CMN 548 EXAM SCRIPT 2025/2026 QUESTIONS WITH
SOLUTIONS GRADED A+
✔✔How long should the NP wait to begin another tx for depression when stopping an
MAOI to begin another MAOI or SSRI? - ✔✔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)? - ✔✔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? -
✔✔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? - ✔✔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? - ✔✔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? - ✔✔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? - ✔✔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? - ✔✔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? - ✔✔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? - ✔✔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? -
✔✔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? -
✔✔Can cause increased anxiety and panic reactions
-b/c of the potential initial anxiogenic effects of the TCAs, starting dosages should be
small, the dosage should be titrated upward slowly
✔✔Which TCA is commonly used in the management of pain and in prophylaxis of
migraine HA? - ✔✔Amitriptyline
✔✔Indications for use of TCAs in children? - ✔✔indications: enuresis, insomnia, ADHD,
MDD, obsessional d/o, panic d/o, school phobia, separation anxiety d/o, bulimia and
Tourette's syndrome
✔✔What are the prudent labs for TCAs recommended prior to tx, during tx, and at
dosage changes for children? - ✔✔Prior tx: baseline ECG
SOLUTIONS GRADED A+
✔✔How long should the NP wait to begin another tx for depression when stopping an
MAOI to begin another MAOI or SSRI? - ✔✔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)? - ✔✔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? -
✔✔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? - ✔✔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? - ✔✔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? - ✔✔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? - ✔✔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? - ✔✔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? - ✔✔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? - ✔✔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? -
✔✔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? -
✔✔Can cause increased anxiety and panic reactions
-b/c of the potential initial anxiogenic effects of the TCAs, starting dosages should be
small, the dosage should be titrated upward slowly
✔✔Which TCA is commonly used in the management of pain and in prophylaxis of
migraine HA? - ✔✔Amitriptyline
✔✔Indications for use of TCAs in children? - ✔✔indications: enuresis, insomnia, ADHD,
MDD, obsessional d/o, panic d/o, school phobia, separation anxiety d/o, bulimia and
Tourette's syndrome
✔✔What are the prudent labs for TCAs recommended prior to tx, during tx, and at
dosage changes for children? - ✔✔Prior tx: baseline ECG
