TCA

Question 1

TCA drugs

Answer 1

Amitriptyline,
Nortriptyline,
Imipramine,
Desipramine,
Clomipramine,
Doxepin
Amoxapine

All TCAs end in iptyline or ipramine except for
doxepin and amoxapine

Question 2

MOA

Answer 2

blocks NE and serotonin reuptake

Question 3

Clinical use

Answer 3

Major depression,
Bedwetting (imipramine)
OCD (clomipramine)
Fibromyalgia

Question 4

Toxicity

Answer 4

Sedation
alpha 1 blocking (hypotension)
anticholinergic (tachycardia, urinary retention, dry mouth)

Tri C’s:
Convulsions,
Coma
CV (arrhythmias)

Also respiratory depression, hyperpyrexia,
Confusion/hallucination in elderly due to anticholinergic

Tx: NaHCO3 for CV toxicity (acid so block with base)

Question 5

3rd gen vs. 2nd gen

Answer 5

3rd gen TCA (amitriptyline) more anticholinergic effect than 2nd gene TCA (nortriptyline)

Question 6

Desipramine vs other TCAs

Answer 6

Less sedating and has higher seizure threshold.