Alzheimer’s Delirium and Dementia Q 47
Which of the following best explains why tricyclic antidepressants are used with caution in elderly patients?
A. Central Nervous System effects
B. Cardiovascular system effects
C. Gastrointestinal system effects
D. Serotonin syndrome effects
Correct Answer: B. Cardiovascular system effects
The TCAs affect norepinephrine as well as other neurotransmitters and thus have significant cardiovascular side effects. Therefore, they are used with caution in elderly clients who may have increased risk factors for cardiac problems because of their age and other medical conditions. TCAs may also cause cardiovascular complications, including arrhythmias, such as QTc prolongation, ventricular fibrillation, and sudden cardiac death in patients with preexisting ischemic heart disease. Therefore, the examination of a patient’s cardiac health is important before TCA prescription.
Option A: TCAs may cause mild liver enzyme elevation; however, acute hepatitis rarely has an association with the use of tricyclic antidepressants. TCA use has shown to lead to an increased risk of suicidal ideation and behavior in individuals aged 24 or less. Therefore, individuals started on TCAs that are age 24 or less should be followed closely to assess for thoughts and behaviors related to suicide.
Option C: 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.
Option D: Serotonin syndrome is a potentially life-threatening condition precipitated by the use of serotonergic drugs. It may be a consequence of therapeutic medication use, accidental interactions between medications or recreational drugs, or intentional overdose. Symptoms can range from mild to fatal and classically include altered mental status, autonomic dysfunction, and neuromuscular excitation.