TCAs

Question 1

Tricyclic Antidepressants

Answer 1

Therapeutic class: Antidepressant

Question 2

Examples

Answer 2

amitriptyline (Elavil)
nortiptyline (Pamelo)
desipramine (Norpramin)
doxepin (Senequan)
imipramine (Tofranil)

Question 3

Mechanism of Action

Answer 3

blocks reuptake of norepinephrine and serotonin (blocks pump mechanism responsible for absorption)
sedative property

Question 4

Actions and Uses

Answer 4

Primary use for major depression

Off-label used in anxiety and nocturnal enuresis (bed wetting) in children

Question 5

Adverse Effects

Answer 5

Dry mouth
blurred vision
urine retention
hypertension
orthostatic hypertension
sedation and anticholinergic effect
cardiac dysrhythmias
weight gain
agranulocytosis
neuroleptic malignant syndrome
suicide

Question 6

Black Box Warning

Answer 6

Not for use if Hx MI, heart block or arrhythmia (bundle branch block)
risk for suicide

Question 7

Contraindications

Answer 7

Narrow-angle glaucoma, severe renal or hepatic

MAOIs: severe convulsions, death

Question 8

Interactions

Answer 8

MAOIs (neuroleptic malignant syndrome)
Oral contraceptives
Phenothiazines
St. John’s wort

Question 9

Pregnancy Category

Answer 9

C

Question 10

Neuroleptic malignant syndrome

Answer 10

Fever, encephalopathy, vitals unstable, elevated enzymes (CPK), rigidity of muscles