Written for anesthesia first, the Unit 9 letter from MN667 explains what an MAOI means for a composite zookeeper's surgery and why stopping it is a shared decision. Searches like "mn 667 unit 9 assignment example", "mn667 unit 9 sample" and "mn667 unit 9 example" land here.
Letter to Anesthesia: Phenelzine and a Knee Replacement in a 66-Year-Old Former Zookeeper
[Student Name]
Purdue University Global
MN667: PMHNP Diagnosis and Management Across the Lifespan III
Unit 9 Assignment
[Instructor Name]
[Date]
Composite patient written as a model document. Doses and dates are bracketed; nothing here is an anesthetic plan.
Header
To: [anesthesiologist], preoperative assessment clinic. Copies: [orthopedic surgeon]; [hospital pharmacist]. From: psychiatric mental health nurse practitioner, outpatient psychiatry. Date: [date]. Re: phenelzine and total knee replacement scheduled [date]. Consent: the patient agreed to this letter and to each copy.
Situation
Your patient, a composite 66-year-old man, takes phenelzine, an irreversible monoamine oxidase inhibitor, at [a composite dose] daily. He is scheduled for a right total knee replacement on [date], five weeks from today. I am writing so that we can decide together, before his preoperative visit, whether he continues phenelzine through surgery.
Background
He has recurrent major depressive disorder. Three antidepressants from other classes failed at adequate doses and durations before phenelzine was started in [2018]; he has been in remission since. Once, in [2021], he ran out of phenelzine for about a week while traveling, and his depression returned within a month, with thoughts of death, before he recovered on restarting. He is otherwise healthy apart from knee osteoarthritis and treated hypertension. He follows the tyramine diet and has had no hypertensive reactions.
Assessment
The interactions come first, since they are the risk in your setting.
Drugs to avoid while he takes phenelzine, as the product labeling and perioperative reviews advise:
Meperidine, which has caused severe and sometimes fatal serotonin toxicity with MAOIs.
Other opioids with serotonin reuptake activity, including tramadol, methadone and dextromethorphan (Gillman, 2005).
Indirect-acting sympathomimetics, such as ephedrine, which release stored norepinephrine and can cause a severe hypertensive response.
Other serotonergic drugs, including SSRIs, SNRIs and linezolid.
Opioids without serotonin reuptake activity, such as morphine, oxycodone and fentanyl, are generally considered acceptable with MAOIs (Gillman, 2005). If a vasopressor is needed, a direct-acting agent such as phenylephrine, at a reduced starting dose and titrated to effect, is generally preferred to an indirect one.
The two paths:
Continue phenelzine, with an anesthetic plan that avoids the interacting agents and a chart alert throughout his stay. This preserves his remission. Recent pharmacological reviews generally favor continuing MAOIs through surgery with these precautions rather than stopping them (Gillman, 2005).
Taper and stop phenelzine before surgery. An irreversible MAOI needs a washout of about two weeks for the enzyme to regenerate, so it would be stopped [about two weeks] before surgery and restarted after recovery. An earlier perioperative proposal noted that patients taking MAOIs carry serious interaction risks and that, from the physical perspective alone, discontinuation could be justified, but it also stressed the risk of relapse and the need for joint anesthetic and psychiatric management (Huyse et al., 2006). For him, stopping would mean at least three to four weeks without his antidepressant, and his one lapse was followed by relapse within a month.
My assessment is that the relapse risk of stopping is high and known for him, while the interaction risk of continuing can be managed with planning. I recognize that the anesthetic plan and its risks are yours to judge. If you would find it useful, I can join his preoperative visit by phone so that the three of us can discuss the plan with him directly.
Recommendation
I recommend continuing phenelzine through surgery, with the precautions above, if you agree that an anesthetic plan avoiding those agents is workable for him. If you judge that stopping is safer, I will manage the taper and his mental health during the washout, and I would need to know by [date, three weeks before surgery] to begin it safely.
