CMN 548 Unit 5 Questions with Correct
Answers
What are the indications for nefazodone?✔✔-MDD
A patient reports the side effect of visual trails, what does this mean?✔✔-pts sees an after
image when looking at moving objects or when moving their heads quick. Can be seen with
nefazodone
Due to major safety concerns with the use of nefazodone, recommended laboratory✔✔tests of
hepatic function and liver should be monitored. Dig and Lithium level too
What are the clinical indications for mirtazapine?✔✔depression.
What are the two (2) characteristic side effects of mirtazapine?✔✔sedation and increased
appetite
What is the most common adverse effect of mirtazapine?✔✔• somnolence*
• dry mouth
• increased appetite
• constipation
• weight gain
Monitoring of WBCs for patients who develop signs of infection is needed as mirtazapine is
associated with•✔✔agranulocytosis.
,What are the symptoms of discontinuation syndrome with abrupt withdrawal of mirtazapine?
When would this most likely occur? How long does this typically last?✔✔Abrupt discontinuation
may cause a syndrome consisting of dizziness, lethargy, nausea, vomiting, diarrhea, headache,
fever, sweating, chills, malaise, incoordination, insomnia, vivid dreams, myalgia, paresthesias,
dyskinesia, electric- shock like sensation, visual discoordination, anxiety, irritability, confusion,
slowed thinking, disorientation, rarely aggression, impulsivity, hypomania, and
depersonalization. Within 1-7 days after drug stopped or drug drastically reduced. Typically
disappears within 3 days.
What are the therapeutic indications for bupropion?✔✔-MDD, smoking cessation, bipolar,
ADHD
Discuss the risk of sexual dysfunction, sedation, and discontinuation syndrome for
bupropion.✔✔-low risk of sexual dysfunction & sedation with modest weight loss during acute
& long-term tx. No withdrawl syndrome
Why is it not recommended to prescribe bupropion to patients with severe anxiety or panic
disorder?✔✔-restlessness and agitation side effects
-because of its potentiating effects on dopaminergic neurotransmission
Discuss the potential effects on plasma concentrations with concurrent use of bupropion and
carbamazepine (Tegretol); discuss the potential plasma concentration effects with concurrent
use of bupropion and valproic acid (Depakene).✔✔-Tegretol may decrease plasma
concentrations of wellbutrin
-Valproic acid levels may be increased by wellbutrin
What are the therapeutic indications for Lithium?✔✔Bipolar I Disorder (Manic Episodes, Bipolar
Depression, & Maintenance); Major Depressive Disorder; Schizoaffective Disorder and
Schizophrenia; and OTHER Indications including Psychiatric and Non-Psychiatric
,When treating acute mania, how long would it take for lithium to exert antimanic effects?✔✔1-
3 weeks
What treatment options/medications may be used as adjunct for acute mania while lithium
levels are reaching therapeutic?✔✔Benzo's, DRA's, SDA's, or valproic acid
What types of patients respond less well to lithium during acute mania than those with classic
mania?✔✔Pt's with mixed or dysphoric mania, rapid cycling, comorbid substance abuse, or
organicity respond less well to lithium
What differential diagnoses would the clinician include for an individual who is taking lithium as
maintenance for bipolar disorder and a depressive episode occurs?✔✔Lithium induced
hypothyroidism, substance abuse, and lack of compliance with lithium therapy
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
Answers
What are the indications for nefazodone?✔✔-MDD
A patient reports the side effect of visual trails, what does this mean?✔✔-pts sees an after
image when looking at moving objects or when moving their heads quick. Can be seen with
nefazodone
Due to major safety concerns with the use of nefazodone, recommended laboratory✔✔tests of
hepatic function and liver should be monitored. Dig and Lithium level too
What are the clinical indications for mirtazapine?✔✔depression.
What are the two (2) characteristic side effects of mirtazapine?✔✔sedation and increased
appetite
What is the most common adverse effect of mirtazapine?✔✔• somnolence*
• dry mouth
• increased appetite
• constipation
• weight gain
Monitoring of WBCs for patients who develop signs of infection is needed as mirtazapine is
associated with•✔✔agranulocytosis.
,What are the symptoms of discontinuation syndrome with abrupt withdrawal of mirtazapine?
When would this most likely occur? How long does this typically last?✔✔Abrupt discontinuation
may cause a syndrome consisting of dizziness, lethargy, nausea, vomiting, diarrhea, headache,
fever, sweating, chills, malaise, incoordination, insomnia, vivid dreams, myalgia, paresthesias,
dyskinesia, electric- shock like sensation, visual discoordination, anxiety, irritability, confusion,
slowed thinking, disorientation, rarely aggression, impulsivity, hypomania, and
depersonalization. Within 1-7 days after drug stopped or drug drastically reduced. Typically
disappears within 3 days.
What are the therapeutic indications for bupropion?✔✔-MDD, smoking cessation, bipolar,
ADHD
Discuss the risk of sexual dysfunction, sedation, and discontinuation syndrome for
bupropion.✔✔-low risk of sexual dysfunction & sedation with modest weight loss during acute
& long-term tx. No withdrawl syndrome
Why is it not recommended to prescribe bupropion to patients with severe anxiety or panic
disorder?✔✔-restlessness and agitation side effects
-because of its potentiating effects on dopaminergic neurotransmission
Discuss the potential effects on plasma concentrations with concurrent use of bupropion and
carbamazepine (Tegretol); discuss the potential plasma concentration effects with concurrent
use of bupropion and valproic acid (Depakene).✔✔-Tegretol may decrease plasma
concentrations of wellbutrin
-Valproic acid levels may be increased by wellbutrin
What are the therapeutic indications for Lithium?✔✔Bipolar I Disorder (Manic Episodes, Bipolar
Depression, & Maintenance); Major Depressive Disorder; Schizoaffective Disorder and
Schizophrenia; and OTHER Indications including Psychiatric and Non-Psychiatric
,When treating acute mania, how long would it take for lithium to exert antimanic effects?✔✔1-
3 weeks
What treatment options/medications may be used as adjunct for acute mania while lithium
levels are reaching therapeutic?✔✔Benzo's, DRA's, SDA's, or valproic acid
What types of patients respond less well to lithium during acute mania than those with classic
mania?✔✔Pt's with mixed or dysphoric mania, rapid cycling, comorbid substance abuse, or
organicity respond less well to lithium
What differential diagnoses would the clinician include for an individual who is taking lithium as
maintenance for bipolar disorder and a depressive episode occurs?✔✔Lithium induced
hypothyroidism, substance abuse, and lack of compliance with lithium therapy
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
