Tricyclic Antidepressents

Question 0

Amitriptyline (Elavil)

Answer 0

Broken down to active metabolite (nortriptyline). Treats: depression, panic disorder, pain/HA, fibromyalgia, ADHD.

Question 1

Imipramine (Tofranil)

Answer 1

Broken down to active metabolite (desipramine). Treats Enuresis, depression, panic disorder, pain/HA, fibromyalgia, ADHD.

Question 2

Trimipramine (Surmontil)

Answer 2

TCA

Question 3

Doxepine (Sinequan)

Answer 3

TCA

Question 4

Clomipramine (Anafranil)

Answer 4

Approved only for use in OCD, similar to SSRI, DOC for OCD.

Question 5

Desipramine (Norpramin)

Answer 5

Secondary amine, causes cardiac depression and increased irritability.

Question 6

Nortriptyline (Pamelor)

Answer 6

Secondary amine, least likely to potentiate antihypertensive drugs.

Question 7

Protriptyline (Vivactil)

Answer 7

Secondary amine

Question 8

Tricyclic Antidepressents (Tertiary and Secondary)

Answer 8

Inhibit uptake of NE/5-HT. Also cause alpha, muscarinic, and histamine blockade. Not CNS stimulants (sedating), orally absorbed, long t1/2. Interactions: when used with MAOI’s will cause serotonin syndrome. Fluoxetine and other SSRIs compete for metabolism.
Pharamacological Effects: include drowsiness/sedation, impairment of memory/cognition, analgesia
Side effects:
- dry mouth, palpitations, constipation, urinary retention, etc. (anticholinergic)
- membrane stabilizing effect- arrythimia, torsade des points, vfib, - dont use in someone with MI or BBB
- postural hypotension,
- wt gain,
- seizure
OD sx: hypotension, tosade des points, neuromuscular irritability and seizures, respiratory depression