Latest 2023 / 2024
Tricyclic antidepressants (TCA) - baseline data
- ECG should be checked, especially in patients with known
dysrhythmias or patients older than 40.
Pt. education for TCA
- Can minimize orthostatic hypotension by moving slowly when
assuming upright posture. In additional, patients should be instructed to sit or lie down if symptoms should occur. along with hypotension effects can be dry mouth, blurred vision, constipation and urinary hesitancy.
Black box warning for TCA
- Tricyclic antidepressants and all other antidepressants may increase
the risk for suicide in depressed patients, especially during the early phase of treatment. The risk for antidepressant-induced suicide is greatest among children, adolescents and young adults.
Monoamine Oxidase Inhibitors baseline data
- Baseline blood pressure should be obtained and then obtained
periodically.
High risk patients: monoamine oxidase inhibitors are
contraindicated in patients taking SSRI's, patients with heart failure, severe renal impairment, hypertension, and cardiovascular disease. use in caution with patients taking serotonergic drugs 1 / 2
MOAI's pt. education
- Must not be dispensed to patients considered incapable of rigid
adherence to dietary restrictions, must be educated on importance of ingesting tyramine-rich foods. must be given a list of detailed foods and beverages to avoid. should avoid all medications that are not approved by the provider.
Dietary restrictions
- AVOID foods rich in tyramine.
avocados, fermented bean curds, soybeans and soybean paste, figs, bananas, fermented/smoked/aged meats, liver, spoiled fish, milk and milk products, all cheeses, foods with yeast, beer, wine, protein dietary supplements, soups, shrimp paste, soy sauce.
Hypertensive Crisis
- Characterized by severe headache, tachycardia, hypertension,
nausea, vomiting, confusion, and profuse sweating - possibly leading to stroke and death.
Symptoms of Serotonin Withdrawal
- Abrupt discontinuation of selective serotonin reuptake inhibitors
can cause a withdrawal syndrome. Symptoms include dizziness, headache, nausea, sensory disturbances, tremor, anxiety, and dysphoria. These begin within days to weeks of the last dose and then can persist for 1 to 3 weeks. Resumption of drug use will make symptoms subside. The withdrawal syndrome can be minimized by tapering the dosage slowly.
Benzodiazepine’s - "pams"
- Alprazolam, Clonazepam, Diazepam, Lorazepam
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