CMN 548 Unit 5 Questions with Correct
Answers
Nocturnal Myoclonus symptoms:✔✔consists of highly stereotyped, abrupt contractions of
certain leg muscles during sleep. Patients lack any subjective awareness of the leg jerks. The
condition may be present in about 40 % of persons over 65 years of age. The cause is unknown,
but it is a rare side effect of SSRIs. The repetitive leg movements occur every 20 to 60 seconds,
with extension of the large toe and flexion of the ankle, the knee, and the hips. Frequent
awakenings, unrefreshing sleep, and daytime sleepiness are major symptoms.
Nocturnal Myoclonus treatment:✔✔no treatment for nocturnal myoclonus is universally
effective. Treatments that may be useful include benzodiazepines, levodopa (Laradopa),
quinine, and in rare cases, opioids.
Restless Leg Syndrome symptoms:✔✔persons feel deep sensations of creeping inside the calves
whenever sitting or lying down. The dysesthesias are rarely painful but are agonizingly relentless
and cause an almost irresistible urge to move the legs; thus, this syndrome interferes with sleep
and with falling asleep. It peaks in middle age and occurs in 5 percent of the population. The
cause is unknown, but it is a rare side effect of SSRIs.
Restless Leg Syndrome treatment:✔✔symptoms are relieved by movement and by leg massage.
The dopamine receptor agonists ropinirole (Requip) and pramipexole (Mirapex) are effective in
treating this syndrome. Other treatments include the benzodiazepines, levodopa, quinine,
opioids, propanol, valproate, and carbamazepine.
Drugs that commonly cause Hyperthermia (decreased heat dissipation)
(increased heat production)✔✔Atropine, lidocaine, meperidine NSAID toxicity,
pheochromocytoma, thyrotoxicosis.
Frequent symptoms of Hyperthermia, diaphoresis, malaise:✔✔Hyperthermia, diaphoresis,
malaise
,Common drug that cause Malignant hyperthermia (increased heat production):✔✔NMJ
blockers (succinylcholine), halothane
Frequent symptoms of Malignant hyperthermia (increased heat production):✔✔Hyperthermia,
muscle rigidity, arrhythmias, ischemia, hypotension,, rhabdomyolysis; disseminated
intravascular coagulation
Common drugs that cause Tricyclic overdose (increased heat production)✔✔Tricyclic
antidepressants, cocaine
Frequent symptoms of Tricyclic overdose (increased heat production)✔✔Hyperthermia,
confusion, visual hallucinations, agitation, hyperreflexia, muscle relaxation, anticholinergic
effects (dry skin, pupil dilation), arrhythmias,
what medications are irreversible MAOIs (MAOA&B and MAOB MAOB)?✔✔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?✔✔2
weeks
What are the most frequent adverse effects of irreversible MAOIs?✔✔MAOA&B: dizziness,
drowsiness, fatigue, headache (without increased BP), hyperreflexia, & sleep disturbances
Reversible MAOIs (RIMAs) Include what medication?✔✔Maclobemide (Manerix)
How long will it take to recover MAO activity after a final dose of RIMA?✔✔24-48 hours
,What are the most frequent adverse effects of RIMAs?✔✔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?✔✔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:✔✔MDD, dysthymic, chronic
Irreversible MAOA&B used to treat:✔✔Depression, atypical
MDD, unresponsive to other antidepressants
Irreversible MAO-B used to treat:✔✔MDD in adults
What is the treatment for MAOI induced orthostatic hypotension?✔✔•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?✔✔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)?✔✔Don't use within 5 weeks of prozac
, Describe potential complications for using MAOIs for patients who have Bipolar I and
Schizophrenia.✔✔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?✔✔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?✔✔2 weeks
Tyramine containing foods should be avoided for how long after discontinuing an
reversible MAOI?✔✔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?✔✔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?✔✔REVERSABLE MAOI's: No discontinuation
syndrome evident
Answers
Nocturnal Myoclonus symptoms:✔✔consists of highly stereotyped, abrupt contractions of
certain leg muscles during sleep. Patients lack any subjective awareness of the leg jerks. The
condition may be present in about 40 % of persons over 65 years of age. The cause is unknown,
but it is a rare side effect of SSRIs. The repetitive leg movements occur every 20 to 60 seconds,
with extension of the large toe and flexion of the ankle, the knee, and the hips. Frequent
awakenings, unrefreshing sleep, and daytime sleepiness are major symptoms.
