Pharmacologic: monamine oxidase (MAO) inhibitors
Treatment of depression (usually reserved for patients who do not tolerate or respond to other modes of therapy [e.g., tricyclic antidepressants, SSRIs, SSNRIs, or electroconvulsive therapy]).
Inhibits the enzyme monoamine oxidase, resulting in an accumulation of various neurotransmitters (dopamine, epinephrine, norepinephrine, and serotonin) in the body. Therapeutic Effects: Improved mood in depressed patients.
Adverse Reactions/Side Effects
CNS: SEIZURES, dizziness, headache, akathisia, anxiety, ataxia, drowsiness, euphoria, insomnia, restlessness, weakness. EENT: blurred vision. CV: HYPERTENSIVE CRISIS, orthostatic hypotension. GI: nausea, black tongue, constipation, diarrhea, dry mouth. GU: dysuria, sexual dysfunction, urinary incontinence, urinary retention. Derm: photosensitivity.
PHYSICAL THERAPY IMPLICATIONS
Examination and Evaluation
Be alert for new seizures or increased seizure activity, especially at the onset of drug treatment. Document the number, duration, and severity of seizures, and report these findings to the physician immediately.
Measure blood pressure (BP) periodically and compare to normal values (See Appendix F). Immediately report a large, rapid increase in BP (hypertensive crisis). Signs and symptoms of hypertensive crisis include chest pain, tachycardia or bradycardia, severe headache, nausea, vomiting, neck stiffness, sweating, and enlarged pupils. The risk of hypertensive crisis is increased when this drug is taken with other antidepressants, excessive caffeine, other drugs that increase BP, or foods that contain tyramine (e.g., fermented wines, cheeses).
Assess BP when patient assumes a more upright position (lying to standing, sitting to standing, lying to sitting). Document orthostatic hypotension and contact physician when systolic BP falls >20 mm Hg, or diastolic BP falls >10 mm Hg.
Be alert for increased depression and suicidal thoughts and ideology, especially when initiating drug treatment or in children and teenagers. Notify physician or mental health professional immediately if patient exhibits worsening depression or other changes in mood and behavior such as anxiety, euphoria, or severe restlessness.
Assess dizziness, drowsiness, and ataxia that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician and nursing staff, and caution the patient and family/caregivers to guard against falls and trauma.
Guard against falls and trauma (hip fractures, head injury, and so forth), and implement fall-prevention strategies in patients with dizziness, ataxia, or other conditions that affect balance (See Appendix E).
To minimize orthostatic hypotension, patient should move slowly when assuming a more upright position.
Help patient explore nonpharmacologic methods to reduce depression (exercise, counseling, support groups, and so forth).
Causes photosensitivity; use care if administering UV treatments. Advise patient to avoid direct sunlight and use sunscreens and protective clothing.
Log In to View More
If your institution is currently a subscriber
of the F.A. Davis PT Collection please sign in below.
If your institution is not a subscriber
please click here
to learn more.
Want remote access to your institution's subscription?
Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.
If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.
Pop-up div Successfully Displayed
This div only appears when the trigger link is hovered over.
Otherwise it is hidden from view.