Questions and Answers
What is the classification of amitriptyline?
What action does amitriptyline facilitate in the CNS?
Potentiates the effect of serotonin and norepinephrine
The starting dose for adults can be increased up to _____ mg/day for amitriptyline.
150
For geriatric patients, the usual dose range of amitriptyline is _____ to _____ mg/day.
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What route is used for administering amitriptyline?
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What are some indications for using amitriptyline?
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What is one of the serious side effects associated with amitriptyline?
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Match the following side effects of amitriptyline with the categories they fall under:
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The recommended response to a missed dose of amitriptyline is to take it as soon as possible unless it is almost time for the _____ dose.
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What should patients avoid while taking amitriptyline?
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Amitriptyline can cause dry mouth and constipation.
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Study Notes
Classification
- Therapeutic class: Antidepressants
- Pharmacologic class: Tricyclic antidepressants
Action
- Enhances serotonin and norepinephrine effects within the central nervous system (CNS)
- Exhibits significant anti-cholinergic properties
- Main therapeutic effect: Antidepressant action
Dose
- Adults: Starting dosage is 75 mg/day, may increase to 150 mg/day or use 50-100 mg at bedtime; may escalate by 25-50 mg up to a maximum of 150 mg. In hospital settings, initiation can be at 100 mg/day, possibly increasing to 300 mg.
- Geriatric patients: Starting dose of 10-25 mg at bedtime; may increase by 10-25 mg weekly as tolerated, with a usual range of 25-150 mg/day.
Route
- Administered orally (PO) for both adults and geriatric patients.
Indications
- Primarily prescribed for depression.
- Unlabeled uses include anxiety, insomnia, treatment-resistant depression, and chronic pain syndromes (such as fibromyalgia, neuropathic pain, and low back pain).
Side Effects
- CNS: Risk of suicidal thoughts, lethargy, and sedation.
- EENT: Can cause blurred vision, dry eyes, and dry mouth.
- Cardiovascular: Potential for arrhythmias, torsades de pointes, hypotension, ECG changes, and QT interval prolongation.
- Gastrointestinal: Possible constipation, hepatitis, paralytic ileus, increased appetite, and weight gain.
- Genitourinary: May lead to urinary retention and decreased libido.
- Dermatological: Photosensitivity can occur.
- Endocrine: Possible alterations in blood glucose levels and gynecomastia.
- Hematological: May cause blood dycrasias.
Toxic Symptoms
- Information pending; list of toxic symptoms not provided.
Nursing Implications
- Assess and monitor weight, BMI, fasting glucose, and cholesterol levels especially in overweight patients.
- Monitor blood pressure and pulse closely, particularly at the start of treatment; notify healthcare provider of significant changes.
- Conduct regular mental health assessments for suicidal tendencies, especially during early treatment weeks.
- Limit the quantity of medication available to the patient to reduce risk of overdose.
- In geriatric patients, start with a low dose due to increased fall risk and monitor for anticholinergic effects.
- Routine lab tests may include leukocyte counts, liver function, and serum glucose monitoring; changes in bilirubin and alkaline phosphatase levels may be observed.
Patient/Family Teaching
- Advise adherence to prescribed dosage and timing; instruct on handling missed doses.
- Inform patients of the delayed onset of effects, which may take a minimum of 2 weeks.
- Warn against abrupt discontinuation to avoid withdrawal symptoms like nausea, insomnia, and irritability.
- Caution regarding drowsiness and blurred vision; advise against driving until familiar with the drug's effects.
- Discuss common side effects, including orthostatic hypotension and sedation, highlighting the importance of making position changes slowly.
- Recommend avoiding alcohol and other CNS depressants during and for 3-7 days after therapy.
- Emphasize the need to monitor for signs of suicidality, mood changes, and other behavioral concerns; immediate reporting to the healthcare provider is necessary if these occur.
- Suggest remedies for dry mouth and constipation, such as sugarless gum and increased fluid intake.
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Description
Test your knowledge of Amitriptyline, a tricyclic antidepressant. This quiz covers key concepts such as classification, actions, and dosing information. Perfect for students studying pharmacology or healthcare professionals refreshing their knowledge.
