Antidepressants (TCAs)

Question 1

Antidepressant drugs - 5 groups

Answer 1

Tricyclic antidepressants.
Selective seotonin reuptake inhibitors.
Serotonin and norepinephrine reuptake inhibitors. 
Monoamine oxidase inhibitors. 
Others.

Question 2

TCAs - 5 drugs

Answer 2

Clomipramine 
Amitriptyline
Desipramine
Imipramine
Nortriptyline

Question 3

TCAs - MOA

Answer 3

Block reuptake of NE and SER. Immediate blockade and increase in synaptic concentration of SER and NE. Adaptive changes in NE and SER neurotransmission.
Over time: down-regulation of presynaptic autoreceptors for SER and increased firing rate of serotonergic neurons.
Blockade of muscarinic and 1-adrenoceptors: side effects

Question 4

TCAs - administration

Answer 4

At nighttime because of sedative effect

Question 5

TCAs - contraindications

Answer 5

Should not be given with SSRIs or MAOI

Question 6

TCAs - adverse effects

Answer 6

Autonomic side effect by blocking muscarinic and alpha1-adrenoceptors.
Some cause marked sedation.
Lower seizure threshold

Question 7

TCAs - symptoms of overdose

Answer 7

Life-threatening cardiac dysrhythmia (wide QRS tachycardia)
Marked autonomic effects (hypotension, sinus tachycardia)
Excessive sedation
Seizures

Question 8

Treatment of TCA overdose

Answer 8

Arrhythmia can be treated with IV sodium bicarbonate

Question 9

TCAs - interactions

Answer 9

TCA serum levels are increased by antipsychotic drugs, CCBs, cimetidine, SSRIs.
TCA serum levels are decreased by barbiturates, carbamazepine, phenytoin

Question 10

Which drugs are tertiary and secondary TCAs, and difference between them

Answer 10

Tertiary: Clomipramine, amitriptyline, imipramine.
Secondary: Desipramide, nortriptyline.
Tertiary cause more sedation and autonomic side effects, and they block NE reuptake more than SER reuptake.

Question 11

Clomipramine - indications

Answer 11

Depression.

OCD.