MAOIs Quiz and Flashcards: Monoamine Oxidase Inhibitors Overview

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Questions and Answers

Why are MAOIs infrequently used in mental health nursing and psychiatry today?

They have a long half-life

They are more expensive than other antidepressants

They require strict dietary restrictions (correct)

They are less effective than other available drugs

What is the primary use of MAOIs?

Treatment of generalized anxiety disorder

Treatment of obsessive-compulsive disorder

Treatment of refractory unipolar depression (correct)

Treatment of bipolar depression

How do MAOIs exert their effects?

By irreversibly inactivating the enzymes that metabolize norepinephrine, serotonin, and dopamine (correct)

By stimulating the release of neurotransmitters

By blocking the reuptake of neurotransmitters

By reversibly inhibiting the enzymes that metabolize neurotransmitters

What is the main pharmacokinetic difference between the transdermal MAOI selegiline (Emsam) and the oral MAOIs?

Selegiline requires less dietary restriction Signup and view all the answers

What is the primary route of administration for MAOIs?

Oral Signup and view all the answers

What is the primary metabolic pathway for MAOIs?

First-pass liver metabolism Signup and view all the answers

What is the most significant potential interaction between monoamine oxidase inhibitors (MAOIs) and anorexiants?

Increased serotonergic effect and potential serotonin syndrome Signup and view all the answers

Why should patients taking MAOIs avoid concurrent use of antihypertensive medications?

To prevent increased blood pressure and hypertensive crisis Signup and view all the answers

What is the primary reason patients taking MAOIs should avoid consuming certain foods like cheese, yogurt, and aged meats?

To prevent hypertensive crisis Signup and view all the answers

Which of the following is the most appropriate recommendation for a patient taking an MAOI who also requires treatment with carbamazepine?

Monitor carbamazepine levels closely and consider switching to an alternative anticonvulsant Signup and view all the answers

Why should patients taking MAOIs avoid concurrent use of meperidine (Demerol)?

To prevent increased CNS depression and potential vascular collapse Signup and view all the answers

What is the most appropriate patient education for individuals taking MAOIs?

Advise the patient to follow a strict dietary restriction and provide a written list of foods to avoid Signup and view all the answers

What is the approximate onset time for patients taking MAOIs to experience relief of their depressive symptoms?

Within 14 days Signup and view all the answers

Which adverse effect may occur due to the delayed metabolism of dopamine when taking MAOIs?

Insomnia Signup and view all the answers

What are some common side effects associated with MAOI use?

Headache and hypotension Signup and view all the answers

What is a contraindication for taking MAOIs?

Congestive heart failure Signup and view all the answers

What is the usual treatment for hypertensive crisis that can occur due to MAOI interactions with certain foods and drugs?

Phentolamine (Regitine) Signup and view all the answers

What is the Pregnancy Category rating for MAOIs?

Category C Signup and view all the answers

What is a potential serious risk of taking MAOIs concurrently with other drugs or foods that raise blood pressure?

Hypertensive crisis Signup and view all the answers

Why should MAOIs be limited to conditions resistant to other forms of pharmacotherapy?

Safer and more convenient drugs are available Signup and view all the answers

Study Notes

Monoamine Oxidase Inhibitors (MAOIs)

Infrequently used in mental health nursing and psychiatry due to availability of safer and equally efficacious drugs.
Reserved for treatment of refractory unipolar depression.
Four MAOIs available: phenelzine (Nardil), isocarboxazid (Marplan), tranylcypromine (Parnate), and selegiline (Emsam), a transdermal preparation.

Pharmacodynamics

MAOIs irreversibly inactivate enzymes that metabolize norepinephrine, serotonin, and dopamine, increasing bioavailability of these neurotransmitters.
Prevent breakdown of tyramine, found in aged or fermented foods, which can cause rapid extreme hypertension.

Pharmacokinetics

Administered orally and rapidly absorbed from the GI tract.
Major first-pass effect of liver metabolism, with CYP2D6 as a substrate.
Metabolized by the liver, with a half-life of 1-3 hours.
Excreted by the kidneys.

Drug Interactions

Combination with anorexiants, venlafaxine, SSRIs, bupropion, bromocriptine, L-dopa, L-tryptophan, and MAO-B inhibitor can lead to increased serotonergic effect and serotonin syndrome.
Combination with CNS depressants, meperidine, and antipsychotics can increase CNS depression.
Combination with amphetamines, buspirone, L-dopa, reserpine, tetrabenazine, guanethidine, and meperidine can increase blood pressure and lead to hypertensive crisis.
Combination with antihypertensives, propoxyphene, meperidine, diuretics, nitroglycerin, and dextromethorphan can lead to hypotension, agitation, diaphoresis, and vascular collapse.
Combination with insulin and sulfonylureas can lead to hypoglycemia.
Combination with carbamazepine can increase carbamazepine level.

Patient Education

Advise patients to follow strict dietary restrictions, avoiding foods such as cheese, yogurt, sour cream, aged meat, and fermented vegetables.
Provide written list of foods to be avoided.

Onset, Peak, and Duration

Onset of action: 1-2 weeks.
Peak: 0.7-3 hours for isocarboxazid and tranylcypromine, and 1-2 hours for phenelzine.
Duration: 14 days.

Pharmacotherapeutics Precautions and Contraindications

Contraindications: liver or kidney disease, hypersensitivity, congestive heart failure or arteriosclerotic disease, and age older than 60 years.
Precautions: pregnancy, breastfeeding, impulsive or cognitively impaired patients, and patients unable to follow dietary restrictions.
Postural hypotension and suppression of myocardial pain may occur.

Adverse Drug Reactions

Initial adverse effects: insomnia, anxiety, and agitation due to delayed metabolism of dopamine.
Anticholinergic effects: dry mouth, blurred vision, urinary retention, and constipation.
Common side effects: dizziness, headache, insomnia, restlessness, and hypotension.

Clinical Use and Dosing

Reserved for drug-resistant, refractory depressions.
Dosing: individualized, with careful titration to achieve therapeutic effects.

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Description

Explore the key points about Monoamine Oxidase Inhibitors (MAOIs) in mental health nursing and psychiatry. Learn about their limited use, precautions, and primary indication for refractory unipolar depression. Get familiar with the four available MAOIs: phenelzine, isocarboxazid, tranylcypromine, and selegiline.

Monoamine Oxidase Inhibitors (MAOIs) Overview

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