MIDTERM EXAM NR 572 ADVANCED ACUTE
CARE MANAGEMENT GUIDE 2026 EXAMPREP
PRACTICE SET SOLUTION QUESTIONS WITH
FULL ANSWER
◉ SSRIs
dose should start at 1/3 to 1/2 of normal dose
ABSOLUTE CONTRAINDICATION- do not combine with MAOI
take at least 4 weeks to achieve response
-Fluoxetine 5-10 mg, paroxetine 10mg, sertraline 25-50 mg
SNRI
-venlafaxine 37.5 mg (contraindicated with MAOIs)
helps reduce anticpatory anxiety, fear and avoidance
MAOIs
beneficial if the patient has comorbid atypical depression
-maintain a low-tyramine diet
no cheese or wine
,Benzos
-helpful early in the course of treatment and sporadically throughout
(limit to 4-6 weeks and discontinue by week 7)
-don't use as monotherapy
alprazalam and clonazepam
Can use aripiprazole, divalproex sodium or pindolol for short-term
augmentation for treatment-resistant cases
Psychotherapy for panic disorder
-Breathing techniques, stop smoking, aerobic exercise (walking for
60 minutes or running for 20-30 minutes, 4 days/week), CBT, self-
help books. Answer: Panic disorder treatment
◉ drowsiness, fatigue
-avoid operating heavy machineray
retrograde amnesia/memory impairment
-risk worsens with use of alcohol
withdrawl symptoms
-taper dose on discontinuation
,paradoxical disinhibition
-can increase anxiety, irritability or agitation especially wit
hchildren and old people
Patients with hx of multiple substance use are at greatest risk for
sedative, hypnotic or anxiolytic use disorder.
Patients with GAD and panic disorder have highest risk for
devloping physical dependence
-get abstinence syndrome (withdrawl)
causes acute decrease in GABA neurotransmission
symptoms include anxiety, insomnia, resetlessnes, diaphoresis,
nausa, coryza, blurred vision, depression, hyperreflexia, ataxia,
depression
reduce dose by 25% per week for no more than 8 weeks
longterm use requires 2 -4 month taper
can use pregablin to when tapering
avoid alcohol and stimu,ants. Answer: Side effects and precautions
of prescribing benzodiazepines
, ◉ AVOID PAROXETINE during pregancy
- tetratogenic
-can cause cardiovascular malformations
Hypnaatremia
-baseline BMP and monitor preriodically especially 65 and older pts
Thrombocytopenia with citalopram
-get CBC
QT prolongation
--EEG before starting citalopram and in patients with cardiac disease
avoid abrupt discontinuation in all expcept fluoxetine. Answer:
SSRIs
◉ Concurrent use of medications that inhibit CYP3A4 (eg,
ketoconazole, nefazodone, and ritonavir) can increase the blood
levels of alprazolam and diazepam
Medications that induce cytochrome CYP3A4 (eg, carbamazepine, St.
John's wort) can reduce benzodiazepine levels
CARE MANAGEMENT GUIDE 2026 EXAMPREP
PRACTICE SET SOLUTION QUESTIONS WITH
FULL ANSWER
◉ SSRIs
dose should start at 1/3 to 1/2 of normal dose
ABSOLUTE CONTRAINDICATION- do not combine with MAOI
take at least 4 weeks to achieve response
-Fluoxetine 5-10 mg, paroxetine 10mg, sertraline 25-50 mg
SNRI
-venlafaxine 37.5 mg (contraindicated with MAOIs)
helps reduce anticpatory anxiety, fear and avoidance
MAOIs
beneficial if the patient has comorbid atypical depression
-maintain a low-tyramine diet
no cheese or wine
,Benzos
-helpful early in the course of treatment and sporadically throughout
(limit to 4-6 weeks and discontinue by week 7)
-don't use as monotherapy
alprazalam and clonazepam
Can use aripiprazole, divalproex sodium or pindolol for short-term
augmentation for treatment-resistant cases
Psychotherapy for panic disorder
-Breathing techniques, stop smoking, aerobic exercise (walking for
60 minutes or running for 20-30 minutes, 4 days/week), CBT, self-
help books. Answer: Panic disorder treatment
◉ drowsiness, fatigue
-avoid operating heavy machineray
retrograde amnesia/memory impairment
-risk worsens with use of alcohol
withdrawl symptoms
-taper dose on discontinuation
,paradoxical disinhibition
-can increase anxiety, irritability or agitation especially wit
hchildren and old people
Patients with hx of multiple substance use are at greatest risk for
sedative, hypnotic or anxiolytic use disorder.
Patients with GAD and panic disorder have highest risk for
devloping physical dependence
-get abstinence syndrome (withdrawl)
causes acute decrease in GABA neurotransmission
symptoms include anxiety, insomnia, resetlessnes, diaphoresis,
nausa, coryza, blurred vision, depression, hyperreflexia, ataxia,
depression
reduce dose by 25% per week for no more than 8 weeks
longterm use requires 2 -4 month taper
can use pregablin to when tapering
avoid alcohol and stimu,ants. Answer: Side effects and precautions
of prescribing benzodiazepines
, ◉ AVOID PAROXETINE during pregancy
- tetratogenic
-can cause cardiovascular malformations
Hypnaatremia
-baseline BMP and monitor preriodically especially 65 and older pts
Thrombocytopenia with citalopram
-get CBC
QT prolongation
--EEG before starting citalopram and in patients with cardiac disease
avoid abrupt discontinuation in all expcept fluoxetine. Answer:
SSRIs
◉ Concurrent use of medications that inhibit CYP3A4 (eg,
ketoconazole, nefazodone, and ritonavir) can increase the blood
levels of alprazolam and diazepam
Medications that induce cytochrome CYP3A4 (eg, carbamazepine, St.
John's wort) can reduce benzodiazepine levels
