TCA's

Question 1

Mechanism of Action

Answer 1

Blocks re-uptake of norepinephrine, dopamine and serotonin at presynaptic receptor, leading to norepinephrine depletion. Blocks calcium, sodium, and potassium channels, alpha adrenergic receptors and acetylcholine release

Question 2

Indications

Answer 2

Depression, Anxiety, PTSD, Eating Disorders, Personality Disorders, ADHD, Parkinson’s Disease, Chronic Pain Syndromes, Tourette Syndrome, Smoking Cessation, IBS, Schizophrenia

Question 3

Patient Presentation

Answer 3

CARDIO: AVB, prolonged QT, hypotension, cardiac arrest, ventricular dysrhythmias CNS: dizziness, confusion, delerium, agitation, EPS, myoclonus, seizures, coma ANTICHOLINERGIC: tachycardia, mydriasis, decreased bowel sounds, urinary retention, hyper/hypotension, vision changes, dry mouth

Question 4

Management of Overdose

Answer 4

Fluid bolus for hypotension -> Sodium Bicarb for hypotension, ventricular arrhythmias, seizure activity, and/or widened QRS -> Inotropes for refractory hypotension -> Benzos for seizures -> hyperventilation due to agitation

Question 5

Special Considerations

Answer 5

May cause Discontinuation Syndrome if stopped suddenly; Mostly replaced by safer antidepressants

Question 6

Examples

Answer 6

Elavil, Imiprimire, Clomiprimine, Doxepine, Nortriptyline

Question 7

Class

Answer 7

Anti-Depressant