Please reply by [date]. My direct line is [number].
For the Surgeon
Postoperative pain after knee replacement is significant. Please avoid tramadol, meperidine and methadone. Morphine, oxycodone or hydromorphone, with acetaminophen and regional anesthesia as you see fit, are compatible with phenelzine. If a nerve block is used, local anesthetics without epinephrine are preferred where possible, although small amounts are generally tolerated. Please call me before prescribing any new antidepressant, pain adjuvant or cough medicine at discharge.
For the Hospital Pharmacist
Attachment: tyramine diet sheet for the inpatient diet order. Please avoid aged cheeses, cured or fermented meats, soy sauce, tap beer and fermented soy products. Most modern foods contain less tyramine than they once did, which has lowered the risk of reactions (Gillman, 2011), but the restrictions still apply.
Please add a chart alert for phenelzine that flags meperidine, tramadol, methadone, dextromethorphan, ephedrine, linezolid, SSRIs and SNRIs, and notify me if any is ordered.
References
Gillman, P. K. (2005). Monoamine oxidase inhibitors, opioid analgesics and serotonin toxicity. British Journal of Anaesthesia, 95(4), 434-441. https://doi.org/10.1093/bja/aei210
Gillman, P. K. (2011). Advances pertaining to the pharmacology and interactions of irreversible nonselective monoamine oxidase inhibitors. Journal of Clinical Psychopharmacology, 31(1), 66-74. https://doi.org/10.1097/JCP.0b013e31820469ea
Huyse, F. J., Touw, D. J., van Schijndel, R. S., de Lange, J. J., & Slaets, J. P. J. (2006). Psychotropic drugs and the perioperative period: A proposal for a guideline in elective surgery. Psychosomatics, 47(1), 8-22. https://doi.org/10.1176/appi.psy.47.1.8
How this MN667 Unit 9 example is structured
Its reader's question shapes the letter, and that question is not whether the depression matters but what might harm him in the operating room. So the interactions lead the assessment, in the terms anesthesia uses, and the psychiatric history is compressed to the facts that bear on the stopping decision. The author's role is marked clearly: the letter offers the psychiatric side of a shared decision and leaves the anesthetic plan to the anesthesiologist. Stopping is presented with its real cost, since [a washout of about two weeks] before surgery and his relapse history make it no small step. Each copy is tailored. The surgeon receives a paragraph on postoperative pain options that avoid serotonergic opioids; the pharmacist receives the diet sheet and a request for a chart alert. A direct phone number and a reply-by date close the letter.
Get an MN667 Unit 9 example written to your instructions
Name the discipline your MN667 Unit 9 letter is addressed to and the decision that reader faces, then send the case and rubric. The free first communication follows in 24-48h, organized around that reader's question, clear about which decisions are whose, with a separately tailored version for each person copied on it. The paper above is an original model document written by our desk, not a submitted student paper and not an official Purdue University Global document.
MN667 Unit 9 questions, answered
What format suits an interprofessional communication?
Whatever the receiving discipline reads fastest, and SBAR is popular for that reason: it puts the situation and the request where a busy reader finds them. Some prompts specify a letter, a consult note or a structured message. Follow the prompt, then order the content by what the reader needs first, which is rarely the psychiatric history.
Should the letter recommend continuing or stopping a medication before surgery?
It can give the psychiatric view on relapse risk and share what the literature says, while leaving the perioperative decision to anesthesia and surgery. Frame it as a joint decision with a date. A letter that orders the choice oversteps, and one that offers no view leaves the other team without information only the psychiatric clinician holds.
How much should each copied recipient receive?
What that reader will act on, and little else. The surgeon needs postoperative pain considerations; the pharmacist needs interaction alerts and diet guidance; the anesthesiologist needs the full assessment. Tailored copies get read, identical ones get skimmed. Note the patient's consent for each recipient, and keep the psychiatric detail to what bears on their decisions.