Upload
sunel
View
77
Download
10
Embed Size (px)
DESCRIPTION
To help remember commonly used psychiatric drugs
Citation preview
PSYCHIATRIC PHARMACOLOGY
Receptor typeEffects of psychiatric drugsReceptor type
Dopamine (D2)Antagonists antipsychotic effect, relief of + symptoms of schizophrenia, extrapyramidal symptoms, increased prolactin levelsSerotonin 3 (5-HT3)
Serotonin 1A (5-HT1A)Agonists antidepressant & anxiolytic effectsAlpha-1 adrenergic (-1)
Serotonin 2A (5-HT2A)Antagonists improvement in neg symptoms of schizophrenia and improved cognitionHistamine (H1)
Serotonin 2C (5-HT2C)Antagonists weight gain and associated risksMuscarinic (m1)
Class & MOAGeneric AgentBrandInfo
SSRIs: inhibit reuptake of serotonin as well as slight effects on histamine-R, 1-R, and muscarinic-RFluoxetineProzac
-Longest half-life = highest risk for serotonin syndrome-Many drug interactions-Most stimulating SSRI-Lowest weight gain = good for eating disorders
-AEs: GI, CNS, sexual, sedation, fatigue, dry mouth, hypotension, withdrawal if d/c abruptly, prolonged QT, rash, insomnia, asthenia, seizure, tremor, somnolence, mania, suicidal ideation, worsened depression-Risk of serotonin syndrome: shivering, hyperreflexia, myoclonus, ataxia, n/v/d
CitalopramCelexa-Low risk of sexual AEs
EscitalopramLexapro
FluvoxamineLuvox
SertralineZoloft-Few drug interactions-Highest risk of GI problems
ParoxetinePaxil-Shortest half-life = highest risk of d/c symptoms-Most sedating SSRI and greatest weight gain and greatest sexual AEs-Greatest anticholinergic activity
SNRIs: inhibits reuptake of both serotonin and norepinephrineVenlafaxine (ER avail)Effexor-HTN-Sedating-Equally effective as SSRIs for treating major depression-May be more effective in the setting of diabetic neuropathy, fibromyalgia, msk pain, stress incontinence, sedation, fatigue, and patients with comorbid anxiety-AEs: GI, HTN, CNS, permanent sexual?, diaphoresis, dizziness, fatigue, insomnia, blurred vision, suicidal ideation, dysuria, worsened depression-Fewer drug interactions
DuloxetineCymbalta-Less AEs than venlafaxine-Works well for fibromyalgia-Good for sleep and pain
DesvenlafaxinePristiq
Atypical AntidepressantsBupropionWellbutrin
-May increase sexual function-Has stimulant effects = good for comorbid ADHD or for helping quit smoking but dont use if comorbid anxiety or eating disorder-AEs: lower seizure threshold, insomnia, nervousness, agitation, anxiety, tremor, arrhythmias, HTN, tachycardia, S-J, weight loss, GI, arthralgia or myalgia, confusion, dizziness, HA, psychosis, suicidal ideation
Mirtazapine
Remeron-Less nausea and sexual AEs-Overdose is generally safe-AEs: the most sedating antidepressant (= good for insomnia!), weight gain, orthostatic hypotension, dizziness, dry mouth
NefazodoneSerzone
Trazodone
Oleptro-AEs: arrhythmia, hyper or hypotension, diaphoresis, GI, hemolytic anemia, leukocytosis, dizziness, HA, insomnia, lethargy, memory impairment, seizure, somnolence, priapism, weight gain
Class & MOAGeneric AgentBrandInfoClass & MOA
Tricyclic Antidepressants: inhibits reuptake of both serotonin and norepinephrineAmitriptylineElavil
-Good for sleep, pain, and depression
-AEs: anticholinergic, CV, CNS, weight gain, sexual dysfunction, decreased seizure threshold-CV effects: orthostatic hypotension, conduction disturbance, cardiotoxicity consider EKG prior to initiation-Overdose can be lethal
ClomipramineAnafranil
DesipramineNorpramin-Least sedating
DoxepinSilenor
ImipramineTofranil
NortriptylinePamelor
MAOIs: block destruction of monoamines centrally and peripherallyPhenelzineNardil-Irreversible-MAO-A acts on norepinephrine and serotonin-MAO-B acts on phenylethylamine and DA-AEs: anticholinergic, lower seizure threshold, weight gain, rash, orthostasis, sexual dysfunction, insomnia or somnolence, HA, HTN crisis in presence of monoamines-Must be on tyramine-free diet = no wine, beer, cheese, aged food, or smoked meats-Overdose is lethal-2 week washout period of other antidepressants needed before starting in order to prevent serotonin syndrome
