CMN 548 MODULE 3 COMPREHENSIVE
QUESTIONS AND COMPLETE SOLUTIONS
◉ A single dose of MAOIs may persist in its inhibition of MAO for
how long.
Answer: because they irreversibly inactivate MAOs, the therapeutic
effect of a single dose of irreversible MAOIs may persist for as long
as 2 weeks
◉ What are the most frequent adverse effects of MAOIs.
Answer: orthostatic hypotension, insomnia, weight gain, edema,
sexual dysfunction
◉ Reversible MAOIs (RIMAs) medications.
Answer: Moclobemide (Maerix)
◉ How long will it take to recover MAO activity after a final dose of
RIMA?.
Answer: MAO activity recovers completely 24-48 hrs after the last
dose of a RIMA
◉ MAOIs are used to treat what conditions?.
Answer: depression
,panic disorder
social phobia
bulimia nervosa
ptsd
anginal pain
atypical facial pain
migraine
adhd
idiopathic orthostatic hypotension
Depression associated with TBI
◉ Treatment for MAOI induced orthostatic hypotension?.
Answer: Avoid caffeine
intake of 2L of fluid/day
addition of dietary salt
adjust HTN meds
support stocking
severe cases *tx with fludrocortisone (Florinef) a mineralcorticoid
◉ 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)
QUESTIONS AND COMPLETE SOLUTIONS
◉ A single dose of MAOIs may persist in its inhibition of MAO for
how long.
Answer: because they irreversibly inactivate MAOs, the therapeutic
effect of a single dose of irreversible MAOIs may persist for as long
as 2 weeks
◉ What are the most frequent adverse effects of MAOIs.
Answer: orthostatic hypotension, insomnia, weight gain, edema,
sexual dysfunction
◉ Reversible MAOIs (RIMAs) medications.
Answer: Moclobemide (Maerix)
◉ How long will it take to recover MAO activity after a final dose of
RIMA?.
Answer: MAO activity recovers completely 24-48 hrs after the last
dose of a RIMA
◉ MAOIs are used to treat what conditions?.
Answer: depression
,panic disorder
social phobia
bulimia nervosa
ptsd
anginal pain
atypical facial pain
migraine
adhd
idiopathic orthostatic hypotension
Depression associated with TBI
◉ Treatment for MAOI induced orthostatic hypotension?.
Answer: Avoid caffeine
intake of 2L of fluid/day
addition of dietary salt
adjust HTN meds
support stocking
severe cases *tx with fludrocortisone (Florinef) a mineralcorticoid
◉ 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)
