Tricyclic Antidepressants and its Therapeutic Actions
三环抗抑郁剂及其治疗作用
The tricyclic antidepressants (TCAs), including the amines, secondary amines, and tetracyclics, all reduce the reuptake of 5HT and NE into nerves. Because all TCAs are similarly effective, the choice of TCA depends on individual response to the drug and tolerance of adverse effects. A patient who does not respond to one TCA may respond to another drug from this class. TCAs that are available include the amines amitriptyline (generic), amoxapine (Asendin), clomipramine (Anafranil), doxepin (Sinequan), imipramine (Tofranil), and trimipramine (Surmontil); the secondary amines desipramine (Norpramin), nortriptyline (Aventyl, Pamelor), and protriptyline (Vivactil); and the tetracyclic drug maprotiline (generic).
The TCAs inhibit presynaptic reuptake of the neurotransmitters 5HT and NE, which leads to an accumulation of these neurotransmitters in the synaptic cleft and increased stimulation of the postsynaptic receptors. The exact mechanism of action in decreasing depression is not known but is thought to be related to the accumulation of NE and 5HT in certain areas of the brain.
TCAs are indicated for the relief of symptoms of depression. The sedative effects of these drugs may make them more effective in patients whose depression is characterized by anxiety and sleep disturbances. They are effective for treating enuresis in children older than 6 years. Some of these drugs are being investigated for the treatment of chronic, intractable pain. In addition, the TCAs are anticholinergic. Clomipramine is now also approved for use in the treatment of obsessive–compulsive disorders (OCDs).
amine – n. 胺
secondary amine – n. 仲胺
tetracyclic – a. n. 四环（药）
amitriptyline – n. 阿米替林
amoxapine – n. 阿莫沙平
Asendin – n. 氯氧平
clomipramine – n. 氯米帕明
Anafranil – n. 安那芬尼
doxepin – n. 多塞平
Sinequan – n. 神宁健
imipramine – n. 丙咪嗪
Tofranil – n. 托法尼
trimipramine – n. 曲米帕明
Surmontil – n. 苏蒙第尔
desipramine – n. 地昔帕明
Norpramin – n. 诺波明
nortriptyline – n. 去甲替林
Aventyl – n. 阿凡替尔
Pamelor – n. 帕米乐
protriptyline – n. 普罗替林
Vivactil – n. 新米替林
maprotiline – n. 马普替林
presynaptic – a. 突触前的
postsynaptic – a. 突触后的
postsynaptic receptors – 突触前受体
OCDs -- obsessive–compulsive disorders – 强迫性障碍
★Video ★
Antidepressants 2
★Test ★
1. The client is admitted to the chemical dependence unit with an order for continuous observation. The nurse is aware that the doctor has ordered continuous observation because:
A. Hallucinogenic drugs create both stimulant and depressant effects.
B. Hallucinogenic drugs induce a state of altered perception.
C. Hallucinogenic drugs produce severe respiratory depression.
D. Hallucinogenic drugs induce rapid physical dependence. 2. A client with mania is unable to finish her dinner. To help her maintain sufficient nourishment, the nurse should:
A. Serve high-calorie foods she can carry with her.
B. Encourage her appetite by sending out for her favorite foods.
C. Serve her small, attractively arranged portions.
D. Allow her in the unit kitchen for extra food whenever she pleases.
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答案 Key to Questions
1. A: Serve high-calorie foods she can carry with her. Rationale: The client with mania is seldom sitting long enough to eat and burns many calories for energy. Answer B is incorrect because the client should be treated the same as other clients. Small meals are not a correct option for this client. Allowing her into the kitchen gives her privileges that other clients do not have and should not be allowed, so answer D is incorrect. 2. B: Hallucinogenic drugs induce a state of altered perception. Rationale: Hallucinogenic drugs can cause hallucinations. Continuous observation is ordered to prevent the client from harming himself during withdrawal. Answers A, C, and D are incorrect because hallucinogenic drugs don’t create both stimulant and depressant effects or produce severe respiratory depression. However, they do produce psychological dependence rather than physical dependence.
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