Adult-Gerontology Clinical Nurse Specialist (CNS) Practice Exam

Which of the following drugs can cause severe hypertensive reactions when mixed with aged cheese or cured meats?

1. Benzodiazepines

2. Angiotensin-converting enzyme (ACE) inhibitors

3. Warfarin

4. Monoamine oxidase (MAO) inhibitors

The correct answer is: Monoamine oxidase (MAO) inhibitors

The interaction between certain medications and specific foods is crucial for patient safety, particularly with monoamine oxidase (MAO) inhibitors. MAO inhibitors are known to affect the metabolism of tyramine, a substance found in aged cheeses and cured meats. When individuals taking MAO inhibitors consume foods high in tyramine, it can lead to the release of large amounts of norepinephrine, resulting in severe hypertensive reactions, known as hypertensive crises. This reaction occurs because tyramine is normally broken down by the MAO enzyme in the body. When MAO is inhibited, as it is with these medications, tyramine can accumulate to dangerous levels, leading to dangerously high blood pressure. Symptoms can include severe headache, palpitations, and perspiration, which necessitate immediate medical intervention. In contrast, the other medications listed do not have similar interactions with foods that contain tyramine. For example, benzodiazepines generally do not have dietary restrictions, ACE inhibitors are commonly prescribed for blood pressure management without specific dietary concerns, and warfarin's main dietary consideration is with vitamin K, not tyramine. Therefore, understanding the unique interactions associated with MAO inhibitors is essential for managing patients on these medications safely.