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afsha - depression > antidepressants - MAOI > Flashcards

antidepressants - MAOI Flashcards

1
Q

why are they less frequently used than TCAs or SSRIs and related antidepressants.

A

due to danger of dietary and drug interactions

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2
Q

This MAOI has a greater stimulant action than the other two and are more likely to cause a hypertensive crisis

A

Tranylcypromine has a greater stimulant action than phenelzine or isocarboxazid

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3
Q

These two drugs are more likely to cause hepatoxicity than the this other one

A

Isocarboxazid and phenelzine are more likely to cause hepatotoxicity than tranylcypromine.

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4
Q

This drug should be reserved as a 2nd line treatment

A

Moclobemide

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5
Q

Phobic pt and depressed pt with atypical, hypochondriac or hysteria features are said to respond best to which AD?

A

MAOIs

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6
Q

MAOIs should be tried in any patients who are refractory to treatment with other AD as there is

A

occasionally a dramatic response

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7
Q

response to treatment with MAOI can take ..

A

can be delayed for 3 weeks or more
may take an additional 1-2 weeks to become maximal

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8
Q

How long to start other AD after treatment with MAOIs has been stopped.

A

do not start for 2 weeks after treatment has been stopped
3 weeks if starting clomipramine or imipramine

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9
Q

A patient is to be commenced on imipramine. They were previously on isocarboxazid. How long to wait until they can start taking imipramine?
1 day
1 week
2 weeks
3 weeks
4 weeks
No need to wait

A

Need to wait 3 weeks (if going onto imipramine or clomipramine from MAOI, otherwise normally wait 2 weeks)

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10
Q

A patient is taking tranylcypromine but have not had response. They are going to be switched onto phenelzine. When can they start taking phenelzine?

A

An MAOI should not be started until at least 2 weeks after a previous MAOI has been stopped (then start at reduced dose)

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11
Q

An MAOI should not be started until at least ….. days after a TCA has been stopped

A

7-14 days
3 weeks for clompiramine, imipramine

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12
Q

An MAOI should not be started until at least ……. after an SSRI has been stopped

A

A week
5 weeks in the case of fluoxetine

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13
Q

A patient has just stopped taking fluoxetine and is going to be switched to phenelzine, an MAOI. How long do they have to wait to be switched onto this after stopping?

A

5 weeks

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14
Q

Not MAOI - this drug has antidepressant properties when given by mouth in low doses. It is also used for the treatment of psychoses. It is a thioxanthene.

A

Fluanxol (flupentixol)

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15
Q

What food must be avoided in patients taking MAOIs and why

A

tyramine rich foods (mature cheese, salami, pickles herring, Borvi, Oxo, Marmite, any similar meat or yeast extract or fermented soya bean extract, some beers, lagers or wines)
food containing dopa (e.g. broad bean pods)
need to avoid these with, or for 2-3 week after stopping MAOI
potentially life threatening hypertensive crisis can develop

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16
Q

One reversible and 3 irreversible MAOIs

A

reversible: mocolobemide
irreversible: tranycylpromine, phenelzine, isocarboxazid

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17
Q

A patient is on an MAOI so you counsel them not to eat certain types of food as it increases the risk of potentially life threatening hypertensive crisis. which of the following is NOT a food that they need to avoid?
- Mature cheese
- Salami
- Marmite
- Green vegetables
- Red wine
- Broad bean pods

A

Green vegetables

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18
Q

4 contraindications

A
  • cerebrovascular disease
  • not indicated in manic phase
  • phaeochromocytoma
  • severe CVD
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19
Q

is postural hypotension a SE

A

yes more common in elderly

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20
Q

is akathisia (inability to remain still) a SE?

A

yes

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21
Q

what to do if pt develops palpitations or frequent headaches

A

discontinue

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22
Q

use in pregnancy

A

avoid unless compelling reasons
risk of neonatal malformations

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23
Q

use in HI

A

generally avoid

24
Q

monitoring requirements

A

BP
risk of postural hypotension and hypertensive responses

25
Q

patient and carer advice regarding fresh food & alcohol & non alcoholic drinks

A
  • only eat fresh food
  • avoid food suspected of being stale or going off
  • esp important with meat, fish, poultry or offal
  • avoid game
  • danger of interaction persists for up to 2 weeks after treatment discontinued
  • avoid alcoholic drinks or de-alcoholised drinks
26
Q

true or false - pt should avoid dealcoholised aka low alcohol drinks

A

true

27
Q

for tranylcypromine, it is given BD, but second dose should be taken at a time no later than…

A

3pm

28
Q

tranylcypromine CI

A

history of hepatic disease
hyperthyroidism

29
Q

use in BF

A

avoid

30
Q

MOA moclobemide

A

reversible inhibition of MAO type A

31
Q

all MAOIs are licensed for depressive illness. Moclobemide is also licensed for this indication

