Treatment for Asthmatics that are on MAOI's or TCA's

[captainstandup]

Just wondering how others care for an acute asthmatic patient who also has a history of psychological problems requiring them to take MAOI's or TCA's?

[AZCEP]

There really aren't very many options commonly available.

Standard issue treatments with Albuterol/Atrovent/Epi/steroids/BMV are the only options we have.

[Eydawn]

MAOI's interact with asthma meds? I don't remember reading that... and I read about everything I take. What exactly happens?

Wendy

CO EMT-B

[captainstandup]

It's my understanding that administration of Albuterol and like preparations to patients taking MAOI's may induce hypertensive crisis. I haven't fully researched the subject and honestly beginning this thread is part of that research. I called one of our pharmacists and am awaiting her return call.

[fiznat]

Sounds to me like more of a problem for long-term care rather than emergent, prehospital care? If they can't breathe they cant breathe... I can't imagine that worries about potential drug interaction induced hypertension really would stop a provider from doing everything they can to get a patient breathing effectively.

[captainstandup]

Did I in any manner imply that we should not treat an acute asthmatic? Hell no!! The point of this discussion is to; discuss what, if any, other therapies and medications are used by other providers in these situations and not a the ridiculous notion of not treating the patient.

[VentMedic]

COMPARISON OF INHALED SYMPATHOMIMETIC BRONCHODILATORS

http://www.medpin.org/education/monodocs/B...lators-0506.pdf

The Treatment of Acute Asthma: Role of Short-Acting ß-Agonists in Acute and Emergency Department Treatment

http://www.cmecorner.com/macmcm/accpchest/accp2003_02.htm

After reading all the cautions, it's a wonder we give any meds at all.

I had been very cautious in the past when oral and IV Xanthines were popular.

I do get concerned and monitor closely if the patient is also taking OTC cold meds with pseudoephedrine and MAOIs and/or TCAs.

Most of the COPD pts will already be on bronchodilators and MAOIs and/or TCAs and beta blockers. The receptor sites will just have to compete for a drug. Oral meds do free up the sites at varying times.

In the field, the delivered dose of a 2.5 mg Albuterol neb is less than 20% especially if a face mask is used. For the MDI without an aerochamber, it can be less.

There are a lot of new meds on the market but they are still in the same family with the same cautions.

[Dustdevil]

After reading all the cautions, it's a wonder we give any meds at all.

Seriously. I recall making my drug cards in medic school almost thirty years ago, and thinking, "Holy Jesus, is there anything I can give patients on MAOIs?" I actually consider myself lucky that they won't deploy anybody on MAOIs, so I don't have to worry about it. But now I'll have to get back in the habit of watching for it when I get back to the states, becauase yeah... there are a LOT of potentially serious interactions.

[VentMedic]

http://www-personal.umich.edu/~mshlafer/Le...ebsli3_4rgb.pdf

http://www.oqp.med.va.gov/cpg/MDD/MDD_cpg/...mdd_app5_fr.htm

A couple more links for one's viewing pleasure. This was a good review because I don't always keep up with how many MAOIs and TCAs there are on the market and how many combinations they are used in.

note: Albuterol is a direct acting sympathomimetic and beta-2 agonist.

Also, don't be mislead by levalbuterol. The use of levalbuterol over the more traditionally used racemic albuterol is still controversial. A solid college education in the sciences (chemistry and pharmacology) is definitely helpful when evaluating new and/or improved meds objectively.

[captainstandup]

Perhaps this is more a function of risk vs. benefit than just straight up pharmacology. In theory we can treat hypertension, even hypertensive crisis, if absolutely necessary. Untreated or improperly treated status asthmaticus can kill our patient before we can deliver them to definitive care.

How many of you, when treating hypostensive CHF patients, administer a small fluid bolus to increase the BP to a level which permits treatment of the underlying CHF? This is illustrative of a therapy that runs the risk of at least temporarily worsening the patient’s condition in order to treat a more life threatening condition