Psychiatric Drugs (Not Specific Neuro Drugs)

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Treatment for selected psych conditions

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follow

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Alcohol Withdrawal

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benzos, support, AA

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Anxiety

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SSRIs, SNRIs, buspirone

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ADHD

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Methylphenidate, amphetamines, Ritalin

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Bipolar D/O

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Mood Stabilizers (Valproate, Li, Carbamazepine), atypical antipsychotics

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Bulimia

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SSRIs

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Depression

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SSRIs, SNRIs, buspirone, mirtazapine (especially with insomnia)

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Obsessive compulsive D/O

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SSRIs, clomipramine

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Panic D/O

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SSRIs, venlafaxine, benzos

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PTSD

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SSRIs

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Schizophrenia

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Antipsychotics

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Social phobias

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SSRIs

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Tourette's Syndrome

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antipsychotics (haloperidol, risperidone)

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CNS Stims: methylphenidate, dextroamphetamine, methamphetamine

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INCREASE CATECHOLAMINES at the synaptic cleft, especially NE/DA.

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Antipsychotics (neuroleptics)

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Haloperidol, trifluoperazine, fluphenazine, thioridazine, chlorpromazine (haldol+azines)

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MOA of Anti-psychotics? Clinical use?

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BLOCK DOPAMINE-2 RECEPTORS (increase cAMP). 2. Schizo (positive symptomes), psychosis, acute mania, tourette's

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High POTENCY AP's ?

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TRY TO FLY HIGH, Trifluoperazine, Fluphenazine, Haldol. (NEURO SIDEFX- EXTRAPYRAMIDAL SYMPTOMS)

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Low POTENCY AP's?

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Cheating Thieves are LOW- Chlorpromazine, Thioridazine. NONNEURO SIDEFX- (anticholinergic, antihistamine, antialpha1 efx)

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Chlorpromazine??? Sidefx

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Corneal deposits

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Thioridazine??? SIDEFX

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reTINal deposits

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HALDOL Sidefx?

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NMS, TARDIVE DYSKINESIA

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Evolution of EPS sidefx???

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4hr acute dystonia (muscle spasm, stiffness, oculogyric crisis); 4 day akathisia (restless); 4 wk bradykinesia (parkinsonism); 4month TD

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General Toxicity of Antipsychotics???

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High lipid solube, stored in body fat = slow body removal….endocrine: DA receptor antagonism= hyperprolactinemia/galactorrhea.

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Other TOX???

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NMS (neuroleptic malignant syndrome)- rigidity, myoglobinuria, autonomic instability, hyperpyrexia…. Tardive dyskinesia (repetitive movements, perioral bunny mouth movements)

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FOR NMS think….

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FEVER: Fever, Encephalopathy, Vitals unstable, Elevated enzymes, Rigidity of muscles

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Treating NMS??

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Dantrolene (muscle relaxant that acts by abolishing excitation-contraction coupling in muscle cells, probably by action on the ryanodine receptor) , D2 agonists (bromocriptine)

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Tardive Dyskinesia?? Sidefx tx

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often irreversible…

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ATYPICAL ANTIPSYCHOTICS??

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Olanzapine, Clozapine, Quetiapine, Risperidone, Aripiprazole, Ziprasidone.

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Mechanism of Atypicals??

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not completely understood. Efx on 5-HT2, DA, alpha, H1-receptors.

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Clinical use atypicals

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schizo (pos + neg symptoms); bipolar d/o, ocd, anxiety disorder, mania, tourettes

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Toxicity atypicals

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FEWER EPS and ANTICHOLINERGIC S/E than traditionals.

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Risperidone??

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weight gain and metabolic problems, as well as tardive dyskinesia and neuroleptic malignant syndrome…better option than CLOZAPINE.

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Weight gain with atypicals?

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Olanzapine, Clozaril (Clozapine)

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Clozapine major sidefx??

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AGRANULOCYTOSIS, Seizure

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Ziprasidone may cause what??

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QT interval prolongation

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Lithium. Uses? Tox?

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1. mood stabilizer bipolar, blocks relapse of acute mania. Also used in SIADH. 2. Tremour, sedation, edema, heart block, hypothyroidism, POLYURIA (ADH ANTAGONISM- nephrogenic DI)

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Lithium more on toxicity??

