Tricyclic Antidepressants

Question 1

TCA names

Answer 1

imipramine and derivatives desipramine and clomipramine (imprint on the girls face)
amitriptyline, nortriptyline (tripping on tricycle)

Question 2

how TCAs work

Answer 2

like SNRI, inhibit NE and serotonin re-uptake by blocking activity of transporters: NET and SRT(smiley face and North compass balls being prevented from picking up)
also block H1 histamine receptors (bee swatting kid)
alpha-1 antagonism (alpha candle)

Question 3

TCA uses

Answer 3

MDD (third line treatment because lethal in overdose and have serious drug interactions and adverse effects)
mostly for treatment resistant depression (happy and sad masks next to the kid struggling to get in the resistant door)
diabetic neuropathy (diasweeties vending machine)
neuropathic chronic pain
migraine prevention, amitriptyline only (pounding head bell)
OCD, clomipramine only though SSRI is first line because TCA is less well tolerated (OCD marble guy)

Question 4

TCA adverse effects

Answer 4

sexual dysfunction (rejected advances) 
anticholinergic toxicity b/c inhibition of central and peripheral muscarinic receptors causing dry mouth, constipation, blurry vision, urinary retention, (ball disrupting tea party) 
increased appetite and weight gain and sedation b/c H1 blockade 
orthostatic hypotension - falls (passed out girl with the a-1 candle)

Question 5

most potent anticholinergic effects with what TCA

Answer 5

amitriptylene 
secondary amines (nortriptyline and desipramine) have few anticholinergic side effects (northside prep sign protecting the girl from being hit)
*important in elderly who are at increased risk for side effects

Question 6

TCA overdose

Answer 6

inhibition of myocardial Na channels leads to fatal cardiac arrhythmia (broken heart peanut better cookies)
widened QRS complex b/c block of fast Na channels decreasing slope of AP and slowing conduction through myocardium (ventricles) (wide QRS crack in the heart)
QT interval prolonged = torsades de pointes and syncope (twisted streamer)
seizures b/c antagonism of GABA-A receptor (shaking kid)
serotonin syndrome - hyperthermia, autonomic instability, hyperreflexia, myoclonus (many happy dodgeballs)

Question 7

how to treat TCA overdose

Answer 7

sodium bicarb therapy = increased serum pH which favors non-ionized drug making it less likely to bind to channels and increases extracellular Na which overcomes competitive Na block by TCAs (girl throwing baking soda)