CMN 548 PRACTICE EXAMINATION 2026
QUESTIONS WITH ANSWERS
GUARANTEED TO PASS.
■ What is the treatment for MAOI induced orthostatic hypotension?
Answer: •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? Answer: 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)? Answer: Don't use within 5 weeks of
prozac
■ Describe potential complications for using MAOIs for patients who
have Bipolar I and Schizophrenia.. Answer: 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?
Answer: 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? Answer: 2 weeks
■ Tyramine containing foods should be avoided for how long after
discontinuing an
reversible MAOI? Answer: 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?
Answer: 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?
Answer: 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?
Answer: 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? Answer:
CYPD2D6
■ What are the indications for use for TCAs? Answer: MDD, panic
disorder, GAD, OCD, PTSD, & pain syndromes
■ Why are TCAs not recommended to use in patients with Bipolar I and
Bipolar II? Answer: 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? Answer: 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? Answer: 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).. Answer: 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?
Answer: -Baseline EKG for children and monitored regularly
-CBC, WBC w/ diff & serum electrolytes
QUESTIONS WITH ANSWERS
GUARANTEED TO PASS.
■ What is the treatment for MAOI induced orthostatic hypotension?
Answer: •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? Answer: 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)? Answer: Don't use within 5 weeks of
prozac
■ Describe potential complications for using MAOIs for patients who
have Bipolar I and Schizophrenia.. Answer: 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?
Answer: 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? Answer: 2 weeks
■ Tyramine containing foods should be avoided for how long after
discontinuing an
reversible MAOI? Answer: 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?
Answer: 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?
Answer: 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?
Answer: 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? Answer:
CYPD2D6
■ What are the indications for use for TCAs? Answer: MDD, panic
disorder, GAD, OCD, PTSD, & pain syndromes
■ Why are TCAs not recommended to use in patients with Bipolar I and
Bipolar II? Answer: 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? Answer: 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? Answer: 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).. Answer: 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?
Answer: -Baseline EKG for children and monitored regularly
-CBC, WBC w/ diff & serum electrolytes
