Phenelzine PMHNP Exam

Phenelzine PMHNP Exam

Phenelzine (Nardil) in the PMHNP Exam Phenelzine (Nardil) is a monoamine oxidase inhibitor (MAOI) used for treatment-resistant depression and anxiety disorders. The PMHNP-BC exam frequently tests its indications, dietary restrictions, drug interactions, and hypertensive crisis management. 1. Mechanism of Action Irreversibly inhibits monoamine oxidase (MAO-A & MAO-B) Increases levels of serotonin (5-HT), norepinephrine (NE), and dopamine (DA) Takes 2–4 weeks to achieve full therapeutic effect Requires a 2-week washout when switching from/to another antidepressant (5 weeks for Fluoxetine) 2. FDA-Approved Uses Indication Dosing Notes Treatment-Resistant Depression (MDD) Used when SSRIs, SNRIs, TCAs fail Atypical Depression Best response in patients with hypersomnia, leaden paralysis Panic Disorder & Social Anxiety Effective for refractory anxiety disorders Off-Label Uses PTSD, Bulimia Nervosa, Migraine prophylaxis • MAOIs are last-line due to high side effect burden & dietary restrictions. 3. Contraindications & Warnings 🚫 Hypertensive Crisis (Tyramine Reaction) → Avoid tyramine-rich foods🚫 Serotonin Syndrome → Avoid SSRIs, SNRIs, TCAs, Meperidine, Tramadol, MDMA🚫 Sympathomimetic Toxicity → Avoid pseudoephedrine, phenylephrine, amphetamines🚫 CNS Stimulation → May worsen anxiety, agitation, or insomnia🚫 Liver Disease → Hepatotoxic risk🚫 Must have a 2-week washout before starting another serotonergic drug (5 weeks for Fluoxetine) 4. Hypertensive Crisis & Dietary Restrictions Tyramine Hypertensive Crisis = MAO-A inhibition prevents tyramine breakdown → Excess norepinephrine release → Severe hypertension Symptoms: Headache, stiff neck, nausea, vomiting, palpitations, diaphoresis, stroke risk. Treatment: Phentolamine (alpha-blocker), Nifedipine (sublingual for emergency use). High-Tyramine Foods to Avoid ❌ Aged cheeses (Cheddar, Blue cheese, Brie)❌ Cured meats (Salami, Pepperoni, Bacon, Hot dogs, Sausages)❌ Fermented foods (Sauerkraut, Soy sauce, Kimchi, Miso, Tofu)❌ Alcohol (Red wine, Beer, Vermouth, Sherry, Draft beer)❌ Pickled or smoked fish❌ Overripe fruits (Bananas, Avocados, Figs, Raisins, Plums) ✅ Safe Foods: Fresh meats, fresh cheese (cream cheese, ricotta), milk, eggs, grains, non-aged vegetables. 5. Side Effects of Phenelzine Side Effect Cause Management Orthostatic Hypotension Alpha-adrenergic blockade Hydration, slow position changes Weight Gain Increased serotonin and histamine activity Monitor diet & exercise Sexual Dysfunction Dopamine & serotonin modulation Consider adjunct Bupropion Insomnia, Agitation NE & DA increase Take in the morning, use Trazodone for sleep Hypertensive Crisis Tyramine excess Emergency: Phentolamine, Nifedipine Serotonin Syndrome Excess serotonin with SSRIs, SNRIs, TCAs Avoid serotonergic medications 6. Drug Interactions Drug Class Interaction with MAOIs Risk SSRIs, SNRIs, TCAs, Meperidine, Tramadol, MDMA Serotonin accumulation Serotonin Syndrome (life-threatening) Tyramine-Rich Foods Increased norepinephrine Hypertensive Crisis Amphetamines, Pseudoephedrine, Phenylephrine Excess sympathetic activation Severe hypertension Antihypertensives Additive hypotension Increased fall risk • Must wait at least 2 weeks after stopping an MAOI before starting another serotonergic drug. 7. PMHNP Exam Key Takeaways Phenelzine = Irreversible MAOI that increases serotonin, norepinephrine, and dopamine. Used for treatment-resistant depression, atypical depression, and panic disorder. Requires strict tyramine-free diet to avoid hypertensive crisis. Avoid with SSRIs, SNRIs, TCAs, Meperidine (Serotonin Syndrome risk). Monitor for orthostatic hypotension, weight gain, and insomnia. Emergency treatment for hypertensive crisis = Phentolamine or Nifedipine. Requires a 2-week washout before starting another antidepressant (5 weeks for Fluoxetine). Avoid stimulants, decongestants, and other sympathomimetics. #PMHNP #mentalhealth #psychiatricnursing PMHNP,PMHNP EXAM,PMHNP Study,PMHNP EXAM PREP,PMHNP EXAM STUDY GUIDE