Week 13: Tricyclic antidepressants

Question 1

tricyclic antidepressants indication and examples

Answer 1

-“ipramine”

Amitriptyline (Elavil)
Clomipramine (Anafranil)
Desipramine (Norpramin)
Doxepin (Sinequan)
Imipramine (Tofranil)
Nortriptyline (Pamelor)

indic:

• Depression
• Anxiety with sleep disturbance (doxepin
 and elavil)
• Enuresis in children six years old or older (imipramine)
• OCD (clomipramine)
• Eating disorders

Question 2

TCA MOA

“-ipramine”

Answer 2

Blocks norepinephrine and serotonin reuptake into the presynaptic neuron = elevates mood, mental alertness, inc physical activity, reduce morbidity in MDD
-similar to SNRI but more side effects

Question 3

Fatal facts of TCA’s

Answer 3

2. 4% overdose in 2014
   - very narrow TI (5-6x max daily can be lethal)
   - bad side effects

Question 4

when do TCA’s take effect and works best in?

Answer 4

2 weeks or longer

good for moderate to severe depression

Question 5

TCA ADE’s

Answer 5

blocks muscarinic receptors = blurred vision, dry mouth, urinary retention, tachycardia, constipation, worsen glaucoma

orthostatic hypotension
arrhythmia overdose
sedation (tapers off)
weight gain

Question 6

TCA’s precuations

Answer 6

don’t give to suicidal pt
-no cardiovascular disorders
lower seizure threshold
CAUTION ELDERLY !!!! falls, confusion, anticholinergic