Mono Amine Oxidase Inhibitors (MAOIs)

4 common types of MAOIs

1. Isocarboxazid
2. Phenelzine
3. Selegiline
4. Tranylcypromine
- This group of medication inhibits the enzyme Amine Oxidase.
- Estabilat
- Clients who have depression and have not respond to antidepressants. MAOI may be given
- MAOI is not always available that is why it is given as a last option.
- Concurrent use are along with antidepressant etc may cause hypertensive crisis.
- When patient take analgesics with MAOI, pt may experience hypertension and hypotension and
coma or seizure

SS

- Orthostatic hypotension
- Restlessness
- Insomnia
- Dizziness
- Weakness and Lethargy
- GI upset.
- Dry mouth
- Weight Gain
- Peripheral edema
- Anti-cholinergic effect
- CNS agitation (anxiety, mania)
- Dela in ejaculation

HYPERTENSIVE CRISIS

-Hypertension

-Occipital Headache/dizziness

-Stiff neck and soreness

-nausea and vomiting

-excessive sweating

-fever and chills

-cold clammy skin

-dilated pupils

-presence of angina

ANTIDOTE OF HYPERTENSIVE CRISIS THAT IS CAUSED BY MAOIs is Phentolamine.

INTERVENTION

- Monitor BP.
- Monitor for signs for Hypertensive crisis.
- If pt develops tachycardia, palpitation or frequent headache, stop the medication immediately
and inform the physician.
- Full stomach and 1 glass of water before administration
- Inform the pt that side effects may felt 1 week but the full effect will be felt on 3 rd week.
- Instruct the pt to report immediately if he exp stiff neck and headache.
- Instruct the pt to change position slowly to avoid orthostatic hypotension.
- Instruct the client to avoid caffeine.
- Avoid administration during the night. It may cause insomnia.
- AVOID FOODS THAT CONTAIN TYRAMINE\
o Avocado
o Banana
o Beef
o Chicken Liver
o Cheese
o Eggplant
o Papaya
o Raisins
o Soy sauce
o Sausage

MOOD STABILIZERS

Mood Stabilizers

*Lithium Preparations

1. Lithium carbonate

2. Lithium citrate

LITHIUM TOXICITY

- Concurrent use of Lithium with Diuretics and NSAIDs may lead to lithium toxicity. Increase
consumption of lithium but decreases removing of lithium or can’t be excreted by the kidney.

Causes of Lithium Toxicity

- Decreased sodium intake

- Electrolyte imbalance caused by diaphoresis

- Dehydration

- Diarrhea
-Cannot be administered to pregnant pt because it will lead to fetal toxicity.

- Therapeutic level of Lithium in the blood 0.6 to 1.2 mEq/L (0.6 to 1.2 mmol/L)

- Higher than 1.5 is considered lithium toxicity

MILD TOXICITY

- Reach 1.2- 1.5 meq/l

-Apathy

-Unable to concentrate

-Course hand tremor

-Slight muscle weakness

MODERATE

- Range 1.5 to 2.5 meq/l

- Nausea and vomiting
- Diarrhea
- Mild to moderate incoordination
- Slurred speech
- Tinnitus
- Blurred vision
- Muscle twitching
- Irregular tremors

- more that 2.5 meq/l

-impaired

INTERVENTION

- Discontinue and inform physician

- Monitor vs and level of consciousness

- Monitor cardiac status of the pt

- Prepare the pt for blood extraction

- monitor for suicidal tendencies

*Other Mood Stabilizers

1. Aripiprazole

2. Carbamazepine

3. Clozapine
4. Gabapentin

5. Lamotrigine

6. Olanzapine

7. Olanzapine / Fluoxetine

8. Oxcarbazepine

9. Paliperidone

10. Quetiapine

11. Risperidone

12. Valproate

13. Ziprasidone

- This affects the chemical transport

- They facilitate faster and better functioning of serotonin and GABA - Gamma Amino Butyric Acid

SS

- Polyuria
- Polydipsia
- Anorexia and nausea
- Dry mouth
- Weight Gain
- Abdominal bloating
- Soft stool or may have diarrhea
- Fine hand tremors
- Hair loss (Alopecia)
- Inability to concentrate
- Hypothyroidism

INTERVENTION

1. Monitor for suicidal client

2. Administer w/ food (full stomach)
3. Please avoid caffeine (Water only)
4. Don’t administer diuretics and lithium medication at the same time
5. If late, you have to administer it within 2 hours to avoid changes in cycle
6. Watch out for ss of lithium toxicity.
7. If symptoms persist, consult your doctor.
8. Remember when taking lithium medication, drink 6-8 cups of water.
Antianxiety or Anxiolytic Medications:

Benzodiazepines

- muscle relaxant

- anti-convulsant

- highly addicting

Ss

-daytime sedation

-dizziness and headache

-Bluured or double vision

-Hypotension

-Tremor

-Amnesia

-slurred speech

- urinary incontinence

- constipation

- liturgy and behavioral change

INTERVENTION

1. Monitor for motor responses

2. Monitor for cold clummy skin and sweating
3. Monitor for vision disturbance
4. Monitor for liver and kidney fuction test
5. Assist in ambulation
6. Avoid alcohol
7. Don’t do sudden discontinue of medication. It might lead to seizure

1. Alprazolam (Xanax)

2. Chlordiazepoxide (Librium)

3. Clonazepam (Klonopin)

4. Chlorazepate (Tranxene)

5. Diazepam (Valium)

6. Flurazepam (Dalmane)
7. Lorazepam (Ativan)

8. Midazolam (Versed)

9. Oxazepam (Serax)

10. Quazepam (Doral)

11. Temazepam (Restoril)

12. Triazolam (Halcion)

Nonbenzodiazepine Anxiolytic

1. Buspirone (BuSpar)

- Slow nervous system

-Increase GABA (Gamma Amino Butyric Acid- increases the relaxation and may depress the limbic
system

- it depresses the limbic system

Barbiturates

Amobarbital sodium

Butabarbital sodium

Pentobarbital sodium

Phenobarbital sodium

Secobarbital sodium

- Depresses reticular activity system. GABA is

- Used for short term treatment of insomnia
- Use for sedation to relieve anxiety, tension

Side effects

Dizziness and drowsiness

Confusion

Irritability

Ss for overdose

Tachydardia
hypotension

Cold and clummy skin

Interventions

1. Administer lower doses as prescribe

2. Medication should be used with caution with pt with suicidal tendencies.
3. Maintain safety during ambulation
4. Avoid driving
5. May hangover kinabukasan pag tinake ng gabi

Sedative-Hypnotics:

1. Chloral Hydrate

2. Eszopiclone

3. Meprobamate

4. Ramelteon

5. Zaleplon (Sonata)

6. Zolpidem