Change MS (EKGs from Nisha Chauhan, MD)































Selected TCA's (Complete List)

Amitriptyline (Tryptomer, Elavil)	Imipramine (Tofranil, Janimine, Praminil)
Desipramine (Norpramin, Pertofrane)	Nortriptyline (Pamelor, Aventyl, Norpress)
Doxepin (Adapin, Sinequan)	Protriptyline (Vivactil)

TCA Toxicity

• Inhibits Norepinephrine and Serotonin re-uptake - SEIZURES
• Anticholinergic - HOT AS A HARE, BLIND AS A BAT, DRY AS A BONE, RED AS A BEET, MAD AS A HATTER
• Alpha blockade - HYPOTENSION
• Sodium Channel Inhibition - CARDIAC EFFECTS
  

TCA inhibition of sodium channels - Cardiac Effects

• Delayed depolarization and conduction abnormalities
• Decreased contractility
• Prolonged PR
• Prolonged QRS
• RAD
• Bradycardia
• Ventricular arrhythmias

Toxicity

• Mild
• Drowsy, confused, slurred speech, ataxia
• Severe
• Within 6 hours of ingestion
• Coma, respiratory depression, Sz's
  
• SVT, hypoTN, PVC's, VTach
  

Treatment

• Bicarb
• Lidocaine
• Pressors
• Defibrillation
• Lipid Therapy
  

Good review of TCA's