NAPLEX Practice Question # 40

NAPLEX Examination.

Practice Question # 40.



Tertiary amine TCA

TCAs may be considered for patients with a history of response to TCAs, patients refractory to other medications, or patients with comorbidities that might benefi t from TCAs, such as neuropathic pain and migraines.

(b) TCAs can be lethal in overdose and should not be used in patients with suicidal ideations. Additionally, TCAs should be avoided or used with caution in patients with cardiovascular conditions, closed-angle glaucoma, urinary retention, or severe prostate hypertrophy.


Tetracyclic Antidepressents

Mechanism of action.   

TCAs produce their antidepressant eff ect by inhibiting the reuptake of 5-HT and NE. TCAs also have eff ect at -adrenergic, histamine, and cholinergic receptors. Tertiary and secondary amines have equal potency in blocking NE reuptake. Tertiary amines possess greater potency for blocking 5-HT reuptake and greater affi nity for these other receptors.

Adverse effects.

Several adverse eff ects exist for TCAs and may diff er between agents, depending on their affi nity for -adrenergic, cholinergic, and histamine receptors

(a) Tertiary amine TCAs have been associated with a higher risk of causing anticholinergic adverse eff ects (blurred vision, constipation, urinary retention, dry mouth), sedation, weight gain, and orthostatic hypotension than secondary amine TCAs. Elderly patients may experience memory impairment and confusion due to anticholinergic eff ects of this medication class. Anticholinergic-induced delirium may be seen in overdose.

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