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Questions and Answers
Why are MAOIs infrequently used in mental health nursing and psychiatry today?
What is the primary use of MAOIs?
How do MAOIs exert their effects?
What is the main pharmacokinetic difference between the transdermal MAOI selegiline (Emsam) and the oral MAOIs?
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What is the primary route of administration for MAOIs?
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What is the primary metabolic pathway for MAOIs?
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What is the most significant potential interaction between monoamine oxidase inhibitors (MAOIs) and anorexiants?
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Why should patients taking MAOIs avoid concurrent use of antihypertensive medications?
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What is the primary reason patients taking MAOIs should avoid consuming certain foods like cheese, yogurt, and aged meats?
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Which of the following is the most appropriate recommendation for a patient taking an MAOI who also requires treatment with carbamazepine?
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Why should patients taking MAOIs avoid concurrent use of meperidine (Demerol)?
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What is the most appropriate patient education for individuals taking MAOIs?
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What is the approximate onset time for patients taking MAOIs to experience relief of their depressive symptoms?
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Which adverse effect may occur due to the delayed metabolism of dopamine when taking MAOIs?
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What are some common side effects associated with MAOI use?
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What is a contraindication for taking MAOIs?
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What is the usual treatment for hypertensive crisis that can occur due to MAOI interactions with certain foods and drugs?
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What is the Pregnancy Category rating for MAOIs?
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What is a potential serious risk of taking MAOIs concurrently with other drugs or foods that raise blood pressure?
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Why should MAOIs be limited to conditions resistant to other forms of pharmacotherapy?
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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.
