Tricyclic Antidepressant (TCA) Toxicity

IMPORTANT: It is best to refer to your local hospital protocol for management of TCA toxicity or call DPIC . The below resource should be used to support your learning. 

Emergency Care BC

• Overview of management of TCA toxicity including pathophysiology, expected presentation and treatment recommendations

1. Which mechanism is primarily responsible for tachycardia?

a) Antihistaminic effects 

b) Sodium channel blockade 

c) Alpha-adrenergic blockade

d)  Anticholinergic effects

2. Which of the following is NOT a clinical finding consistent with TCA toxicity? 

a) Seizures

b) Prolonged QRS

c) Clammy skin 

d)  Hypotension

3. What agent is recommended for the management of TCA induced seizures? 

a) Benzodiazepine

b) Glucose

c) Phenytoin

d)  Sodium bicarbonate

4.  True or false - Activated charcoal can bind TCAs?

a) True

b) False

5. Which of the following agents is recommended for widened QRS associated with TCA toxicity? 

a) Sodium bicarbonate infusion

b) Sodium bicarbonate bolus

c) Anti-arrhythmic  

d) IV fluids