Psych Meds

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Psychopharmacology 4

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antipsychotics
antidepressant
stimulants for mood disorders
anxiolytics (sedatives/hypnotics)

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mechanism of action: Anti psychotics

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Dopa mine antagonists (D2 receptors)

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Classes Anti psychotics

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Typical Anti psychotics (antagonist D2 only)

Risperidone ( antagonist D2 and 5HTZ)

Atypical Anti psychotics (antagonist D2, D4, 5 HTZ)

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Typical Anti psychotics

high potency

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high- ( haloperidol)

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haloperidol

mechanism of action

when used

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Typical

Dopa mine antagonists (D2 receptors)
high potency
acute agitation

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chlorpromazine

mechanism of action

when used

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Typical Anti psychotics

Dopa mine antagonists (D2 receptors)
low potency
acute agitation

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risperidone

mechanism of action

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atypical antipsychotics

Dopa mine antagonists (D2 and 5HTZ receptors)

Treats schizophrenia and certain problems caused by bipolar disorder.

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aripiprazole

generic name

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abilify

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clozapine
generic name
class
mechanism of action
use
warning

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clozaril
atyipical antipsychotic
Dopa mine antagonists (D2, D4 and 5HTZ receptors)
Treats schizophrenia. Also lowers the risk of suicidal behavior in patients who have schizophrenia or schizoaffective disorder.
Low white blood cell count (can increase risk of infection)

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olanzapine

generic name
class

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( zyprexa)
atypical anti psychotic
Dopa mine antagonists (D2, D4 and 5HTZ receptors)
psychotic mental disorders, such as schizophrenia or bipolar disorder (manic-depressive illness).

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Quetiapine

generic name
class
mechanism of action
use
warning

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Seroquel
atypical anti psychotic
Dopa mine antagonists (D2, D4 and 5HTZ receptors)
Treats schizophrenia and symptoms of bipolar disorder (manic-depressive illness). Used together with other medicines to treat major depressive disorder (MDD).

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Ziprasidone

use

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geodon

Treats schizophrenia and certain problems caused by bipolar disorder.

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2 meds prescribed for acute agitation at any time

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haloperidol, zipraxidone

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antipsychotics when prescribed -4

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1. psychotic disorders - schizophrenia, delusion
2. acute agitation at any time
3. major depressive disorders or Bipolar disorder, as adjunctive therapy to SSRI ( esp ariprazole ( abilify) )
4. movement disorders involving basal ganglia dopaminegic system ( huntingtons disease, tourette syndrome)

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an atypical antipsychotic - good for persons with depressive symptoms

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aripripazole

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atypical antipsychotic

DO NOT USE AS FIRST LINE - due to agranulocytosis

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clozapine

side effect

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atypical antipsychotic

causes prolongation of QT interval

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Zipraxidone

side effect

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atypical does not bock D4, good for elderly patients ( less sedation)
Rise and shine

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Risperidone

why its good

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common side effect in atypical anti psychotics

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WEIGHT GAIN

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adverse effect typical anti psychotic

secondary to dopamine blockade

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1. nigostridal - extrapyramidal symptoms ( TD, NMS, akathisia.

2. Tubuloinfindibular: increased prolactin: galactorrhea, gynecomastia, amenorrhea

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adverse effect typical anti psychotic

secondary to antihistamine properties

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sedation

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adverse effect typical anti psychotic

secondary to alpha1 adrenegic properties

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hypotension

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extrapyramidal symptoms and management( TD, NMS, akathisia)

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most significant adverse effect of antipsychotics especially TYPICAL

acute dystonia- comes on within hours to days of treatment.
s/s: torticolis, oculogyric crisis, widespread muscular spasm
tx- anticholinergics ( diphenhydramine, benzotropine)

2. akathisia (comes on months after treatment)
s/s - restlessness tremors
tx - monitor dosage closely, lower dosage, change to atyipical if possible

3. tardive dyskinesia ( irreversible)
s/s- involuntary movent of the facial muscles, jaw, chorea

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adverse effect typical anti psychotic

secondary to anticholinergic properties

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constipation, dry mouth, dry eyes, bradycardia

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extrapyramidal symptoms and management

medical emergency

lab

tx

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NMS

hyperthermia, muscular ridgity, cramps, tremor, severe hypotension or hypertensio, tachycardia, delirium, agitation.

lab will have increased cpk, elevated white count

tx- immediate dc of treament, start iv dantrolene, hydration, cooling

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Typical Anti psychotics

low potency

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low - ( chlorpromazine)

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ariprazole

class
mechanism of action
use

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atypical anti psychotic
Dopa mine antagonists (D2, D4 and 5HTZ receptors)

Treats schizophrenia, bipolar disorder, and depression. Also treats irritability associated with autism.

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antidepressant

mechanism of action

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all cause increased availability of serotonin

SSRI ( safest)
TCA- no more 2 week supply, suicide overdose
MAOI

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stimulants for mood disorders

mechanism of action

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modafinil ( provigil)

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anxiolytics (sedatives/hypnotics)

mechanism of action

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benzodiazepines

non benzos

GABA

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adverse effect SSRi

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sedation, sexual, reduction in apetite, diarhrea

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adverse effect TCA

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orthostatic hypotension, overdose suicide

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adverse effect MAOIs

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hypertentive crisis

tyramine foods

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hypersomnia

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wellbutrin ( bupropion)- but keep in mind that also increases the risk of seizure

so try effexor ( which does not increase the risk of seizures)