Antidepressants Classification and FDA Black Box Warning

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What is the primary reason the nurse practitioner needs to be alert for an energizing effect when prescribing tricyclic antidepressants (TCAs) for a patient with depression and suicidal ideation?

The energizing effect may indicate the medication is not working effectively.

The energizing effect may lead to increased physical activity and restlessness.

The energizing effect may contribute to sufficient neurocognitive activation to follow through with a suicidal plan. (correct)

The energizing effect may cause the patient to become more impulsive and reckless.

Which of the following is a common anticholinergic adverse effect associated with tricyclic antidepressants (TCAs)?

Nausea and vomiting

Drowsiness

Dry mouth (correct)

Orthostatic hypotension

Why should tricyclic antidepressants (TCAs) be used with extreme caution, if at all, in older adults?

Older adults are more sensitive to the sedative effects of TCAs.

Older adults are more likely to experience adverse drug interactions with TCAs.

Older adults are more likely to experience weight gain as a side effect of TCAs.

Due to their anticholinergic and norepinephrine effects, TCAs can contribute to confusion, orthostatic hypotension, and falls in older adults. (correct)

Which of the following is a significant drug interaction that can increase the plasma level of a tricyclic antidepressant (TCA) and the risk of cardiotoxicity?

Concurrent use of selective serotonin reuptake inhibitors (SSRIs) (C) Signup and view all the answers

Which of the following tricyclic antidepressants (TCAs) is specifically noted for its efficacy in treating obsessive-compulsive disorder (OCD)?

Clomipramine (A) Signup and view all the answers

Which of the following is a common reason that some tricyclic antidepressants (TCAs) are more commonly used for insomnia than for depression?

Some TCAs, especially secondary and tertiary amines, contribute to significant drowsiness as a side effect. (D) Signup and view all the answers

What is the potential effect of concurrent use of tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs)?

Increased risk of hyperpyrexia (high fever) (B) Signup and view all the answers

Which of the following tricyclic antidepressants (TCAs) is specifically mentioned as being useful for the treatment of neuropathic pain?

Amitriptyline and imipramine (B) Signup and view all the answers

What is the recommended maximum daily dosage of amitriptyline (Elavil) for the treatment of depression in adults?

120 mg/day (A) Signup and view all the answers

Which of the following drug interactions with tricyclic antidepressants (TCAs) can lead to increased prothrombin time?

Concurrent use of dicumarol (B) Signup and view all the answers

What neurotransmitters do Tricyclic Antidepressants (TCAs) act on?

Serotonin and Norepinephrine (A) Signup and view all the answers

Why are Tricyclic Antidepressants (TCAs) considered less safe in treating depression in those at high risk for suicide?

Overdose of TCAs can be fatal (A) Signup and view all the answers

Which organ is primarily responsible for the first-pass metabolism of Tricyclic Antidepressants (TCAs)?

Liver (B) Signup and view all the answers

Why should Tricyclic Antidepressants (TCAs) be used with caution in patients with glaucoma?

They block acetylcholine (B) Signup and view all the answers

What is the primary reason Tricyclic Antidepressants (TCAs) are contraindicated in patients with cardiovascular disorders?

They prolong the QRS complex (B) Signup and view all the answers

Which Pregnancy Category are Tricyclic Antidepressants (TCAs) classified under?

Category C (C) Signup and view all the answers

What common side effect is associated with abrupt discontinuance of Tricyclic Antidepressants (TCAs)?

Nausea (B) Signup and view all the answers

Which of the following neurotransmitters does Loxapine, an active metabolite of amoxapine, act on?

Dopamine (C) Signup and view all the answers

What effect do Tricyclic Antidepressants (TCAs) have on cardiac conduction?

They prolong the QRS complex (B) Signup and view all the answers

Why are baseline ECG and periodic monitoring recommended when prescribing Tricyclic Antidepressants (TCAs)?

To monitor cardiac effects (C) Signup and view all the answers

What is the maximum daily dose of amoxapine (Asendin) for adults and children over 16 years old?

400 mg/d (C) Signup and view all the answers

For clomipramine (Anafranil) in children and adolescents, what is the maximum daily dose?

3 mg/kg/d or 200 mg, whichever is smaller for adolescents (D) Signup and view all the answers

What is the maximum daily dose of desipramine HCl (Norpramin) for adults?

300 mg/d (B) Signup and view all the answers

Which of the following is NOT an indication for the use of tricyclic antidepressants (TCAs)?

Hypertension (B) Signup and view all the answers

What information should be obtained prior to prescribing TCAs, according to the text?

Patient and family history of suicide and cardiovascular disease (B) Signup and view all the answers

What should be done with older adults when prescribing TCAs?

TCAs should be used with caution with older adults (D) Signup and view all the answers

What monitoring should be done when prescribing TCAs?

A preliminary ECG with QT correction should be done and repeated after 3 weeks (D) Signup and view all the answers

What should be monitored carefully during the first month after initiating TCAs?

Suicidal ideation (B) Signup and view all the answers

If a patient develops dry mouth while taking TCAs, what should be advised?

Use sugarless candy or gum (C) Signup and view all the answers

If constipation develops while taking TCAs, what should be advised?

Increase fluid and fiber intake, and use a bulk-forming agent or stool softener (C) Signup and view all the answers

What are the five main classes of antidepressants identified in the text?

Tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), monoamine oxidase inhibitors (MAOIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and atypical antidepressants (A) Signup and view all the answers

Which age group is most likely to experience an increased risk of suicidal thoughts and behavior when taking antidepressants?

Teenagers and young adults up to age 24 (B) Signup and view all the answers

What is the primary mechanism of action for the novel antidepressants ketamine and LY3020371 described in the text?

They increase the number of active dopamine-producing cells and increase biogenic amines in the prefrontal cortex (D) Signup and view all the answers

What is the main reason the text emphasizes for monitoring patients closely for suicidal ideation and behavior when prescribing antidepressants?

Depression and other serious psychiatric illnesses are themselves important causes of suicide (B) Signup and view all the answers

What is the current status of the novel antidepressant LY3020371 described in the text?

It is undergoing animal studies to further investigate its antidepressant effects (C) Signup and view all the answers

What is the primary route of administration for ketamine when used as an antidepressant?

Both oral and IV (A) Signup and view all the answers