Depressive Disorders Tricyclic Antidepressants(TCAS) Flashcards
Name the Tricyclic Antidepressants (TCAS)
Primary Amitriptyline (elavil)
Others
- Imipramine ( Tofranil)
- Doxepin (Sinequan)
- Nortriptyline (Aventyl, Pamelor)
- Amoxapine (Asendin)
- Trimipramne (Surmontil)
What is the expected Pharmacological Action of Tricyclic Antidepressants?
These Medications Blocle the Reuptake of norephinephrine and serotonin in the synaptic space, thereby intensifying the effects of these neurotransmitters
What are the Theraputic Uses for Trycyclic A/D’s
Depressive Disorders are the primary Use
What are some other uses for Tricyclic A/D’s
- Neropathic pain
- Fibromyalgia
- anxiety disorders
- Insomnia
There are always complications to meds There are 6 Major adverse effects to TCA’s What are they
- Orthostatic(postural) Hypotension
- Anticholinergice Effects
- Sedation
- Toxicity
- Decreased Seziure Threshhold
- Excessive Sweating
What are some Nursing interventions and Teachings for the adverse Effect Orthostatic Hypotension(postural Hypotension)
- instruct the client about the indications of postural hypotension(lightheaded/dizzyness)
- if these Occur Advise the client to sit or lie down, Orthostatic Hypostension is minimized by getting up or changing positions slowly
- Montior the hospitalized clients blood pressure and heart rate for orthostatic changes.
- if significant decrease in blood pressure and or increase in heart rate is note, do not adminster the medication and notify the md
- Advise Client to avoid Dehydration, which increses the risk for Hypotension
What are AntiCholinergic Effects?
What do these tend to cause?
- Dry mouth
- Blurred VIsion
- photophobia
- Urinary Hesitency or Retention
- Constipation
- Tachycardia
These Side effects tend to cause NonCompliance due to undesirable States
What Teaching and Interventions should a nurse provide for Antcholinergice Effects from TCA’s
Instruct the Client on ways to minimize anticholinerginic Effects. And advise client to notify MD if any effects persist
These include:
- Chewing sugarless gum
- sipping on water
- wearing sunglasses when outdoors
- eating foods hight in fiber
- exercising regularly to romote peristalisis
- Increasing fluid intake to at least 2L per day from food and beverages
- voiding just before taking medications
What teaching and interventions should nurse utilize in relation to the adverse effect of Sedation with TCAS?
- Teach that this effect usually diminishes over time.
- Advise the Client to avoid hasardous activities, such as driving, if sedation is excessive
- advise the client to take the medication at bedtime to minimize daytime Sleepinessand to promote sleep
What does toxicity cause and what are the evidences for the toxicity
Toxicity resulting in cholerinergic blockade, and CARDIAC Toxicity as evidence by dysrhythmias, mental confusion, and agitation, followed by sesiures, coma, and posssible Death
What are some Nursing Interventions and Teaching in relation to toxicity
- Give no more than 1 week supply of medication to clients who are acutely ill due to the high risk of lethality with overdose
- obtain clients baseline ECG
- Monitor Vital signs Frequently
- Monitor clients for Signs of toxicity
- Notify MD if signs of Toxicity occur
What is the primary nursing action when using TCA’s with Patients with Seziure Disorders
Monitior the patient with Seizure disorders is Key due to the Adverse effect from TCAS that Decreases Seziure threshold increasing the likely hood a pt will have an incident.
A patient on TCAS complains they feel wet and like they are sweating way too much, How could the nurse respond?
Inform the client that Excessive Sweating is an adverse Effect from TCAS and assist the client with frequent linen changes and Bathing.
What are some Contridications and or Precautions to be aware of With TCAS
- Amitriptyline is a pregnacey risk catergory C Medication
- This med is contraindicated for people with seziure disorders
- Use this medcaustioulsy in clients with Coronary Atery disease;Diabetes; Liver, kidney and respiratory disorders; urinary retention and obstruction, anble clousure glaucoma, benign prostatic hypertrophy an hyperthyroidism
What are the Medication/Food interactions for TCAS and what are the respective interventions/Teachings
- Concurrent use with MAOI’s may cause SEVERE HYPERtension
- Avoid concurrent use of TCAS and MAOI’s
- Concurrent use direct acting sympathomimetics may result in increased effects of these medications
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