Alzheimer’s Delirium and Dementia Q 42
Discharge instructions for a male client receiving tricyclic antidepressants include which of the following information?
A. Restrict sodium intake.
B. Don’t consume alcohol.
C. Discontinue if dry mouth and blurred vision occur.
D. Restrict fluid.
Correct Answer: B. Don’t consume alcohol
Drinking alcohol can potentiate the sedating action of tricyclic antidepressants. Dry mouth and blurred vision are normal adverse effects of tricyclic antidepressants. Drinking can counteract the benefits of antidepressant medication, making symptoms more difficult to treat. Alcohol may seem to improve the mood in the short term, but its overall effect increases symptoms of depression and anxiety. Many medications can cause problems when taken with alcohol — including anti-anxiety medications, sleep medications, and prescription pain medications. Side effects may worsen if you drink alcohol and take one of these drugs along with an antidepressant.
Option A: Overall, the therapeutic index of TCAs is narrow, and the therapeutic range for each specific TCA is dependent on the drug prescribed. Because of the narrow therapeutic index of TCAs, patients should be monitored closely for symptoms of toxicity, i.e., QRS-widening on electrocardiogram (ECG), tremors, confusion, muscle rigidity, and coma. Symptoms of overdose include ECG abnormalities such as QTc prolongation and widened QRS complex, hypotension, seizures, tremors, coma, xerostomia, urinary retention, and respiratory depression. Death from TCAs most commonly occurs due to hypotension or arrhythmias.
Option C: TCA use requires caution in individuals with angle-closure glaucoma as its anticholinergic effects may increase the risk of an acute ocular crisis. Additionally, TCAs should be used with caution in patients with a history of seizures, as TCAs may lower the seizure threshold, and in patients with urinary retention, as its anticholinergic properties may worsen this symptom.
Option D: TCAs have varying degrees of receptor affinities, leading to several adverse effects. The most common adverse effects include constipation, dizziness, and xerostomia. Due to its blockade of cholinergic receptors, it can lead to blurred vision, constipation, xerostomia, confusion, urinary retention, and tachycardia. Due to the blockade of alpha-1 adrenergic receptors, it can cause orthostatic hypotension and dizziness. TCA-induced histamine blockade (H1) may lead to sedation, increased appetite, weight gain, and confusion.