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PMHNP Module 3 passed 100%

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What is a decreased effects of the same dose of a drug over time - Tolerance ( mostly patients taking benzo, pain rx etc) Your client Sam is being treated for panic disorder with agorophobia. He is currently prescribed Paroxitine (Paxil CR 37.5, qd) and Clonazepam (Klonopin 0.5 mgqd prn. He has b...

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  • January 30, 2024
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PMHNP Module 3 passed 100%
What is a decreased effects of the same dose of a drug over time - ✔✔Tolerance ( mostly patients
taking benzo, pain rx etc) Your client Sam is being treated for panic disorder with agorophobia. He is
currently prescribed Paroxitine (Paxil CR 37.5, qd) and Clonazepam (Klonopin 0.5 mgqd prn. He has been
on Clonazepam for 2 years and admits needing 4 pills to achieve the same effect that 1 pill initially
produced



What is an electrical stimulus for bipolar which leads to seizure - ✔✔kindling



from Prozac to MAOI, how long to wait - ✔✔5-6 weeks due to prozac have a long half-life



What is combining an MAOI with a serotonergic agent is contraindicated because this may cause what -
✔✔Serotonin Syndrome (PB pg 156)



What causes Serotonin Syndrome - ✔✔drugs combination: 1)SSRIs and MAOIs

2)Drug and herbal interactions

3)SSRI and St. John's wort



What are symptoms of serotonin syndrome - ✔✔-Autonomic Instability

-Altered Sensorium

-Restlessness

-agitation

-myoclonus

-hyperreflexia

-hyperthermia

-diaphoresis

-tremors

,-chills

-diarrhea

-ataxia

-headache

-insomnia

-agitation, restlessness

-rapid heart rate and elevation in BP

-headache

-sweating, shivering, and goose bumps

-myoclonic jerking and loss of coordination

-confusion, fever, seizures, unconsciousness



SSRI to MAOI to TCA how long to switch - ✔✔14 days to prevent serotonin



What is the tx for Serotonin Syndrome - ✔✔d/c rx, supportive treatment and Cyproheptadine,
anticonvulsants and autonomic support



A 24 yr old female attempts suicide by overdose with a MAOI phenelzine. She is stabilized at the
hospital. Ten days later she started on venlafaxine and becomes tachycardic and diaphoretic and she
develops myoclonic jerks, what condition is this?

a) NMS

b) Opisthotonos

C) Akathisia

D) Serotonin Syndrome - ✔✔D) Serotonin Syndrome - myoclonic jerk, tachycardia, diaphoretic

- MAOI ( test hypertensive crisis or Serotonin Syndrome?)

-Switching to MAOI must always be 14 days later between RX

, Patient is being treated for 2 weeks develops symptoms of NMS. The following factors help PMHNP to
differentiate NMS from serotonin syndrome:

1) Autonomic instability, diaphoresis, tremors

2) hyperthermia, leukopenia, tachycardia

3) rigidity, hyperreflexia, orthostatic hypertention

4) mutism, leukocytosis, myoglobinuria - ✔✔PB 253

1) Both

2) no leukopenia in both

3) both hyperreflexia (SS), rigidity (NMS), both

4) NMS only

What is in NMS that is not in Serotonin Syndrome:

-NMS increase WBC, rhabo may lead to myoglobinuria



What is serotonin discontinuation syndrome? F.I.N.I.S.H - ✔✔F- lu-like syndrome

I-nsomnia

N-ausea

I- mbalance

S-ensory disturbances

H-hyperarousal

flu-like sx (due to cholinergic rebound; particulary problematic with TCA's)

fatigue and lethargy

myalgia (muscle soreness and achiness)

agitation

decreased concentration

ataxia

nausea and vomiting

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