of MAOIs
, What hepatic enzyme in the CYP450 enzyme system can have a dramatic difference in
plasma concentrations of TCAs? - Correct Answers -CYPD2D6
What are the indications for use for TCAs? - Correct Answers -MDD, panic disorder,
GAD, OCD, PTSD, & pain syndromes
Why are TCAs not recommended to use in patients with Bipolar I and Bipolar II? -
Correct Answers -May induce manic episodes in up to 50% of bipolar patients; risk of
cycling more likely to induce mania, hypomania, or cycling than new antidepressants
Why is it important to titrate TCAs slowly in patients with panic or anxiety disorders? -
Correct Answers -Because of the potential initial anxiogenic effects of TCA's
Which TCA is commonly used in the management of pain and in prophylaxis of
migraine headaches? - Correct Answers -Amitriptyline, usually at lower doses
List the indications for use of TCAs in children (keeping in mind that use in this
population is done as a last resort). - Correct Answers -ADHD, sleepwalking disorder,
separation anxiety disorder, sleep terror disorder, compulsive behavior in kids with
autism, movement disorders, premature ejaculation
Enuresis (imipramine), insomnia, and parasomnias, ADHD, MDD, obsessional disorder,
panic disorder, school phobia, separation anxiety disorder, bulimia, & tourette's
syndrome (clomipramine)
What are the prudent diagnostics/labs recommended prior to treatment, during
treatment, and at dosage changes with TCAs? - Correct Answers --Baseline EKG for
children and monitored regularly
-CBC, WBC w/ diff & serum electrolytes
Anticholinergic effects of TCAs at plasma levels above 300 ng/ml can cause what? -
Correct Answers -Delirium (pts w/ dementia are more vulnerable to this)
What symptoms would a patient present with who was experiencing anticholinergic side
effects? - Correct Answers -• Increased frequency (elderly)
• Dry mouth
• Blurred vision
• Dry eyes
• Constipation
• Urinary retention
• Excessive sweating
• Confusion, disorientation, delirium, delusions, & hallucinations
• hyperthermia
What is one of the most common side effects in young persons that causes
discontinuation of TCAs - Correct Answers -Tachycardia
