<prompt> MAO inhibitors should not be used with -BuprenorphinePethidinePentazocinMorphine  <response>: Ans. is b i.e., Pethidine o Nonselective MAO inhibitors interact with many food constituents and drugs : 1-Cheese reaction o Ceain varieties of cheese, beer, wines, picked meat and fish, yeast extract contain large quantities of tyramine, dopa. o In MAO inhibited patients these indirectly acting sympathomimetic amines escape degradation in the intestinal wall and liver -- reaching into systemic circulation they displace large amount of NA from adrenergic nerve endings Hypeensive crisis, cerebrovascular accidents. This can be treated by Lv. injection of a rapidly acting a-blocker eg, phentolamine. Prazosin and chlorpromazine are alternative. 2. Reserpine, guanethidine, tricyclic antidepressant. o Rise in BP and body temprature can occur when these drugs are given with MAO inhibits -- due to their initial NA releasing or uptake inhibiting action. 3. Levodopa Excitement and hypeension occur due to increase V of DA that is produced from levodopa. 4. Antiparkinsonism anticholinergic Symptoms of atropine poisoning occur. 5. Brabiturates, opoids, alcohol, antihistamininc o Action of these drugs is intensified and prolonged. 6. Pethidine o High fever, sweating, excitation, delirium, convulsion and respiratory depression occur. o This is due to excess production of norpethidine normally it is minor metabolites. o MAO inhibitors inhibit hydrolysis but not detmethylation more norpethidine is produced. 7. SSRIs o MAO inhibitors produce serotonine syndrome when given with SSRIs. 