A

social anxiety disorder

32
Q

moclobemide 2 CI

A

acute confusional states
pheochromocytoma

33
Q

treatment cessation

A

if possible avoid abrupt withdrawal
if possible withdraw slowly
withdrawal effects may occur within 5 days of stopping treatment with AD drugs, usually mild and left limiting but sometimes sever

34
Q

risk of withdrawal is increased if …

A

stopped suddenly after regular administration for 8 weeks or more

35
Q

gradually reduce dose over period of …

A

about 4 weeks, or longer if withdrawals occur
6 months in pt who have been on long term maintenance

36
Q

this drug is claimed to cause less potentiation of the pressor effect of tyramine than the traditional MAOIs but pt should still avoid consuming large amounts of tyramine rich foods e.g. mature cheese, yeast extracts, fermented soya bean products)

A

moclobemide

37
Q

moclomebmide dose reduction with concurrent use of cimetidine

A

reduce dose to 1/2 or 1/3 usual dose

38
Q

Moclobemide interactions - these drugs are predicted to increase risk of severe toxic reaction with given with moclobemide. avoid.

(hint: drug class!)

A

TCAs

39
Q

Moclobemide slightly increases the exposure to this drug class. avoid.

A

Triptans (+increased risk serotonin syndrome)

40
Q

Moclobemide may increase exposure to this BZDPN, adjust dose

A

clobazam

41
Q

moclobemide and cimetidine interaction

A

C increases exposure to M
Adjust M dose to 1/2 or 1/3 normal dose with concurrent use

42
Q

Bupropion 2 interactions with moclobemide

A

B might increase risk of serotonin syndrome with given with M, monitor
B may increase risk of severe hypertension with given with M, avoid

43
Q

Avoid these drugs with moclombemide as they are predicted to increase risk of hypertensive crisis.

A

dexamfetamine, lisdex, methylphenidate
ephedrine, phenylephrine, pseudoephedrine, reboxetine
opicapone (Increased risk of elevated BP)

44
Q

Moclobemide interaction with this SSRI

A

escitalopram
M predicted to increase exposure to E
use with caution and adjust dose
+ increased risk serotonin syndrome

45
Q

Moclobemide interaction with this anti platelet

A

clopidogrel
predicted to reduce efficacy of C

46
Q

moclobemide interaction with tramadol

A

avoid
serotonin syndrome

47
Q

moclobemide interaction with MAO-B inhibtiors rasagiline and selegiline

A

M predicted to increase the effect of this drugs
avoid
also increased risk serotonin syndrome

48
Q

all MAOI interaction with this high risk abx

A

linezolid
Moclobemide/others is predicted to increase the risk of adverse effects when given with Linezolid. Manufacturer advises avoid and for 14 days after stopping Moclobemide or the irreversible MAOIs . Also increased risk serotonin syndrome

49
Q

irreversible MAOIs (phenelzine, tranylcypromine, isocarboxazid). They have antimuscarinic properties, there fore avoid antimuscarinic drugs e.g.

A

acrivastive
azelastine
buclizine
cetirizine
chlorphenamine
cinnarizine
cyclizine
doxylamine
desloratidine
fexofenadine
hydroxyzine
loratidine
pizotifen
promethazine

50
Q

True or false - pt taking irreversible MAOIs should avoid antihistamines (even non drowsy)

A

Yes, avoid as increased antimuscarinic adverse effects

51
Q

increases risk hypertensive crisis when given with these drugs. avoid and for 14 days after stopping irreversible MAOI

A

adrenaline, dexamfetamine, ephedrine, dopamine, levodopa, lisdexamfetamine, methylphenidate, midrodrine, phenyl ephedrine, psuedoephedrine, reboxetine

52
Q

avoid these drugs as they are predicted to increase the risk of CNS excitation or depression when given with irreversible MAOIs

A

alfentanil, buprenorphine, codeine, diamorphine, dihydrocodeine, dipipanone, fentanyl, hydromorphone, methadone, morphine, oxycodone, pethidine, pentazocine, tramadol, tapentadol

53
Q

avoid these 3 drugs with irreversible MAOIs because they are predicted to increase risk of elevated BP when given when them.

A

buspirone, entacapone, opicapone

54
Q

these drugs are predicted to increase the risk of severe toxic reaction when given with Isocarboxazid. Manufacturer advises avoid and for 14 days after stopping the MAOI.

A

Carbamazepine + TCAs

55
Q

A patient is suffering from pain that paracetamol and NSAIDs have not controlled. You are looking to optimise their pain by adding an opioid, but quickly realise this is contraindicated because they are taking a certain type of AD. Opioids are predicted to increase risk of CNS excitation or depression when given with these type of ADs, so avoid. which AD?

A

MAOIs

afsha - depression (10 decks)

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