AMITRYPTILINE

Question 1

Drug class

Answer 1

Tricyclic antidepressant

Question 2

How does it work? (4)

Answer 2

1. inhibit neuronal reuptake of serotonin and nordrenaline from the synaptic cleft
2. this increases their availability for neurotransmission
3. consequently improving mood in depression
4. and improving neuropathic pain

Question 3

Indications (2)

Answer 3

1. moderate to severe depression

2. neuropathic pain

Question 4

Contra-indications (4)

Answer 4

1. Elderly
2. CVD
3. Head

• epilepsy
• raised intra-occular pressure

4. GI/ Urological

• prostate hypertrophy
• constipation

Question 5

Side effects (4)

Answer 5

1. block anti-muscarinic receptors

• dry mouth
• constipation
• urinary retention
• blurred vision

2. Blockage of H1 and alpha 1 receptors

• sedation
• hypotension

3. ECG changes
   - prolongation of QT and QRS
4. Brain

• convulsions
• hallucinations
• mania

Question 6

What happens in overdose? (4)

Answer 6

1. BP
   - severe hypotension
2. heart
   - arrhythmias
3. resp
   - reap failure
4. brain

• convulsions
• coma

Question 7

What happens in sudden withdrawal of amitryptiline? (4)

Answer 7

1. GI upset
2. neurological
3. influenza like symptoms
4. sleep disturbance

Question 8

Interactions and why?

Answer 8

1. monoamine oxidase inhibitors

• both increase serotonin and NA levels at synapse
• precipitates hypertension and hyperthermia or serotonin syndrome

Question 9

Eliminations (2)

Answer 9

1. faeces

2. bile