Sketchy Pharm: Tricyclic Antidepressants

Question 1

What drugs are tricyclic antidepressants?

Answer 1

The -pramines: imipramine (the “IMPRInt” on Amy’s cheek), desipramine, and clomipramine

The -triptylines: amitriptyline and nortriptyline (Amy tripping on the tricycle)

Question 2

By what mechanism do TCAs work?

Answer 2

They block the norepinephrine and serotonin reuptake channels

Question 3

When are TCAs used?

Answer 3

When SSRIs and SNRIs fails

Question 4

Other than resistant depression, for what disorders are TCAs used?

Answer 4

Diabetic neuropathy, OCD, and migraine (the bell, Dwayne and the marbles, and the guy with his hand stuck in the diasweeties machine)

Question 5

TCAs are not used frequently due to their adverse effects. What are they?

Answer 5

Sexual dysfunction (gym teacher getting rejected)
Anticholinergic effects (atropine Alice’s tea party)
H1 histamine antagonism (guy swatting a bee-ball away)
Alpha-1 antagonism (vasodilation -> girl falling over by Alice)
Cardiac arrhythmia (the broken peaNAT cookies representing the blocking of fast sodium channels, with widening of QRS)
Convulsions – due to antagonist effect on GABA A (guy shaking on court)

Question 6

Which TCAs have the fewest side effects?

Answer 6

Nortriptyline and desipramine (the ball bouncing off of NORThside PRep academy)

Question 7

How would you treat the cardiac complications of TCA overdose?

Answer 7

Bicarb. This promotes the unionized version of TCAs to predominate, which is less able to block the sodium channels.