You are leaving Medscape Education
Cancel Continue
Log in to save activities Your saved activities will show here so that you can easily access them whenever you're ready. Log in here CME & Education Log in to keep track of your credits.
 

 

CME/CE

Toxicity, Monoamine Oxidase Inhibitor

  • Authors: Steven Marcus, MD
  • CME/CE Released: 1/4/2011
  • THIS ACTIVITY HAS EXPIRED
  • Valid for credit through: 1/4/2013
Start Activity


Target Audience and Goal Statement

This activity is intended for healthcare providers

The goal of the Medscape Clinical Reference is to provide comprehensive, evidence based information in a readily accessible format to healthcare professionals in order to enhance patient care.

Upon completion of this activity, participants will be able to:

  1. Examine the clinical background of a disease, recognizing the typical presentation
  2. Conduct an appropriate diagnostic assessment that addresses a valid differential diagnosis
  3. Construct an evidence-based treatment plan that correctly addresses potential complications


Disclosures

As an organization accredited by the ACCME, Medscape, LLC, requires everyone who is in a position to control the content of an education activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines "relevant financial relationships" as financial relationships in any amount, occurring within the past 12 months, including financial relationships of a spouse or life partner, that could create a conflict of interest.

Medscape, LLC, encourages Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration, at first mention and where appropriate in the content.


CME Reviewer/Nurse Planner

  • Laurie E. Scudder, DNP, NP

    Nurse Planner, Continuing Professional Education Department, Medscape, LLC; Clinical Assistant Professor, School of Nursing and Allied Health, George Washington University, Washington, DC

    Disclosures

    Disclosure: Laurie E. Scudder, DNP, NP, has disclosed no relevant financial relationships.


Accreditation Statements

    For Physicians

  • Medscape, LLC is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

    Medscape, LLC designates this educational activity for a maximum of 0.50 AMA PRA Category 1 Credit(s)™ . Physicians should only claim credit commensurate with the extent of their participation in the activity.

    Medscape, LLC staff have disclosed that they have no relevant financial relationships.

    Contact This Provider

    For Nurses

  • Medscape, LLC is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.

    Awarded 0.50 contact hour(s) of continuing nursing education for RNs and APNs; 0.50 contact hours are in the area of pharmacology.

    Accreditation of this program does not imply endorsement by either Medscape, LLC or ANCC.

    Contact This Provider

    For Pharmacists

  • Medscape, LLC is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

    Medscape, LLC designates this continuing education activity for 0.50 contact hour(s) (0.05 CEUs) (Universal Activity Number 0461-0000-10-147-H01-P).

    Contact this provider

For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact [email protected]


Instructions for Participation and Credit

There are no fees for participating in or receiving credit for this online educational activity. For information on applicability and acceptance of continuing education credit for this activity, please consult your professional licensing board.

This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page.

Follow these steps to earn CME/CE credit*:

  1. Read the target audience, learning objectives, and author disclosures.
  2. Study the educational content online or printed out.
  3. Online, choose the best answer to each test question. To receive a certificate, you must receive a passing score as designated at the top of the test. Medscape Education encourages you to complete the Activity Evaluation to provide feedback for future programming.

You may now view or print the certificate from your CME/CE Tracker. You may print the certificate but you cannot alter it. Credits will be tallied in your CME/CE Tracker and archived for 6 years; at any point within this time period you can print out the tally as well as the certificates by accessing "Edit Your Profile" at the top of your Medscape homepage.

*The credit that you receive is based on your user profile.

CME/CE

Toxicity, Monoamine Oxidase Inhibitor: Treatment

processing....

Treatment

Prehospital Care

Prehospital care for MAOI toxicity may include the following:

  • Stabilization of vital signs - IV fluids
  • Treatment of seizure activity - Benzodiazepines
  • Attention to airway maintenance
  • Attention to temperature control

Emergency Department Care

  • Decontamination
    • Because of the potential for severe toxicity and lack of antidotes, an aggressive decontamination is very important.
    • Consider gastric lavage, particularly in patients with recent ingestion (within an hour).
    • Administer charcoal: Secure unprotected airway prior to lavage and charcoal administration if needed.
    • Because of its pharmacokinetics, extracorporeal removal, such as hemodialysis or repeat dosed of activated charcoal, is likely less effective to reduce its level.
  • If the patient is hyperthermic, rapidly (within 20-30 min) decreasing the temperature is imperative.
    • Antipyretics and use of a cooling blanket are generally inadequate.
    • The best methods for cooling patients include increasing evaporative losses by wetting their skin with warm water and maintaining airflow over them with fans.
    • Removing the patient's clothing and exposing the patient to room air may help. In extreme cases, packing the individual in ice or in a bath of ice water may prove life saving.
  • Fluid therapy is of paramount importance. Patients may be significantly dehydrated from hyperthermia.
  • Treating the associated hypertension is usually not necessary.
    • It may actually be dangerous because of the eventual hypotensive phase (avoid beta-blockers because they leave unopposed alpha-stimulation), which may exacerbate the clinical picture.
    • If antihypertensive therapy is deemed necessary, use of a short-acting antihypertensive agent, such as nitroprusside, nitroglycerine or phentolamine, is advisable.
  • Intravenous benzodiazepines are useful for agitation and seizure control; they also may help control the hypertension.
  • Hospital admission is recommended in a patient with a tyramine reaction if symptoms do not resolve within 6 hours of onset and if it was an intentional MAOI overdose.

Consultations

  • Consult the regional poison control center or a local medical toxicologist (certified through the American Board of Medical Toxicology and/or the American Board of Emergency Medicine) to obtain additional information and patient care recommendations.
  • Critical care management may be required for cardiovascular complications.