NCLEX Review Guide: Monoamine Oxidase Inhibitors (MAOIs)

How MAOIs Work

• MAOIs block the enzyme monoamine oxidase, which normally breaks down neurotransmitters like serotonin, norepinephrine, and dopamine, resulting in increased levels of these mood-regulating chemicals in the brain.
• These medications are typically reserved for treatment-resistant depression when other antidepressants have failed due to their serious drug and food interactions.

Dangerous Drug Combinations

• NEVER combine MAOIs with SSRIs, SNRIs, or tricyclic antidepressants - this can cause potentially fatal serotonin syndrome with hyperthermia, muscle rigidity, and altered mental status.
• Sympathomimetic drugs (decongestants, stimulants) can cause hypertensive crisis when combined with MAOIs due to excessive norepinephrine accumulation.

Foods to Avoid

• Tyramine-rich foods must be strictly avoided because MAOIs prevent tyramine breakdown, leading to dangerous blood pressure spikes and potential stroke.
• High-tyramine foods include: aged cheeses, cured meats, fermented foods, draft beer, wine, overripe fruits, and soy products like soy sauce.

Essential Nursing Actions

1. Obtain comprehensive medication history including OTC drugs and supplements before initiation
2. Monitor vital signs closely, especially blood pressure, during therapy initiation
3. Provide detailed dietary education with written lists of foods to avoid
4. Assess for signs of serotonin syndrome or hypertensive crisis at each visit
5. Educate about the importance of medical alert identification