A depressed older adult client is being treated with a tricyclic antidepressant (TCA). Which side effects are important to assess for?

Choice A reason: Pseudoparkinsonism and tardive dyskinesia are side effects of antipsychotics, not TCAs, due to dopamine blockade in the basal ganglia. TCAs primarily affect serotonin and norepinephrine reuptake, causing anticholinergic and cardiovascular effects, not extrapyramidal symptoms. Choice B reason: Diarrhea and electrolyte imbalance are not common TCA side effects. TCAs’ anticholinergic properties cause constipation, not diarrhea, and do not significantly disrupt electrolyte balance. Their primary effects involve serotonin and norepinephrine modulation, leading to other systemic effects. Choice C reason: TCAs like amitriptyline cause orthostatic hypotension via alpha-1 adrenergic blockade and urinary retention due to anticholinergic effects on bladder muscles. These result from altered autonomic signaling, impacting cardiovascular and urinary systems, making them critical side effects to monitor in older adults. Choice D reason: Photosensitivity and skin rashes are rare with TCAs. Their primary side effects stem from anticholinergic and adrenergic blockade, affecting cardiovascular and urinary function, not dermatological reactions, which are more common with other drug classes like antipsychotics.