When assessing a female client who is receiving tricyclic antidepressant rapy, which of following would alert nurse to possibility that client is experiencing anticholinergic effects?

Correct Answer: A. Urine retention and blurred vision

Anticholinergic effects, which result from blockage of the parasympathetic (craniosacral) nervous system including urine retention, blurred vision, dry mouth & constipation. TCAs have varying degrees of receptor affinities, leading to several adverse effects. The most common adverse effects include constipation, dizziness, and xerostomia. Due to its blockade of cholinergic receptors, it can lead to blurred vision, constipation, xerostomia, confusion, urinary retention, and tachycardia.

• Option B: Overall, the therapeutic index of TCAs is narrow, and the therapeutic range for each specific TCA is dependent on the drug prescribed. Because of the narrow therapeutic index of TCAs, patients should be monitored closely for symptoms of toxicity, i.e., QRS-widening on electrocardiogram (ECG), tremors, confusion, muscle rigidity, and coma.
• Option C: Due to the blockade of alpha-1 adrenergic receptors, it can cause orthostatic hypotension and dizziness. TCA-induced histamine blockade (H1) may lead to sedation, increased appetite, weight gain, and confusion. TCA use has shown to lead to an increased risk of suicidal ideation and behavior in individuals aged 24 or less. Therefore, individuals started on TCAs that are age 24 or less should be followed closely to assess for thoughts and behaviors related to suicide.
• Option D: TCAs may also cause cardiovascular complications, including arrhythmias, such as QTc prolongation, ventricular fibrillation, and sudden cardiac death in patients with preexisting ischemic heart disease. Therefore, the examination of a patient’s cardiac health is important before TCA prescription. There is evidence of TCAs increasing the risk of seizures in those with epilepsy, and use requires caution in this population.