TCAs

Question 1

TCAs: name them

Answer 1

• amitriptyline
• doxepin
• mirtazapine

Question 2

TCAs: MOA

Answer 2

• block neuronal uptake of 2 monoamine NTs: NE and 5-HT
  
  • inc conc of these at CNS synapses and instensify there effects
• biochemical effects w/in hours, therapeutic effects w/in a few weeks

Question 3

TCAs: indication

Answer 3

• depression
• bipolar disorder
• fibromyalgia syndrome
• neuropathic pain
• chronic insomnia
• ADHD
• panic disorder
• OCD

Question 4

TCAs: SEs

Answer 4

• orthostatic hypotension
• anticholinergic effects: blurred vision, urinary retention, dry mouth, constipation, anhydrosis, tachycardia)
• diaphoresis
• sedation (b/c of blockade of histamine receptors in CNS)

Question 5

TCAs: ADRs

Answer 5

• cardiac toxicity: dec vagal influence, act on Bundle of His to slow conduction
• seizures
• hypomania
• suicide risk

Question 6

TCAs: nursing implications

Answer 6

• contraindicated if pt taking another MAOI, after an MI
• w/ hypoTN: make sure pts move slow and get up slowly
  
  • monitor BP and pulse 4x/day for hospitalized pts
    
    • take while lying down and again after sitting/standing for a minute–if BP low or pulse high, then withhold med and notify provider
• inform pt that no effects will develop until 1-3 weeks
  
  • should use 4-9 mos even if feel cured
• caution in pts with heart problems, urinary retention, seizures
• do not d/c abruptly
• do not use alcohol or other CNS depressants
• do not use other anticholinergic drugs

Question 7

doxepin: contraindications

Answer 7

• glaucoma
• tendency to urinary retention