TranylcypromineParnate-Irreversible
SelegilineEmsam (transdermal)-Reversible
Mood StabilizersCarbamazepineTegretol-MOA: antiepileptic; inhibits voltage-gated Na channels-AEs: diplopia, dizziness, drowsiness, nausea, Stevens-Johnson (dont use in Asians), hypoCa, hypoNa, SIADH, hematologic, hepatitis monitor CBC, LFTs, mental status, bone density, levels-Contraindicated with bone marrow depression-Decreases effectiveness of OCPs and warfarin-Pregnancy D
ValproateDepakeneDepakote-MOA: antiepileptic; increases GABA-AEs: GI upset, sedation, unsteadiness, tremor, thrombocytopenia, palpitations, immune hypersensitivity, ototoxicity monitor CBC and LFTs and levels-Contraindicated with liver disease-Many drug interactions-Pregnancy D
LamotrigineLamictal-MOA: blocks voltage-gated Na channels and inhibits glutamate release-AEs: nausea, diplopia, dizziness, unsteadiness, HA, rash, Stevens-Johnson, hematologic, liver failure-Overdose can be fatal-Interaction with valproate-Pregnancy C
LithiumEskalithLithobid-Inhibits adenylate cyclase-AEs: diabetes insipidus, cognitive complaints, tremor, weight gain, sedation, diarrhea, nausea, hypothyroidism-Many drug interactions-Requires baseline BMP, TSH, EKG, Ca as well as monitoring of BMP and TSH q 6-12 mo-Monitoring for signs of toxicity: nausea, tremor, polyuria, thirst, weight gain, diarrhea, cognitive impairment-Need to monitor levels -Pregnancy D for neural tube defects
GabapentinNeurontin-AEs: somnolence, dizziness, ataxia, fatigue, leukopenia, weight gain, Stevens-Johnson
Class & MOAGeneric AgentBrandInfo
Benzodiazepines: GABA-R agonists CNS inhibitionChlordiazepoxideLibrium-Long-acting-Used often during EtOH withdrawal
ClorazepateTranxene-Long-acting
DiazepamValium-Long-acting
FlurazepamDalmane-Long-acting
AlprazolamXanax-Intermediate acting-Approved for panic disorder
ClonazepamKlonopin-Intermediate acting-Approved for panic disorder
LorazepamAtivan-Intermediate acting
TemazepamRestoril-Intermediate acting
OxazepamSerax-Short acting
TriazolamHalcion-Short acting
Other AnxiolyticsBuspironeBuSpar-5-HT partial agonist-Gradual onset in 2 weeks-Does not potentiate effects of alcohol = useful in alcohols-Low addiction potential = good for pts who were addicted to benzos or other drugs-AEs: sexual, dizziness, nausea, HA-Drug interactions
Typical Antipsychotics: nonselective DA-R antagonistsHaloperidol (inj avail)Haldol-Good for acute agitation as onset is 30 min
FluphenazineProlixin
PerphenazineTrilafon
ThioridazineMellaril-AE: retinitis pigmentosa-Less risk of EPSEs
ChlorpromazineThorazine-Less risk of EPSEs
Atypical Antipsychotics: block postsynaptic DA-R, block serotonin-R, variable effect on histaminic and cholinergic-R
AripiprazoleAbilify
Asenapine (SL tablet avail)Saphris-Costs $$$
Olanzapine (inj avail)ZyprexaZyprexa Relprevv (inj)-High risk of weight gain and metabolic syndrome-Injectable can cause post-injection delirium must give at healthcare facility and monitor for 3 hours
QuetiapineSeroquel-Need q 6 month eye exams due to risk of cataracts
RisperidoneRisperdalConsta (inj)-Least amount of AEs-Highest risk of hyperprolactinemia
ZiprasidoneGeodon-AE: dose-related QT prolongation-Less wt gain
Clozapine
Clozaril-The only atypical antipsychotic proven effective in treatment of schizophrenia-Use limited by AEs: high risk of weight gain and metabolic syndrome, seizures, agranulocytosis, myocarditis, lens opacities need to monitor WBC and ANC frequently
IloperidoneFanapt-Costs $$$-Not proven better than other atypical antipsychotics
LurasidoneLatuda-Best choice for reversing metabolic effects
Paliperidone (inj avail)InvegaInvega Sustenna (inj)
Management of Psychiatric Drug Adverse Effects
Dystonias-Benztropine-Biperiden-Diphenhydramine-Trihexyphenidyl
Akathisias = restlessness-Propranolol-BenzosParkinsonianism-Amantadine-Levodopa
Extrapyramidal Symptoms-Parkinsonian syndrome, acute dystonias, akathisia-Benztropine-Benadryl