Neuroscience Pharmacology

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Fluoxetine

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SSRI

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Sertaline

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SSRI

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Paroxetine

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SSRI

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Fluvoxamine

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SSRI

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Vilazodone

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SSRI

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Pros and Cons of SSRI

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Pros: Effective in 60-70%, ease of dosing, broad comorbidity coverage, lower side effects than TCA, safer in overdos
Cons: Nausea and headaches, orgasmic dysfunction, interactions with tryptophan, MAOI, fenfluramine, weight gain

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Buproprion

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Mixed Monoamine Re-uptake inhibitor
Action: weak NA/DA reuptake inhibition
Pros: Efficacy like SSRI, less sexual side effects, smoking cessation, weight loss
Cons: insomnia, nausea, seizures, drug interactions

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Venlafaxine

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Mixed Monoamine Reuptake Inhibitor
Action: 5-HT reuptake inhibitor with NA inhibition at higher doses
Pros: Higher remission rates
Cons: Lots of side effects

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Duloxetine

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Mixed Monoamine Reuptake Inhibitor
Action: Dual NA and 5-HT reuptake Inhibitor
Pros: Higher remission, pain syndromes, no increase in BP
Cons:Insomnia, Nausea, urinary retention.

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Trazodone

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Monoamine Receptor Antagonist
Sleep aid, not usually for depression bc of drowsiness

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Nefazodone

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Monoamine receptor antagoinist
Mechanism: Antagonist of post synaptic 5-HT2 receptor; Weak and transient 5-HT and NA reuptake inhibitor

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Mirtazapine

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Mechanism of action: central presynaptic a-2 adrenonergic autoreceptors on NA nuerons and heterorceptors on 5-HT neurons; 5-HT2 and 5-HT3 antatgonist.
Pros: unique pharmacology, ease of dosing, lower orgasmic dysfunction, can be combined with SSRI
Cons: Somnolence, weight gain

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Amitryptyline

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TCA - Primary

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Imipramine

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TCA - Primary

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Clomipramine

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TCA - Primary

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Doxepin

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TCA - Primary

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Nortriptyline

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TCA - Secondary

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Despramine

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TCA - Secondary

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Maprotiline

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TCA - Tertracyclics

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Tricyclic Antidepressants (mechanism)

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mechanism: MAO-inhibition of NA and 5-HT reuptake transporteres
Irreversbly Inhibit MAO-A and MAO-B, Enhancing synaptic levels of all three monoamines

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Tricyclics Pros and Cons

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Pros: effective in 60-70%; some patients with atypical depression may respond better
cons: food restrictions, orthostatic hypotension, weight gain, sexual dysfunction, potentially lethal drug interactions

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Valproate

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anticonvulsants

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Carbamazepine

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anticonvulsants

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Lamotrigine

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anticonvulsants

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Lithium: mechanism of action

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Increase 5-HT and Ach function
Decrease DA function
Decrease Pl turnover
Decrease adenylate cyclase activity

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Lithium: Pros and Cons

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Pros: efficacy in mania established with largest supporting database; Response predictors known
Cons: Poor Tolerance, Decrease patient acceptance, Narrow therapeutic index. Tremor, neurocongnitive effects, weight gain, renal toxicity, nausea, acne

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Lithium toxicity

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Impaired concentration, irritability, muscle weakness, tremor, slurred speech
Disorientation, confusion, drowsiness, restlessness
Severe: Impaired consciousness, delirium, ataxia, general fasciculations

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Divalproex mechanism; pros and cons

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Mechanism: Increase GABA synthesis and release, Decrease GABA catabolism, Increase effects of GABA at receptor, regulator of PKC activity

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Clozapine

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atypical neuroleptics

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olanzapine

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atypical neuroleptics

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risperidone

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atypical neuroleptics

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quetiapine

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atypical neuroleptics

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atypical neuroleptics mechanism in treating bipolar

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effective in acute mania
superior to conventional neuroleptics with respect to adverse effect
possibly heterogeneous mechanism of action and clinical effects with respect to each other
Limitations: limited long term data, adverse effects (like weight gain), agressive marketing push

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Carbamazepine

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Mechanism: Decrease NE, DA, GABA, adenylate cyclase activity; block adenosine receptors
Pros: efficacy in mania establish, well tolerated
Cons? efficacy in prophylaxis; Ataxia and neurocognitive effects, weight gain, nausea, hair loss, etc

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Lamotrigine

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Anti-depressant for Bipolar Disorder
Inhibits release of excitatory amino acids (glutamate)
Pros: efficacy in preventing bipolar depression relapse, well tolerated
Cons: ? efficacy in actue bipolar depression, can develop Steven's Johnson Rash (fatal)

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Long acting benzo

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diazapam

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lorazapam

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short acting benzo

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Carbamazepine

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Anticonvulsant, use with alcohol withdrawl

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Atenolol

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Adrenergic

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Disease presenting with confusion, ataxia, memory loss, confabulation, personality change

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Wernicke-Korsakoff Syndrome, Thiamine deficiency, caused by hemmhorage and necrosis of mammilary bodies

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Disulfiram

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Aldehyde dehydrogenase inhibitor;
Drinking makes you sick (hypotension, nausea, vomiting, vasodilation)

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Naltrexone

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Opiate Antagonist-Blocks reward pathway
Works better if pt has increased craving, family history of alcholism, genetic factors that increase B endorphin binding

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Acamprosate

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Glutamate receptor moduclator (Glutamate antagonist and GABA agonist).
Helps restore normal balance
Cons: bad bioavailability, us trials show no benefit

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Topiramate

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Antieptyleptic that can help reduce alcohol dependence

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Baclofen

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GABA-B agonist. helps reduce

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Most serious side effect of alcohol withdrawl

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Delirium Tremors: life threatening, peaks 2-5 days
Symptons:
Autonomic hyperactivity (tachycardia, tremors, anxiety, seizures), psychotic symptoms (hallucinations, delusions) and confusion.
treatment is Benzos

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Symptons:
Autonomic hyperactivity (tachycardia, tremors, anxiety, seizures), psychotic symptoms (hallucinations, delusions) and confusion.

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Delirium Tremors, alcohol withdrawal.

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Buspirone

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Generalized Anxiety Disorder, 5-HT1A agonist

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B antagonists can be used from what anxiety disorder

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social anxiety, reduces tremors and tachycardia

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Augmenting agents for OCD with SSRIs

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Clonazepam (benzo)
Haloperidol and Risperidone (neruoleptics, antipsychotics)

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Surgery options for OCD

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Anterior cingulatonomy
Anterior Capsulotomy

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clozapine

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Atypical antipsychotic, watch for agranulocytosis, cardiomyopathy, myocarditis, weight gain,
BUT very effective

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olanzapine

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atypical antipsychotic, weight gain is an issue

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Aripirazole

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atypical antipsychotic, less weight gain

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Haloperidol

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high potency typical antipsychotic

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Fluphenazine

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high potency typical antipsycotic

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Chlorprimazine

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Low potency typical antipsychotic

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atomoxetine

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For treating ADHD

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methylphenidate

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ritalin, treats ADHD

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dextroamphetamine

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treats ADHD

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pemoline

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ADHD, liver function tests every 2 weeks

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Bromocriptine

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Dopamine Agonist

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Pramipexole

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Dopamine Agonis

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Ropinerole

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Dopamine Agonist

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L-Dopa pros and cons

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Pros: works best, cheap, fast
Cons: drug induced movement complications, dyskinesias (looks like Corea)

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Dopamine Agonists prs and cons

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Pros: no long term side affects
Cons: acute side effects, cost, need for L-Dopa