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
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
