Antidepressants: MAOIs – NCLEX Review (Nursing)

1:00:00 Welcome to MAOI inhibitors.

1:00:03 I say welcome because these guys don't play well with others so keep that in mind.

1:00:09 It's an old drug and for certain populations, it can be effective.

1:00:12 However, they've got some special rules unlike any of the other antidepressants that we've looked at.

1:00:19 So MAOI stand for Monoamine Oxidase Inhibitors.

1:00:25 Now, MAOIs inhibit MAO-A in the nerve terminals so this ends up increasing the amount of norepinephrine and 5-HT that's available.

1:00:35 So it's a little bit different mechanism but I promise you they definitely have some very different rules.

1:00:41 Now I've got examples of the names here listed for you so you can familiarize yourself with examples of MAOIs.

1:00:49 So monoamine neurotransmitters like serotonin and norepinephrine and dopamine are used to relay signals between the nerve cells.

1:00:57 That's their job and they regulate important functions throughout the body so in the right format, these guys are really good.

1:01:06 But after the neurotransmitters send a message in the brain, they're absorbed by a protein we call monoamine oxidase.

1:01:12 Okay, so the monoamine trasmitter.

1:01:15 Now, if too many of these are absorbed, there's a chemical imbalance that occurs in the brain.

1:01:22 So see what's going on? That's what happens normally but if too many of these are absorbed, then there's an imbalance in the brain.

1:01:29 Here's the problem and where you really need to focus in.

1:01:33 This is classically an area that's tested on test questions but tyramine is a building block of norepinephrine.

1:01:41 So make that -- make sure that's linked in your brain.

1:01:44 Tyramine is a building block of norepinephrine. Where's it found? Oh, no, there's dietary sources. So you look at the option, it's aged foods.

1:01:54 We're talking about aged salami, truly aged deli meats, aged cheese and not Velveeta, and Chiantis and wines.

1:02:02 So you've got options here of aged foods that your patient needs to understand if they're on this medication, it's dangerous for them to ingest any of these foods because if you take these meds orally, MAOIs inhibit the metabolic breakdown of dietary amines.

1:02:20 So if you're on this medication and you eat those foods, you've got a big problem because sufficient intestinal inhibition can lead to a hypertensive crisis.

1:02:31 So if you eat these foods and are taking an MAOI, there's an extreme risk for a hypertensive crisis.

1:02:39 A life-threatening hypertensive crisis. Aged foods, MAOIs, equals hypertensive crisis.

1:02:47 So you wanna make sure you educate your patients on which foods contain tyramine and you wanna make sure that they avoid them. Now, I've got a list of things there.

1:02:56 Some you may find entertaining like who eats banana peels? Honestly, some people do. But I've got a list of foods there.

1:03:04 Pause for just a minute, walk through, and make sure you have a feel for what those are because that's an easy low hanging fruit kind of test question that might pop up about tyramine foods and MAOI inhibitors.

1:03:23 Now let's take a look at this question.

1:03:26 Which of the following patient statements indicates appropriate patient understanding for a patient receiving phenelzine? When you first went through this, did you recognize what type of medication this is? Well, it's -- right, an MAOI inhibitor. You know that now.

1:03:43 If you knew it before, you are a rock star.

1:03:47 But let's take a look at it because I'm looking for what? Appropriate patient understanding.

1:03:54 Okay, so I'm looking for what's right or correct or safe for a patient receiving this medication.

1:04:00 When you look at these 4 statements, in case you weren't really clear on what this was the first time you took it, you can pause the video and change your answer if you'd like but be sure to eliminate the answers and state why you're doing it as you eliminate each one to come up with the best answer.

1:04:22 Correct answer is D. I cannot take meperidine for pain control while on phenelzine.

1:04:29 That indicates appropriate understanding. Look at the other 3.

1:04:33 I eat smoked -- whoa, smoked salmon. That's out.

1:04:37 That's an aged food so that is not appropriate understanding for an MAOI.

1:04:43 I can drink Chianti wine but not Vermouth.

1:04:46 Whoa, nope, that's not appropriate understanding so we get rid of that one.

1:04:51 C, my blood sugar is better controlled now that I've started phenelzine.

1:04:55 No, this doesn't control blood sugar.

1:04:57 So D, whether you recognize that or not, we put this question in there for you to kind of be thinking through.

1:05:04 Hey, sometimes as I do the work of eliminating answers, I'm gonna end up with one answer choice that I'm not 100% sure is correct but because I've done the work on the other answer choices and eliminating them and saying why, that's my answer and I'm going with it.

1:05:21 Serotonin syndrome is just as dangerous as neuroleptic malignant syndrome.

1:05:27 While it doesn't have the arched back and rigidity of neuroleptic malignant syndrome, it's still potentially life-threatening.

1:05:36 So you're in a hyperserotonergic medical condition.

1:05:40 It's a very fancy word for saying life-threatening.

1:05:43 MAOI inhibitors and certain drugs like SSRIs, MDMA, or phenylethylamines are likely to cause this reaction.

1:05:53 So if someone's on an MAOI, they can't also be taking an SSRI or the other medications that we have listed here.

1:06:02 What will happen is serotonin syndrome and it'll be life-threatening.

1:06:06 So it's very important since these drug to drug interactions can be life-threatening that you make sure you're clear on that and review this slide 'til you have that down solid.

1:06:17 Now, serotonin syndrome can also occur when you combine an MAOI with certain opioids like meperidine.

1:06:24 That's why that was the correct answer on that previous question.

1:06:28 So that's another one I wanna make sure you have highlighted on your list that MAOI doesn't play well with a lot of drugs but it's really a bad deal with the SSRIs, the ones we've discussed, and meperidine.

1:06:41 So MAOI shouldn't be combined with other antidepressants, most notably tricyclics as because this can cause serotonin syndrome.

1:06:50 When I said they didn't play well with others, I wasn't kidding.

1:06:54 So MAOIs can be used for depression, for bulimia, for obsessive compulsive disorder, and panic attacks.

1:07:02 They're not prescribed a lot but sometimes they are the best choice for a patient.

1:07:08 So this requires a lot of patient education.

1:07:11 Teach back, allow them to express it to you so you're very clear on whether they understand what the major risks are and behaviors and food and lifestyle and other medications if they're taking a prescribed MAOI.

1:07:27 So just kind of a summary slide here, indirect-acting sympathomimetic agents and MAOIs, bad deal.

1:07:33 Antidepressants like TCAs and SSRIs, bad deal and particularly meperidine.

1:07:40 So there's a great category slide if you want to keep that in mind.