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drugs - cpt sem 4 > TCAs > Flashcards

TCAs Flashcards

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1
Q

What are TCAs?

A

Tricyclic Antidepressants

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2
Q

What are some examples of TCAs?

A
  • Amitryptiline
  • Nortriptyline
  • Lofepramine
  • Dosulepin
  • Trazodone
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3
Q

What is the mechanism of action of TCAs in depressive illness?

A

Not fully understood, believed to involve adaptive responses to monoaminergic neurotransmission

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4
Q

What are the routes of delivery of TCAs?

A

PO

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5
Q

What are the indications for TCAs?

A
  • Depression
  • Panic attacks and anxiety disorders
  • Neuralgia
  • Noctural enuresis
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6
Q

What are the contraindications for TCAs?

A
  • Suicidal ideation
  • History of psychosis or bipolar disorder
  • QT interval prolongation
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7
Q

Why are TCAs contraindicated in patients with suicidal ideation?

A

More toxic in overdose compared to alternatives

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8
Q

Why are TCAs contraindicated when there is a history of psychosis or bipolar disorder?

A

May aggravate these conditions

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9
Q

When should TCAs be avoided?

A

Post MI or with other heart problems

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10
Q

What anti-depressant should be used in patients post-MI or with other heart problem?

A

Consider sertraline

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11
Q

When should TCAs be used with caution?

A
  • Prostatic hypertrophy
  • Urinary retention
  • Chronic constipation
  • Increased intraocular pressure
  • Mania
  • Severe liver disease
  • High risk of developing acute angle-glaucoma
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12
Q

What might TCAs interact with?

A
  • MAOIs
  • Anti-arrhythmics
  • Alcohol
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13
Q

What might happen if TCAs are given with MAOIs?

A

Severe hypertensive crisis can occur - maintain a 2 week gap between stopping a TCA and starting a MAOI

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14
Q

What might happen if TCAs are given with anti-arrhythmic medication?

A

VT

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15
Q

What might happen if TCAs are given with alcohol?

A

Increased sedation

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16
Q

Who is more susceptible to the side effects of TCAs?

A

Elderly patients (particularly hyponatraemia)

17
Q

What are the common side effects of TCAs?

A
  • Antimuscarinic effects
  • Central nervous system effects
  • Metabolic effects
18
Q

What are the anti-muscarinic side effects of TCAs?

A
  • Dry mouth
  • Blurred vision
  • Constipation
  • Urinary retention
19
Q

What are the CNS side effects of TCAs?

A
  • Anxiety
  • Restlessness
  • Dizziness
  • Agitation
  • Confusion
20
Q

What are the metabolic side effects of TCAs?

A
  • Weight gain

- Altered blood glucose in diabetics

21
Q

What are the less common side effects of TCAs?

A
  • Cardiotoxic in overdose
  • Neuroleptic malignant syndrome
  • Hyponatraemia
22
Q

What counselling is required with TCAs?

A
  • Impairment of normal activities
  • Overdose
  • Increased risk of seizures in epilepsy
  • Treatment cessation
23
Q

What should patients be told about impairment of normal activities with TCAs?

A

TCA can cause drowsiness that may impair their ability to drive or operate machinery. If they drink alcohol, they may experience increased sedation

24
Q

What should the patient be told about the overdose of TCAs?

A

Explain that the drug is very dangerous in overdose

25
Q

What should be done before starting TCAs to reduce the risk of overdose?

A

Ascertain that the patient is not considering suicide or engaging in self-harming behaviours, as this would put them at increased risk of intentionally overdosing

26
Q

What should patients with epilepsy be told before starting TCAs?

A

May experience more seizures as this drug lowers the seizure threshold, making it easier for a seizure to occur, as a lower level of stimuli is required

27
Q

What should the patient be told about treatment cessation with TCAs?

A

Withdrawal symptoms may occur within 4 days of stopping drug. However such symptoms may be mild and self-limiting.
Drug should be withdrawn gradually over at least 4 weeks and this would depend on how long the patient has been taking the antidepressant and how they respond to withdrawal

drugs - cpt sem 4 (81 decks)

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