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12 Cards in this Set

  • Front
  • Back
MAOIs
Drugs in class & brand
- Phenelzine (Nardil)
- Tranylcypromine (Parnate)
MAOIs
Mode of action
Irreversible inhibition of MAO-A and MAO-B. (Moclobemide mostly inhibits MAO-A)
Increasing adrenaline, dopamine, NA and 5HT
MAOI - indications
SECOND LINE
1. MDD (may be particularly useful for psychotic or melancholic depression)
2. Some anxiety disorders, including phobias and panic disorders (sometimes used for PTSD by specialists)
MAOIs - Contraindications
Risk of hypertensive crisis:
1. Sympathomimetics (PSE, cocaine)
2. Tumors of the adrenal medulla (inc phaeochromocytoma)
MAOIs - cautions (name some not all)
Epilepsy
BPD
Seritonin syndrome drugs
Substance misuse
Risk of hypertension - CVD, CAD
Angina - reflex tachcardia
Prostate hypertrophy: risk of urinary retention
MAOIs - A/Es
- orthostatic hypotension VS HYPERTENSION
- insomnia>hypersomnia
- headache, agitation, tremors, hyperreflexia, constipation, dry mouth
- weight gain
- impotence

Rare: hypertensive crisis only with interactions, SIADH
MAOIs - hypertensive crisis
1. symptoms
2. tyramine diet
3. other types on MAOI advice card (APF 20)
1. severe occipital headache, rapid and prolonged rise in BP, which may result in intracranial haemorrhage or acute HF
2. During and for 2 weeks after stopping, avoid at all times:
- Matured or OOD cheese, fermented or matured meat (salami), pickled herrings, protein extracts, yeast extracts (inc vitamins), vegemite, soybean extracts (tofu, miso)
NO beer or chianti
2. Max 2 not over ripe bananas, 1 medium avocado, 1 glass of wine (not chianti), 1 measure of spirits!!
Reduced intake of broad beans, sauerkraut

**Make sure you have a detailed list
** Don't take nasal/eye preparation or tablets containing PSE/PE
** L5
MAOIs - counselling points
1. take last dose before 3pm
2. Tyramine diet & stop taking if you get severe or frequent headache or palpitations
3. l5
4. l1 (yeah right whatever)
5. l16
6. l9
7. Label 2 sort of and tyramine diet etc
AND L6 - refrigerate NARDIL
MAOIS - DI types (5)
1. SS - Many CIs
2. Hypertensive crisis - PSE and PE CONTRAINDICATED. note that PE GI metabolism is also inhibited; caution with eye and nose drops
3. Hypotension
4. seizures
** NB DI for 2-3 weeks after MAOIs are ceased
5. metabolism of PE, sumatriptan, zolmitriptan
Nardil
- dose forms, dose
15mg.100 tab
45-90mg d in 2-3 d.d.
use lowest possible maintainance dose
Parnate
- dose form
- dose
10mg.50 tabs
20-60mg d in 2-3 d.d. Use lowest possible maintainance dose
Preg cat of MAOIs
Tranylcypromine is B2 (Parnate)
Phenelzine is B3 (Nardil)