Tricyclic Antidepressants

Question 1

Name the tertiary Tricyclic Antidepressants

Answer 1

Imipramine
(“Imprint on green shirt boy’s face”)

Amitriptyline
(“green shirt boy tripping from tricycle”)

secondary amines

**Nortriptyline

Desipramine**

Question 2

Name the Secondary amine TCAs

Answer 2

“NORth siDE prep secondary school”

Nortriptyline

**Desipramine

-**
secondary amines have less anticholinergic effects (woman protected by “Northside prep” sign

*most appropiate for the elderly**

Question 3

what is the MOA of TCAs ?

Answer 3

TCAs inhibit presynatpic uptake of serotonin and norepinephrine NET/SERT

(“green shirt boy prevented from picking up smiley and compass balls”)

Question 4

what can TCAs be used for ?

Answer 4

-useful in treatment of resistant depression
(“happy/sad mask next to resistant door that kid can’t open”)

-useful in diabetic neuropathy
(“kid having pain from diasweeties machine”)

-useful in treatment of chronic pain (neuropathic)
(“chronically frayed wire next to diasweeties machine”)

-may be used for migraine prophylaxis
(“pounding headbell” )

• **Amitriptyline is the only TCA with proven efficacy**

-Clomipramine(secondary amine) can treat OCD
(“obessively neat kid re-arranging his marbles”)

• **not as 1st line treatment - SSRIs are.**

Question 5

what are the side effects of TCAs?

Answer 5

-TCAs can cause Sexual dysfunction
(“gym teacher rejected by Mrs. Pearson”)

-can cause Seizures
(“ball hits yellow shirt kid and he becomes shakey”)
——————————————————————————–
-TCAs (mostly tertiary) have severe antimuscarinic effects including:

• dry mouth (“dry as a cracker”)
• ​constipation
• ​blurred vision (“blind as a bat”)
• urinary retention (“full bladder shaped tea kettle”)
• ​CNS effects (“mad as a hatter”)

**the antimuscarinic effects are the most common side effects among all TCAs side effects **

***the most potent antimuscarinic effects are exerted by Amitriptyline***

****TCAs are contraindicated in elderly because of these severe antimuscarinic/antihistamine effects****

• TCAs block H1 receptors (“blacky with bee swatter”)
• leads to sedation
  (“blue shirt kid sleeping on table”)

​leads to increased appetite weight gain
(“red shit fat kid next to sleeping kid”)
​——————————————————————————–
-TCAs block α1 receptors
(“pink shirt girl holding single extinguished candle”)

• may cause orthostatic hypotension
  (“pink shirt girl next to tea party is passed out”)

​​——————————————————————————–
-TCAs can cause Serotonin syndrome
(“stack of smiley balls behind blue shirt dodger”)

Question 6

what are cardiac side effects cause by TCAs ? what is the treatment for these undesired effects ?

Answer 6

-TCAs block cardiac fast Na+ channels that may cause fatal cardiac arrhythmias
(“inactivated peaNa+ butter jar”)

-can cause wide QRS complex on ECG
(“Wide QRS-shaped crack in heart sign”)

-can induce Torsades de pointes ventricular tachycardia
(“twisted Torsades streamer”)

**the most common cause of death of patients treated with TCAs is TCA overdose causing fatal cardiac arrhythmias

(“dodge ball hitting peaNa+ butter cookie stand and breaking <3 cookies”

• Sodium Bicarbonate can be used to treat widened QRS and ventricular arrhythmia caused by TCAs overdose (white