Monoamine Oxidase Inhibitor Toxicity in Emergency Medicine Medication

  • Author: Steven Marcus, MD; Chief Editor: Asim Tarabar, MD   more...
 
Updated: May 15, 2012
 

Medication Summary

Pharmaceutical agents should be used after the patient is adequately hydrated. Choose medications that have a short half-life and are easily titratable because of the rapid changes in cardiovascular status that may occur from a toxic exposure to the MAOIs, or from a drug-drug, or drug-food interaction.

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GI decontaminants

Class Summary

Useful for limiting systemic burden of the ingested substance, especially if administered within 1-4 h of ingestion.

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Activated charcoal (Liqui-Char)

 

Emergency treatment in poisoning caused by drugs and chemicals. Network of pores present in activated charcoal adsorbs 100-1000 mg of drug per gram of charcoal. Does not dissolve in water.

For maximum effect, administer within 30 min of ingesting poison.

Alternate use of cathartic and monitor for active bowel sounds.

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Cardiovascular agents

Class Summary

Used to lower blood pressure during hypertensive crisis.

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Nitroprusside (Nitropress)

 

Produces vasodilation and increases inotropic activity of the heart. At higher doses, may exacerbate myocardial ischemia by increasing the heart rate.

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Nitroglycerin IV (Deponit, Nitrostat)

 

Relaxes vascular smooth muscle by stimulating intracellular cyclic guanosine monophosphate production, resulting in a decreased blood pressure.

May administer bolus of 12.5-25 mcg before continuous infusion.

Initial infusion rate of 10-20 mcg/min may be increased 5-10 mcg/min, q5-10min until desired clinical or hemodynamic response is achieved.

Infusion rates of 500 mcg/min have occasionally been required.

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Benzodiazepines

Class Summary

Useful to control agitation and for treatment of drug-induced seizures.

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Diazepam (Valium)

 

Depresses all levels of CNS (eg, limbic and reticular formation), possibly by increasing activity of GABA.

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Lorazepam (Ativan)

 

Sedative hypnotic with short onset of effects and relatively long half-life.

By increasing the action of GABA, a major inhibitory neurotransmitter in the brain, may depress all levels of CNS, including limbic and reticular formation.

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Midazolam (Versed)

 

Used as alternative in termination of refractory status epilepticus. Because water soluble, takes approximately 3 times longer than diazepam to peak EEG effects. Thus, clinician must wait 2-3 min to fully evaluate sedative effects before initiating procedure or repeating dose. Has twice the affinity for benzodiazepine receptors than diazepam. May be administered IM if unable to obtain vascular access.

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Contributor Information and Disclosures
Author

Steven Marcus, MD  Professor, Department of Preventive Medicine and Community Health, Associate Professor, Department of Pediatrics, New Jersey Medical School, University of Medicine and Dentistry of New Jersey; Executive and Medical Director, New Jersey Poison Information and Education System; Consulting Staff, Departments of Pediatrics and Internal Medicine, University Hospital, University of Medicine and Dentistry of New Jersey; Consulting Staff, Department of Pediatrics, Newark Beth Israel Medical Center

Steven Marcus, MD is a member of the following medical societies: Academy of Medicine of New Jersey, American Academy of Clinical Toxicology, American Academy of Pediatrics, American College of Emergency Physicians, American College of Medical Toxicology, American Medical Association, and Medical Society of New Jersey

Disclosure: Nothing to disclose.

Coauthor(s)

Wirachin Hoonpongsimanont, MD  Resident Physician, Department of Emergency Medicine, University of Medicine and Dentistry of New Jersey

Wirachin Hoonpongsimanont, MD is a member of the following medical societies: American College of Emergency Physicians, Emergency Medicine Residents Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Richard Lavely, MD, JD, MS, MPH  Lecturer in Health Policy and Administration, Department of Public Health, Yale University School of Medicine

Richard Lavely, MD, JD, MS, MPH is a member of the following medical societies: American College of Emergency Physicians, American College of Legal Medicine, and American Medical Association

Disclosure: Nothing to disclose.

John T VanDeVoort, PharmD  Regional Director of Pharmacy, Sacred Heart and St Joseph's Hospitals

John T VanDeVoort, PharmD is a member of the following medical societies: American Society of Health-System Pharmacists

Disclosure: Nothing to disclose.

Fred Harchelroad, MD, FACMT, FAAEM, FACEP  Director of Medical Toxicology, Allegheny General Hospital

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Asim Tarabar, MD  Assistant Professor, Director, Medical Toxicology, Department of Emergency Medicine, Yale University School of Medicine; Consulting Staff, Department of Emergency Medicine, Yale-New Haven Hospital

Disclosure: Nothing to disclose.

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