Tag: tca

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Tricyclic Antidepressants – Test Prep and Practice Pearls

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Welcome to today’s episode on the tricyclic antidepressants, commonly known as TCAs — one of the foundational medication classes in psychopharmacology. Although newer antidepressants like SSRIs often dominate modern prescribing, TCAs remain highly relevant in clinical practice because of their effectiveness in treatment-resistant depression, chronic pain syndromes, migraine prevention, insomnia, and certain anxiety disorders. In this episode, we’ll break down the pharmacology behind these medications, discuss how tertiary amines differ from secondary amines, review major adverse effects and drug interactions, and highlight the key clinical pearls that healthcare professionals and students need to know. Whether you’re a medical, pharmacy, nursing, or PA student preparing for exams, or a practicing clinician looking for a practical refresher, this episode will give you a solid framework for understanding this classic but still clinically important medication class.

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Top 200 Drugs Podcast – Medications 61-65

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This episode is sponsored by Freed – Freed is an amazing time saver for busy healthcare professionals! It listens, transcribes, and writes medical notes for you! Go check them out and support our sponsor!

In this episode, we highlight some of the most important clinical pearls (and highly testable pearls) on the following medications; Suboxone, lisdexamfetamine, nortriptyline, insulin lispro, and valproic acid.

Suboxone is a combination of buprenorphine and naloxone used for opioid use disorder.

Lisdexamfetamine is a stimulant medication that can be used to manage ADHD. Common side effects include weight loss, insomnia, hypertension, and tachycardia.

Nortriptyline is a TCA medication known for its ability to cause anticholinergic side effects like constipation, dry eyes, dry mouth, urinary retention, and confusion.

Insulin lispro is a rapid-acting insulin medication that is most often used to bring down post-prandial blood sugar.

Valproic acid is an antiepileptic medication that can also be used for migraines.

Be sure to check out our free Top 200 study guide – a 31 page PDF that is yours for FREE!

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Doxepin Pharmacology

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Doxepin is under the class of tricyclic antidepressants. It can inhibit the reuptake of serotonin and norepinephrine.

In addition to the serotonin and norepinephrine reuptake inhibition mechanism, doxepin also has antihistamine type effects.

Because of the anticholinergic activity of doxepin, it is recommended to avoid this medication in the elderly, particularly at high doses.

Be aware that anticholinergics like doxepin can reduce the benefit of dementia medications.

CYP2D6 is an important enzyme in the metabolism of doxepin and drugs like bupropion that inhibit CYP2D6 can increase the concentrations of doxepin.

I discuss important drug interactions on the podcast, be sure to check out my latest project which is a 200+ page book on managing drug interactions in primary care.

Be sure to check out our free Top 200 study guide – a 31 page PDF that is yours for FREE!