Antidepressants - Tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs): Nursing pharmacology

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Notes

Notes

ANTIDEPRESSANTS: TCAs, MAOIs
DRUG NAME

Tertiary TCAs: amitriptyline (Elavil), imipramine, clomipramine (Anafranil)

Secondary TCAs: desipramine (Norpramin), nortriptyline (Pamelor)

isocarboxazid (Marplan)
phenelzine (Nardil)
tranylcypromine (Parnate)
selegiline (Emsam, Zelapar)

CLASS
Tricyclic antidepressants (TCAs)
Monoamine oxidase inhibitors (MAOIs)
MECHANISM OF ACTION
Inhibition of serotonin and norepinephrine reuptake into nerve endings
Monoamine oxidase inhibition to prevent the  breakdown of serotonin, norepinephrine, and dopamine
INDICATIONS
  • Major depressive disorder
  • Phobic, panic, anxiety disorders
  • Obsessive-compulsive disorder
  • Neuropathic pain
  • Migraine prevention
  • Major depressive disorder
  • Parkinson disease
ROUTE(S) OF ADMINISTRATION
  • PO
  • PO
  • Transdermal (selegiline)
SIDE EFFECTS
  • Sedation
  • Orthostatic hypotension
  • Atropine-like side effects
  • Lower seizure threshold
  • Serotonin syndrome
  • Black box warning: suicidal thinking in children, adolescents, and young adults
  • Hypertensive crisis
  • Serotonin syndrome
  • Black box warning: suicidal thinking in children, adolescents, and young adults
CONTRAINDICATIONS AND CAUTIONS
  • Administration within 14 days of MAOIs
  • Pheochromocytoma
  • Cerebrovascular diseases
  • Severe hepatic / renal impairment
  • Dietary: avoid
    • tyramine-rich food or drinks
    • foods containing phenylalanine
    • caffeine
NURSING CONSIDERATIONS: ANTIDEPRESSANTS (TCAs, MAOIs)
CLASS
TCAs
MAOIs
ASSESSMENT AND MONITORING
All antidepressants
  • Baseline assessment of depressive symptoms; continue during antidepressant therapy
  • Monitor for suicidal thoughts, especially during the first few weeks
TCA
  • Mental status
  • Baseline and periodic ECG
MAOI
  • Mental status
  • Baseline renal and hepatic
  • Signs of hypertensive crisis
CLIENT EDUCATION
All antidepressants
  • Therapeutic effects can take 1–3 weeks
  • Take medication exactly as prescribed
  • Report any changes in symptoms or suicidal thoughts to health care provider
TCA
  • Make position changes slowly to manage orthostatic hypotension
  • Manage anticholinergic side effects with sugar free gum, or candies; sips of water; fiber, fluids, physical activity;  before taking the medication
  • Take medication in evening; avoid hazardous activities to manage sedative effects
MAOI
  • Make position changes slowly to manage orthostatic hypotension
  • Avoid tyramine-rich foods; also foods containing tryptophan, phenylalanine
  • Seek medical attention for symptoms of hypertensive crisis

Transcript

Antidepressants are medications primarily used to treat major depressive disorder, which is a condition associated with a persistent feeling of sadness and loss of interest in everyday activities.

Even though the exact cause of major depressive disorder is still unknown, there's some evidence that suggests that it’s related to low levels of neurotransmitters called monoamines, which include serotonin, norepinephrine, and dopamine.

In this video, we’re going to cover two of the main classes of antidepressants: tricyclic antidepressants and monoamine oxidase inhibitors.

First, let’s focus on tricyclic antidepressants or TCAs for short, which can be further subdivided into tertiary or non-selective TCAs, like amitriptyline, imipramine, and clomipramine; and secondary or selective TCAs, such as desipramine and nortriptyline.

Now, tricyclic antidepressants are taken orally, and once absorbed into the bloodstream, they travel to the brain. Here, TCAs inhibit the reuptake of serotonin and norepinephrine.

Sources

  1. "Pharmacology: A Patient-Centered Nursing Process Approach (8e)" Elsevier Health Sciences (2014)
  2. "Mosby's 2021 Nursing Drug Reference (34e)" Mosby (2021)
  3. "Saunders Comprehensive Review for the NCLEX-RN® Examination (7e)" Saunders (2016)
  4. "Focus on Nursing Pharmacology" LWW (2019)
Elsevier

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