L3- Antidepressants (TCAs)

Question 1

list the TCAs

Answer 1

(tricyclic antidepressants)
amitriptyline
clomipramine
desipramine
imipramine
nortriptyline

Question 2

TCA MOA

Answer 2

inhibition of SERT (5-HT reuptake) and NET (NE reuptake) –> inc concentration of both in synaptic cleft

Question 3

of the TCAs:

• (1) is/are more selective for SERT
• (2) is/are more selective for NET

Answer 3

1- clomipramine

2- desipramine, nortriptyline

Question 4

list the ‘other effects’ that TCAs have that cause AEs

Answer 4

• α1/α2 receptor blocker
• mAChR blocker
• H1/H2 blocker
• cardiac fast Na channel blocker

Question 5

list the AEs of TCAs due to mAChR blockade (+ what condition is contraindicated)

Answer 5

blurred vision
xerostomia (dry mouth)
urinary retention
constipation

contraindicated in narrow-angle glaucoma

Question 6

list the AEs of TCAs due to α1 blockade

Answer 6

orthostatic hypotension + reflex tachycardia

Question 7

list the AEs of H1 receptor blockade

Answer 7

sedation

weight gain

Question 8

TCAs have a (narrow/broad) therapeutic window. An overdose of TCA can cause (2) via (3) mechanism. (4) is given to treat a TCA overdose.

Answer 8

1- narrow
2- lethal arrhythmia
3- blockade of cardiac fast Na channels
4- sodium bicarbonate

Question 9

(1) type of AEs are common with TCAs, particularly with agents that are more selective for (2), like with clomipramine

Answer 9

1- sexual effects (dysfunction, delayed ejaculation, dec libido)

2- SERT (serotonergic)&raquo_space;> NET