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What is A female treatment for depression took a massive dose of amitriptyline for suicide. Which of the following is wrong regarding management for her? and explain in detail?
Ans. c. Atropine sulphate was administered as an antidote (Ref: Reddy 28/e p524: Goodman Gilman 11/448)Tricyclic antidepressants (amitriptyline) cause anticholinergic effects such as dry skin, ileus, urinary retention etc., administration of atropine would further worsen these symptoms. Atropine is better avoided in poisoning or overdose of cyclic antidepressants.Poisoning/Overdose of Cyclic AntidepressantsMechanism of Action:Inhibition of neurotransmitter uptake leading to cholinergic and alpha-adrenergic blockadeDirect myocardial depressant effectSystemic SymptomsCNS SymptomsCVS SymptomsParasympathetic* Depression of mental state* Coma, Delirium* Altered sensorium* Generalized brief and self-limited convulsions* Myoclonus, NystagmusQ* Dysarthria, AtaxiaQ* Sinus tachycardiaQ* Conduction delays* Ventricular arrhythmias* Negative inotropic action* HypotensionQ* Dry skin and mucosaQ* IleusQ* Urinary retentionQ* MydriasisQ* HypothermiaQPoisoning/Overdose of Cyclic AntidepressantsTreatment:Gastric lavage to remove the unabsorbed drugEmesis should be avoided; Activated charcoal can be usedSymptomatic treatment:Sodium bicarbonate to treat acidosisQAnti-convulsants to treat seizures