TCA's Flashcards
What are the four tertiary amines?
- amitriptyline
- imipramine
- clomipramine
- doxepin
what is MOA of TCA’s?
inhibit reuptake of NE and serotonin, leading to increased avalability of these monoamines in the synapse.
What are two secondary amines?
- nortryptyline
2. desipramine
What is the main difference between tertiary and secondary amines in terms of side effect profiles?
tertiary (amitripyline, imipramine, clomipramine, doxepin) are more sedating, more anticholinergic and have greater lethality in overdose.
the secondary amines are less seating and less anticholinergic
which TCA is useful in chronic pain, migraines, and insomnia?
amitriptyline
which TCA is useful in enuresis and panic disorder?
imipramine
Which TCA is most useful for treatment of OCD?
Clomipramine
Which two are useful for treating chronic pain?
Doxepin and nortrypline
Why use nortriptyline?
is least likely to cause orthostatic hypotension
*use in patients having trouble with hypotension and needing something for chronic pain
What are two tetracyclic amines?
- amoxapine
2. maprotiline
What are side effects of amoxapine?
EPS and others similar to typical antipsychotics (anticholinergic), is a metabolite of antipsychotic loxapine
AE of maprotiline?
higher rates of seizure, arrythmia, and fatal on overdose - why the fuck use it then
Why do TCA’s have a high rate of interacting with other drugs?
are highly protein bound and are lipid soluble
What other broad categories of side effects do TCAs have?
- Antihistaminic - sedation
- Antiadrenergic - orthostatic hypotension, dizziness, reflex tachcardia
3 CV - EKG changes including widening of QRS, QT, PR - Anticholinergic - dry mouth, constipation, blurred vision, urinary retention, exacerbation of narrow angle glaucoma
- sexual side effects - erectile/ejac dysfunction
- weight gain
What other two drugs need to be given with caution with TCA’s due to increased seizure risk?
- clomipramine and tetracyclics
2. high doses of any TCA
