Alzheimer’s Delirium and Dementia Q 27
Which of the following statements should be included when teaching clients about monoamine oxidase inhibitor (MAOI) antidepressants?
A. Don’t take aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs).
B. Have blood levels screened weekly for leukopenia.
C. Avoid strenuous activity because of the cardiac effects of the drug.
D. Don’t take prescribed or over-the-counter medications without consulting the physician.
Correct Answer: D. Don’t take prescribed or over the counter medications without consulting the physician
MAOI antidepressants, when combined with a number of drugs, can cause life-threatening hypertensive crises. It’s imperative that a client checks with his physician and pharmacist before taking any other medications. Tramadol, meperidine, dextromethorphan, and methadone are contraindicated in patients on MAOIs as they are at high risk for causing serotonin syndrome. In general, SSRIs, SNRIs, TCAs, bupropion, mirtazapine, St. John’s Wort, and sympathomimetic amines, including stimulants, are contraindicated with MAOIs.
Option A: MAOIs have the potential to cause drug-to-drug interactions, drug-food interaction, and overdoses, of which the patient should be aware. For example, patients should not be mixing MAOIs with other antidepressants like selective serotonin reuptake inhibitors (SSRIs). These two drugs combined can cause serotonin syndrome, which is potentially fatal. The first cases of serotonin syndrome were reported during the 1960s when patients were on MAOIs and tryptophan.
Option B: Even though MAOIs are no longer a first-line treatment option, they are still in use, and it is essential to note the precautions when initiating treatment. Patients should be encouraged by health providers to carry identification cards or wear a wristband. Patients always need to notify every doctor they encounter, whether dental or medical, to avoid any health consequences, especially due to the medications’ influence on the vasculature.
Option C: The severity not only depends on the amount consumed but also on which type of MAOIs the patient took. For example, phenelzine and tranylcypromine being nonselective and nonreversible, increase the risk of a patient experiencing a hypertensive crisis when ingested with tyramine. However, selegiline is a selective MAO-B inhibitor with less hypertensive risk. Any patient experiencing any of the following: agitation, flushing, tachycardia, hypotension or hypertension, palpitations, twitching, increased deep tendon reflexes, seizures, or high fevers should immediately report to a health provider.