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Tricyclic Antidepressants Cheat Sheet by

Amitriptyline antidepressant




Is medica­tion's block reuptake of norepi­nep­hrine and serotonin in the synaptic space, thereby intens­ifying the effects of these neurot­ran­smi­tters.
It can take 10 to 14 days or longer before TCAs begin to work, and maximum effects might not be seen until 4 to 8 weeks.

Therap­eutic Uses and Other Uses

Therap­eutic Uses
Other Uses
Neurop­athic pain
Depressive episodes of bipolar disorders
Anxiety disorders
Obsessive Compulsive disorder
Attention deficit/ hypera­ctivity disorder
Bipolar disorder


Nursing Action and Education
Orthos­tatic Hypote­nsion
Monitor blood pressure and heart rate for clients in the hospital for orthos­tatic changes before admini­str­ation and one hour after. If a signif­icant decrease in blood pressure or increase in heart rate is noted, do not administer the medica­tion, and notify the provider. Be aware of the effects of postural hypert­ension (light­hea­ded­ness, dizzin­ess). If these occur, advise the client to sit or lie down. Orthos­tatic hypote­nsion is minimized by changing positions slowly. Avoid dehydr­ation, which increases the risk for hypote­nsion.
Antich­oli­nergic Effects: Dry mouth, blurred vision, photop­hobia, urinary hesitancy or retention, consti­pation, tachyc­ardia.
Minimize affects by chewing sugarless gum, sipping on water, wearing sunglasses went outdoors, eating foods high in fiber, partic­ipating in regular exercise, increasing fluid intake to at least 2 to 3 L a day from beverage and food sources, void just before taking medica­tion. Notify the provider if effects persist
Sedation (Usually diminishes over time)
Avoid hazardous activities (driving) if sedation is excessive. Take medication at bedtime to minimize daytime sleepiness and to promote sleep.
Toxicity (resulting in cholin­ergic blockade and cardiac toxicity evidenced by dysrhy­thmias, mental confusion, and agitation, followed by seizures, coma, and possible death.)
Obtain baseline ECG, monitor vital signs freque­ntly, monitor manife­sta­tions of toxicity, notify the provider if manife­sta­tions of toxicity occur.
Decreased seizure threshold
Monitor clients who have seizure disorders
Excessive swetting
Be aware of adverse effects. Preform frequent linen changes

Contra­ind­ica­tions/ Precau­tions

TCAs are pregnancy risk category C. These medica­tions are not generally recomm­ended for use during breast­feeding or pregnancy.
Contra­ind­icated in clients who have seizure disorders for recently experi­enced a myocardial infarc­tion.
Use cautiously in clients who are elderly or who have coronary artery disease, diabetes, liver, kidney, or respir­atory disorders, urinary retention or obstru­ction, angle closure glaucoma, benign prostate hyperp­lasia, and hypert­hyr­oidism.
Clients at an increased risk for suicide should receive a one week supply of medication at a time due to the lethality of a toxic dose


Concurrent use with MAOIs and St. John's Wort can lead to serotonin syndrome
Concurrent use with MAOIs can cause severe hypote­nsion
Antihi­sta­mines and other antich­oli­nergic agents have additive antich­oli­nergic effects
Increased effects of epinep­hrine, dopamine occur because uptake to the nerve terminals is blocked by TCAs
Alcohol, benzod­iaz­epines, opioids, and antihi­sta­mines can cause additive CNS depression when used concur­rently


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