Drug Class:Tricyclic Antidepressants Prototype (Generic/Trade): Amitriptyline

hydrochloride, Tofranil

Medications in this Class:
Psychotherapeutic, Tricyclic Antidepressant

Mechanism of Action/Drug Effects:
Correcting the imbalance in the neurotransmitter concentrations of serotonin and norepinephrine at the nerve endings in the CNS. Block the
presynaptic reuptake of the neurotransmitters, which makes them available for transmission of nerve impulses to adjacent neurons in the brain.
Indications:
Depression, neuropathic pain syndromes and insomnia. Bedwetting, OCD, anorexia.

Contraindications:
MAOIs, acute, or chronic cardiac issues, seizures

Adverse Effects: Sedation, orthostatic hypotension, constipation, dry mouth, urine retention
Toxicity Management/Overdose: No antidote, activated charcoal, sodium bicarb

Interactions: CNS depressants, alcohol, antihypertensives, barbiturates, anticoagulants

Dosages: : PO 25-75 mg per day, may gradually increase to 150-300 mg per day

Nursing Considerations:
Assessment History: Hypersensitivity to tartrazine; significant renal or CV disease; severe debilitation, dehydration; sodium depletion,
patients on diuretics; protracted sweating, diarrhea; suicidal or impulsive patients; infection with fever; pregnancy; lactation Physical: Weight
and T; skin color, lesions; orientation, affect, reflexes; ophthalmic examination; P, BP, R, adventitious sounds; bowel sounds, normal output;
normal fluid intake, normal output, voiding pattern; thyroid, renal glomerular and tubular function tests, urinalysis, CBC and differential, baseline
ECG Interventions Give with caution and daily monitoring of serum lithium levels to patients with renal or CV disease, debilitation, or
dehydration or life-threatening psychiatric disorders. Give drug with food or milk or after meals. WARNING: Monitor clinical status
closely, especially during initial stages of therapy; monitor for therapeutic serum levels of 0.61.2 mEq/L. Individuals vary in their reponse to
this drug; some patients may exhibit toxic signs at serum lithium levels considered within the therapeutic range. Advise patient that this drug
may cause serious fetal harm and cannot be used during pregnancy; urge use of barrier contraceptives. Decrease dosage after the acute
manic episode is controlled; lithium tolerance is greater during the acute manic phase and decreases when manic symptoms subside.
WARNING: Ensure that patient maintains adequate intake of salt and adequate intake of fluid (2,5003,000 mL/day).