Nocturnal Myoclonus treatment:✔✔no treatment for nocturnal myoclonus is universally
effective. Treatments that may be useful include benzodiazepines, levodopa (Laradopa),
quinine, and in rare cases, opioids.
Restless Leg Syndrome symptoms:✔✔persons feel deep sensations of creeping inside the calves
whenever sitting or lying down. The dysesthesias are rarely painful but are agonizingly relentless
and cause an almost irresistible urge to move the legs; thus, this syndrome interferes with sleep
and with falling asleep. It peaks in middle age and occurs in 5 percent of the population. The
cause is unknown, but it is a rare side effect of SSRIs.
Restless Leg Syndrome treatment:✔✔symptoms are relieved by movement and by leg massage.
The dopamine receptor agonists ropinirole (Requip) and pramipexole (Mirapex) are effective in
treating this syndrome. Other treatments include the benzodiazepines, levodopa, quinine,
opioids, propanol, valproate, and carbamazepine.
Drugs that commonly cause Hyperthermia (decreased heat dissipation)
(increased heat production)✔✔Atropine, lidocaine, meperidine NSAID toxicity,
pheochromocytoma, thyrotoxicosis.
Frequent symptoms of Hyperthermia, diaphoresis, malaise:✔✔Hyperthermia, diaphoresis,
malaise
,Common drug that cause Malignant hyperthermia (increased heat production):✔✔NMJ
blockers (succinylcholine), halothane
Frequent symptoms of Malignant hyperthermia (increased heat production):✔✔Hyperthermia,
muscle rigidity, arrhythmias, ischemia, hypotension,, rhabdomyolysis; disseminated
intravascular coagulation
Common drugs that cause Tricyclic overdose (increased heat production)✔✔Tricyclic
antidepressants, cocaine
Frequent symptoms of Tricyclic overdose (increased heat production)✔✔Hyperthermia,
confusion, visual hallucinations, agitation, hyperreflexia, muscle relaxation, anticholinergic
effects (dry skin, pupil dilation), arrhythmias,
what medications are irreversible MAOIs (MAOA&B and MAOB MAOB)?✔✔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?✔✔2
weeks
What are the most frequent adverse effects of irreversible MAOIs?✔✔MAOA&B: dizziness,
drowsiness, fatigue, headache (without increased BP), hyperreflexia, & sleep disturbances
Reversible MAOIs (RIMAs) Include what medication?✔✔Maclobemide (Manerix)
How long will it take to recover MAO activity after a final dose of RIMA?✔✔24-48 hours
,What are the most frequent adverse effects of RIMAs?✔✔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?✔✔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:✔✔MDD, dysthymic, chronic
Irreversible MAOA&B used to treat:✔✔Depression, atypical
MDD, unresponsive to other antidepressants
Irreversible MAO-B used to treat:✔✔MDD in adults
What is the treatment for MAOI induced orthostatic hypotension?✔✔•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?✔✔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)?✔✔Don't use within 5 weeks of prozac
, Describe potential complications for using MAOIs for patients who have Bipolar I and
Schizophrenia.✔✔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?✔✔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?✔✔2 weeks
Tyramine containing foods should be avoided for how long after discontinuing an
reversible MAOI?✔✔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?✔✔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?✔✔REVERSABLE MAOI's: No discontinuation
syndrome evident
