Exam (elaborations)
Nurs 517- Mood D&O Questions answers latest update
- Course
- NURS 517
- Institution
- University Of Hawaii - Manoa
Nurs 517- Mood D&O Questions answers latest update
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Nurs 517- Mood D/OWhat are the Tricyclic Antidepressant Drugs (Nonselective Norepinephrine-
Serotonin Reuptake Inhibitors)? - amitriptyline (Elavil)
amoxapine (Asendin)
clomipramine (Anafanil)
desipramine (Norpramin)
doxepin (Sinequan) (Adapin)
imipramine (Tofranil)
nortriptyline (Aventyl)
protriptyline (Vivactil)
trimipramine (Surmontil)
How do the Tricyclic Antidepressants work? - These drugs block the re-uptake of
norepinephrine and serotonin back into the nerve endings from which they are
released. In doing so, they prolong the presence of these neurotransmitters in the
synapse and also prolong the contact between them and their respective
receptors. It is presumed that prolonged contact between norepinephrine and its
receptors eventually produces a down-regulation of norepinephrine receptors
that creates a disproportionally greater effect of serotonin on its receptors
Kinetics:
All of the tricyclic anti-depressants are well absorbed when administered orally.
Some (amitriptyline, imipramine) are also administered I.M. They are all
, metabolized in the liver, some to active metabolites. Some are excreted in the
bile and undergo enterohepatic recirculation. All are excreted in the urine.
What are the advantages and disadvantages of tricyclic antidepressants? -
Advantages:
- Available orally
- Generally once-a-day dosing; clearly an inducement to compliance
- They have a long duration of action (weeks); this is in part due to enterohepatic
recirculation and in part due to active metabolites
- Most are relatively inexpensive; generally the most cost-effective of the anti-
depressants
- Multiple uses; can be used for depression, insomnia, as adjuncts to analgesia,
for migraine therapy, in the treatment of attention deficit disorder, enuresis, etc
- Wide variability of acceptable doses; allows better individualization for patients
- Can be used for chronic therapy; i.e., the long-term, indefinite treatment of
depression
Disadvantages:
- TCAs have a delayed onset of action; it takes several weeks before good anti-
depressant action begins. Maximal effect may take 2 months. [Note: This is
probably because it takes this long for the norepinephrine receptors to become
down-regulated]
- Most have very prominent anticholinergic adverse effects; dry mouth, blurred
vision, tachycardia, urinary retention, constipation. [Note: These drugs also block
muscarinic receptors]
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