Psychiatric Drugs and Medications Q 40
The nurse performs an initial assessment and nursing history with a client admitted for a major depression. The client has a history of narrow-angle glaucoma. The nurse’s best action would be to:
A. Encourage the client to use his or her own eye drops until the drops can be ordered.
B. Administer the TCA as orders, and expect an ophthalmology consult.
C. Administer the TCA as ordered, and monitor for visual changes.
D. Inform the physician of the client's history before administering the TCA.
Correct Answer: D. Inform the physician of the client’s history before administering the TCA.
Narrow-angle glaucoma is a contraindication for use of TCAs; therefore, the physician should be informed so that an alternative category can be used. TCA use requires caution in individuals with angle-closure glaucoma as its anticholinergic effects may increase the risk of an acute ocular crisis.
Option A: Tricyclic antidepressants e.g., clomipramine, imipramine, amitriptyline, and selective serotonin reuptake inhibitors (SSRI) e.g., venlafaxine, citalopram, escitalopram, fluoxetine, and paroxetine have been reported to precipitate acute angle-closure glaucoma.
Option B: The underlying mechanism is a pupillary block caused by pupil dilatation, which is attributed to the significant anticholinergic and serotonergic side effects of these antidepressants. The role of serotonin in human ocular physiology however has yet to be determined. Clinicians should consider referring patients at increased risk of acute angle-closure glaucoma for an ophthalmic assessment prior to prescribing SSRIs.
Option C: Antidepressants containing monoamine oxidase inhibitors such as tranylcypromine sulphate or phenelzine sulphate have weak anticholinergic effects. However, they have been reported to precipitate acute angle-closure glaucoma when used in combination with other anticholinergic drugs.