EMILLECT 2024/2025 ACADEMIC YEAR ©2024 EMILLECT. ALL RIGHTS RESERVED FIRST PUBLISH OCTOBER, 2024
CMN 548 Unit 5 Questions and Answers-
Updated
what medications are irreversible MAOIs (MAOA&B and MAOB MAOB)? - Answer✔✔-
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? -
Answer✔✔-2 weeks
What are the most frequent adverse effects of irreversible MAOIs? - Answer✔✔-MAOA&B:
dizziness, drowsiness, fatigue, headache (without increased BP), hyperreflexia, & sleep
disturbances
Reversible MAOIs (RIMAs) Include what medication? - Answer✔✔-Maclobemide (Manerix)
How long will it take to recover MAO activity after a final dose of RIMA? - Answer✔✔-24-48
hours
What are the most frequent adverse effects of RIMAs? - Answer✔✔-orthostatic hypotension,
insomnia, weight gain, edema & sexual dysfunction, insomnia
tx by dividing doses, not giving after dinner, and using trazodone
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MAOIs are used to treat what conditions? - Answer✔✔-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: - Answer✔✔-MDD, dysthymic, chronic
Irreversible MAOA&B used to treat: - Answer✔✔-Depression, atypical
MDD, unresponsive to other antidepressants
Irreversible MAO-B used to treat: - Answer✔✔-MDD in adults
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
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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
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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
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