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12 Cards in this Set
- Front
- Back
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MAOIs
Drugs in class & brand |
- Phenelzine (Nardil)
- Tranylcypromine (Parnate) |
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MAOIs
Mode of action |
Irreversible inhibition of MAO-A and MAO-B. (Moclobemide mostly inhibits MAO-A)
Increasing adrenaline, dopamine, NA and 5HT |
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MAOI - indications
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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) |
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MAOIs - Contraindications
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Risk of hypertensive crisis:
1. Sympathomimetics (PSE, cocaine) 2. Tumors of the adrenal medulla (inc phaeochromocytoma) |
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MAOIs - cautions (name some not all)
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Epilepsy
BPD Seritonin syndrome drugs Substance misuse Risk of hypertension - CVD, CAD Angina - reflex tachcardia Prostate hypertrophy: risk of urinary retention |
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MAOIs - A/Es
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- orthostatic hypotension VS HYPERTENSION
- insomnia>hypersomnia - headache, agitation, tremors, hyperreflexia, constipation, dry mouth - weight gain - impotence Rare: hypertensive crisis only with interactions, SIADH |
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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 |
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MAOIs - counselling points
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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 |
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MAOIS - DI types (5)
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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 |
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Nardil
- dose forms, dose |
15mg.100 tab
45-90mg d in 2-3 d.d. use lowest possible maintainance dose |
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Parnate
- dose form - dose |
10mg.50 tabs
20-60mg d in 2-3 d.d. Use lowest possible maintainance dose |
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Preg cat of MAOIs
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Tranylcypromine is B2 (Parnate)
Phenelzine is B3 (Nardil) |
