CMN 548 Unit 5 2025
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? -
answer2 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 Moclobemide (Manerix)
How long will it take to recover MAO activity after a final dose of RIMA? - answer24-48
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
MAOIs are used to treat what conditions? - answerDepression, 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: - answerMDD, dysthymic, chronic
Irreversible MAOA&B used to treat: - answerDepression, atypical
MDD, unresponsive to other antidepressants
Irreversible MAO-B used to treat: - answerMDD 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? -
answerWhen 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)? - answerDon't use within 5 weeks of prozac
Describe potential complications for using MAOIs for patients who have Bipolar I and
Schizophrenia. - answerInduction 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? - answerResults
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? - answer2 weeks
Tyramine containing foods should be avoided for how long after discontinuing an
reversible MAOI? - answerHigh 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? - answerIRREVERSIBLE 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? - answerREVERSABLE 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? - answerOften 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? - answerCYPD2D6
What are the indications for use for TCAs? - answerMDD, panic disorder, GAD, OCD,
PTSD, & pain syndromes
, Why are TCAs not recommended to use in patients with Bipolar I and Bipolar II? -
answerMay 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? -
answerBecause 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? - answerAmitriptyline, 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). - answerADHD, 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
Anticholinergic effects of TCAs at plasma levels above 300 ng/ml can cause what? -
answerDelirium (pts w/ dementia are more vulnerable to this)
What symptoms would a patient present with who was experiencing anticholinergic side
effects? - answer• Increased frequency (elderly)
• Dry mouth
• Blurred vision
• Dry eyes
• Constipation
• Urinary retention
• Excessive sweating
• Confusion, disorientation, delirium, delusions, & hallucinations
• hyperthermia
What is one of the most common side effects in young persons that causes
discontinuation of TCAs - answerTachycardia
The most common cardiac autonomic adverse effect of TCAs that cause discontinuation
is? - answerOrthostatic hypotension
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? -
answer2 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 Moclobemide (Manerix)
How long will it take to recover MAO activity after a final dose of RIMA? - answer24-48
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
MAOIs are used to treat what conditions? - answerDepression, 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: - answerMDD, dysthymic, chronic
Irreversible MAOA&B used to treat: - answerDepression, atypical
MDD, unresponsive to other antidepressants
Irreversible MAO-B used to treat: - answerMDD 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? -
answerWhen 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)? - answerDon't use within 5 weeks of prozac
Describe potential complications for using MAOIs for patients who have Bipolar I and
Schizophrenia. - answerInduction 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? - answerResults
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? - answer2 weeks
Tyramine containing foods should be avoided for how long after discontinuing an
reversible MAOI? - answerHigh 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? - answerIRREVERSIBLE 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? - answerREVERSABLE 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? - answerOften 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? - answerCYPD2D6
What are the indications for use for TCAs? - answerMDD, panic disorder, GAD, OCD,
PTSD, & pain syndromes
, Why are TCAs not recommended to use in patients with Bipolar I and Bipolar II? -
answerMay 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? -
answerBecause 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? - answerAmitriptyline, 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). - answerADHD, 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
Anticholinergic effects of TCAs at plasma levels above 300 ng/ml can cause what? -
answerDelirium (pts w/ dementia are more vulnerable to this)
What symptoms would a patient present with who was experiencing anticholinergic side
effects? - answer• Increased frequency (elderly)
• Dry mouth
• Blurred vision
• Dry eyes
• Constipation
• Urinary retention
• Excessive sweating
• Confusion, disorientation, delirium, delusions, & hallucinations
• hyperthermia
What is one of the most common side effects in young persons that causes
discontinuation of TCAs - answerTachycardia
The most common cardiac autonomic adverse effect of TCAs that cause discontinuation
is? - answerOrthostatic hypotension
