Comprehensive exams for Mental Health Q 138
Which nursing intervention would be most appropriate if a male client develops orthostatic hypotension while taking amitriptyline (Elavil)?
A. Consulting with the physician about substituting a different type of antidepressant.
B. Advising the client to sit up for 1 minute before getting out of bed.
C. Instructing the client to double the dosage until the problem resolves.
D. Informing the client that this adverse reaction should disappear within 1 week.
Correct Answer: B. Advising the client to sit up for 1 minute before getting out of bed.
To minimize the effects of amitriptyline-induced orthostatic hypotension, the nurse should advise the client to sit up for 1 minute before getting out of bed. Amitriptyline is FDA approved medication to treat depression in adults. Secondary to its alpha-adrenergic receptor blockade, it can cause orthostatic hypotension, dizziness, and sedation. It can also cause heart rate variability, slow intracardiac conduction, induce various arrhythmias, and cause QTc (corrected QT) prolongation.
Option A: Orthostatic hypotension commonly occurs with tricyclic antidepressant therapy. Cardiac symptoms include tachycardia, hypotension, conduction abnormalities include QTc prolongation. Amitriptyline is in the tricyclic antidepressant (TCA) drug classification and acts by blocking the reuptake of both serotonin and norepinephrine neurotransmitters. The three-ring central structure, along with a side chain, is the basic structure of tricyclic antidepressants. Amitriptyline is a tertiary amine and has strong binding affinities for alpha-adrenergic, histamine (H1), and muscarinic (M1) receptors. It is more sedating and has increased anticholinergic properties compared to other TCAs.
Option C: In these cases, the dosage may be reduced or the physician may prescribe nortriptyline, another tricyclic antidepressant. Once the patient is stable, amitriptyline should be continued for three months or longer to prevent relapse of depression. In cases of therapy cessation, the clinician should gradually taper to avoid withdrawal. Amitriptyline administration comes in various forms, the most common being oral form. The initial dose recommended for depression is 25 mg/day at bedtime, as it can be sedating.
Option D: Orthostatic hypotension disappears only when the drug is discontinued. The most commonly encountered side effects of amitriptyline include weight gain, gastrointestinal symptoms like constipation, xerostomia, dizziness, headache, and somnolence. Patients on amitriptyline can have anticholinergic, antihistaminic, and alpha-adrenergic blocking effects. It may not be appropriate for patients with cardiac problems.