DEPRESSION: TCAs (new) Flashcards
What are the side effects of
mirtazapine?
- Sedation
- Weight gain
- Blood disorders (Blood dyscrasias)
If blood dyscrasia (blood disorder) is suspected whilst Mirtazapine, what should be done?
FBC
STOP
What are the cautions for Mirtazapine?
- Cardiac disorders
- Diabetes
- History of mania (AVOID if manic)
- History of seizures
- Psychoses (may aggravate it)
What time of day should mirtazipine be taken?
Nocte
TCAs examples
- Amitriptyline
- Nortriptyline
- Clomipramine
- Imipramine
- Lotepramine
- Dosulepin
- Trazadone (TCA related)
TCA MOA
- They block the uptake of both serotonin and
noradrenaline - Different types of TCAs vary in to the extent they block
Which TCA is more selective for serotonergic transmission, Clomipramine or
Imipramine?
Clomipramine
Which TCA is more selective for noradrenergic transmission
Clomipramine or
Imipramine?
Imipramine
What are the side effects of TCAs?
- Antimuscarinic side-effects
- Sedation
- Cardiotoxicity (in overdose)
- QT prolongation
- Seizures
Why are TCAs not commonly used?
- They are reserved for when SSRIs or Mirtazapine doesn’t work
- Less tolerated due to side-effects
- Riskier in overdose (e.g. cardiotoxicity)
Which TCA’s are most sedating?
- Amitriptyline
- Clomipramine
- Dosulepin
- Trazadone
Which TCAs are less sedating?
- Nortriptyline
- Lofepramine
- Imipramine
Which TCA has the most antimuscarinic side-effect in comparison to other
TCAs and
antidepressants?
Imipramine
.
Which TCA is more dangerous in overdose in comparison to others?
- Dosulepin
- Amitriptyline
What time should TCAs be taken?
Nocte
Caution
- Elderly
- CVD
- Epilepsy
- Constipation, prostatic hypertrophy, or raised intraocular pressure may be worsened by antimuscarinic effects
What are the
contraindications for TCA?
- Arrhythmias
- Manic phase of bipolar
- Immediately after a myocardial infarction
Which TCA is used in neuropathic pain?
- Amitripyline
- Nortriptiline
TCA in migraine prophylaxis
Amitriptylline
