TCAs, MAOIs Flashcards
What neurotransmitters do TCAs affect?
Block reuptake of serotonin and norepinephrine.
What are TCAs used for?
Depression, bipolar disorder, fibromyalgia, neuropathic pain, anxiety, OCD, insomnia, ADHD.
What are the major side effects of TCAs?
Orthostatic hypotension, anticholinergic effects, sedation.
What are the anticholinergic side effects of TCAs?
Dry mouth, blurred vision, photophobia, constipation, tachycardia, urinary hesitancy/retention.
What are some ways to manage anticholinergic side effects?
Chew gum, sip water, wear sunglasses, eat more fiber, drink more water, exercise.
What is the mnemonic for TCA anticholinergic effects?
“Can’t pee, can’t see, can’t spit, can’t shit.”
Why should TCAs be taken at bedtime?
They cause sedation.
Why are TCAs not first-line drugs?
Due to their toxicity risk.
What is the toxicity risk with TCAs?
Cholinergic blockade & cardiac toxicity.
How much of a TCA is considered an overdose?
8 times the normal dose.
What are symptoms of TCA toxicity?
Dysrhythmias, mental confusion, agitation → seizures, coma, death.
How is TCA overdose managed?
Gastric lavage, activated charcoal, IV therapy.
What are other notable side effects of TCAs?
Decreased seizure threshold, excessive sweating.
Which medications should NOT be taken with TCAs?
MAOIs, St. John’s Wort, anticholinergics, antihistamines, epinephrine, dopamine, ephedrine, amphetamines, alcohol, benzodiazepines, opioids.
Who should avoid TCAs?
Those with seizure disorders, recent MI, or a high suicide risk.
What do MAOIs inhibit?
Monoamine oxidase (MAO), which breaks down norepinephrine, serotonin, and dopamine.
What happens when MAO is inhibited?
Increased levels of norepinephrine, serotonin, and dopamine.
What are MAOIs used for?
Depression (last-line treatment due to risks).
Why does tyramine need to be avoided with MAOIs?
Tyramine promotes norepinephrine release → Hypertensive crisis.
What foods contain tyramine?
Aged cheese, pepperoni, salami, avocados, figs, bananas, smoked fish, protein supplements, soups, soy sauce, some beers, red wine.
What are symptoms of a hypertensive crisis?
Severe hypertension, headache, nausea, increased HR and BP.
How is a hypertensive crisis from MAOIs treated?
Sodium nitroprusside.
What are the major side effects of MAOIs?
CNS stimulation, orthostatic hypotension, hypertensive crisis, rash (with transdermal).
How long does it take for MAOIs to work?
1–3 weeks for effects, 2–3 months for full response.
Why do MAOIs have so many drug interactions?
They affect multiple neurotransmitters and enzymes.
What should be done before starting MAOIs?
Check ALL medications and consult a provider.
Are MAOIs safe in pregnancy/lactation?
Only if the benefits outweigh the risks.
