What do you know about  Amitriptyline?


1    is more sedative than imipramine

2    a reduced dose is recommended for older persons

3    its use in MC should be revised because of her medical   history


A    1, 2, 3

B    1, 2 only

C    2, 3 only

D    1 only

E    3 only


  1. A is the answer and the winners are Eze and Clement.
    Details below:
    Amitriptyline and imipramine are tricyclic antidepressants that have a tertiary
    amine structure. Imipramine is a dibenzazepine with a structure that is very
    similar to the phenothiazines, whereas amitriptyline is a dibenzocyclohepta-
    diene that has a structure which resembles thioxanthenes. Amitriptyline is more
    sedative than imipramine. Tolerance to this effect tends to develop with long-
    term treatment. Elderly patients may be particularly sensitive to the side-effects
    of tricyclic antidepressants and reduced doses are recommended. MC is
    taking a dose of 20 mg at night, probably to induce sleep and reduce anxiety.
    The dose is appropriate for the age group. Use of amitriptyline in MC requires
    review as its use may result in cardiotoxicity and it may alter blood-glucose
    concentrations, which may include hypoglycaemia unawareness. It may also
    cause confusion, which is a problem in MC as she also has dementia.


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