Comprehensive exams for Mental Health Q 159
Isabel with a diagnosis of depression is started on imipramine (Tofranil), 75 mg by mouth at bedtime. The nurse should tell the client that:
A. This medication may be habit-forming and will be discontinued as soon as the client feels better.
B. This medication has no serious adverse effects.
C. The client should avoid eating such foods as aged cheeses, yogurt, and chicken livers while taking the medication.
D. This medication may initially cause tiredness, which should become less bothersome over time.
Correct Answer: D. This medication may initially cause tiredness, which should become less bothersome over time.
Sedation is a common early adverse effect of imipramine, a tricyclic antidepressant, and usually decreases as tolerance develops. Since imipramine acts on various receptors in the body, it presents with adverse effects on some organs and systems. In the central and autonomic nervous system, the antihistaminic effects of imipramine can lead to dizziness, sedation, confusion, delirium, seizures, increased appetite, and weight gain.
Option A: Antidepressants aren’t habit forming and don’t cause physical or psychological dependence. However, after a long course of high-dose therapy, the dosage should be decreased gradually to avoid mild withdrawal symptoms. It is highly recommended to closely monitor patients for their clinical condition, their response to the medication, and during periods of dose adjustment. Family and caregivers should be encouraged to observe their patients and to contact their psychiatrist if needed. The therapeutic index of TCAs is narrow. Therefore, regular drug monitoring is required to ensure the therapeutic blood level and, at the same time, to avoid toxic effects of imipramine.
Option B: Serious adverse effects, although rare, include myocardial infarction, heart failure, and tachycardia. Extreme precautions are necessary, especially in a patient with cardiovascular disease, including conduction defects, tachycardia, acute myocardial infarction, and hepatic impairment. When coadministering imipramine with a MOAI, it can lead to fatal hypertensive crises or seizures. When imipramine is co-ingested with SSRI, it can cause serotonin syndrome.
Option C: Dietary restrictions, such as avoiding aged cheeses, yogurt, and chicken livers, are necessary for a client taking a monoamine oxidase inhibitor, not a tricyclic antidepressant. The risk of developing toxicity from imipramine and other tricyclics is greater upon increasing the dose. An overdose of imipramine can result in serious side effects, mainly cardiac dysrhythmia, critical hypotension, convulsions, coma, confusion, hyperactive reflexes, and hypothermia. Imipramine has type 1 antiarrhythmic effects as it blocks the fast sodium channel on the myocardium. Therefore, this will lead to inhibition of depolarization of the heart action potential, which will result in QRS prolongation, which can lead to cardiac arrhythmia.