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TERATOGEN. Ebsteins anomaly, malformation of great vessels. LMNOP. Lithium sidefx= Movement (tremor) Nephrogenic d.i. hypOthyroidism Preg. Problems

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Ropinerole? (Requip)

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Ropinirole is prescribed for mainly Parkinson's disease, restless leg syndrome, and extrapyramidal symptoms. It can also reduce the side effects caused by selective serotonin reuptake inhibitors, including Parkinsonism syndrome as well as sexual dysfunction and erectile dysfunction caused by either SSRIs[4] or antipsychotics

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Restless leg syndrome options??

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Ropinerole, Gabapentin, Mirapex (pramipexole)

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Buspirone:

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Stimulates 5-HT1a receptors… Used Generalized Anxiety D/o. DOESNOT CAUSE sedation, addiction, tolerance. Takes 1-2 wks for efx. DOES NOT interact with alcohol (vs barbs, benzos).

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I'm always anxious if the BUS will be ON time.

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so I will take BUSpirONe

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SSRIs

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Fluoxetine (Prozac), Paroxetine (Paxel), Sertraline (Zoloft), Citalopram (Celexa), Lexapro (enantiomer of Citalopram)…normally take 4-8wks to take effect

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Use of SSRIs

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depression, GAD, Panic D/o, OCD, bulimia, social phobias, PTSD

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Tox:

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fewer than TCAs, GI distress, sexual dysfxn (anorgasmia, decreased libido). MOST SERIOUS: Serotonin Syndrome.

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Serotonin syndrome:

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ANY COMBO OF DRUGS INCREASING 5-HT. MAO-Ø, SNRIs, TCAs. HYPERTHERMIA, Confusion, MYOCLONUS, CVS collapse, flushing, diarrhea, seizures.

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TREATMENT OF 5-HT syndrome?

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Cyproheptadine (5-HT2 receptor antagonist)

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SNRIs

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Venlafaxine (Effexor), Duloxetine (cymbalta), 5-HT/NE reuptake inhibition. Used in depression. GAD/panic d/o. Duloxetine can help in DIABETIC PERIPHERAL NEUROPATHY.

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TOX of SNRIs

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increase BP, also stimulant efx, sedation, nausea

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TCAs

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Amitriptyline, nortriptyline, imipramine, desipramine, clomipramine, doxepin, amoxapine. Block reuptake of NE/serotonin. MAJOR DEPRESSION, fibormyalgia, bedwetting (imipramine), OCD (clomipramine)

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Tox:

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sedation, alpha1blockade efx = postural hypotension, atropine-like sidefx (antiACH- tachy, urinary retention, drymouth). 3' amitriptyline has more antiACH efx than 2' (nor). DESIPRAMINE= less sedating, but LOWERS Sz threshold

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Desipramine?

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lower sz threshold, but less sedating

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Amitryptiline??

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3' TCA. more anticholinergic effects than 2' TCA (nortriptyline)

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Tri-C's

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Convulsions, Coma, Cardiotoxicity (arrhythmia) also resp depression. Confusion/hallucination in elderly due to anticholinergic efx. TX Heart by NaHCO3

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MAOØ

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MAO Takes Pride In Shanghai. Tranylcypromine, Phenelzine, Isocarboxazid, Selegiline (MAO-B selective)

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MOA of MAO-inhibitors?

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nonselective MAO inhibition increases the levels of Amine neurotransmitters (DA, NE, Serotonin)

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Uses of MAOs?

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atypical depression, anxiety, hypochondriasis

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Tox of MAOs?

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hypertensive crisis (most notably with ingestion of tyramine (pepperoni, cheese, wine). CNS stimulation. CONTRAINDICATED: SSRIs, TCAs, St. John's Wort, meperidine, dextrmethorphan (prevents Serotonin syndrome)

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MORE ATYPICAL ANTIDEPRESSANTS:

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Bupropion, Mirtazapine, Maprotiline, Trazodone

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Bupropion

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smoking sessation, INCR NE/DA via U/K mechanism. Tox= stiumulant efx (tachy, insomnia), HA, seizure in BULIMICS) NO SEXUAL SIDEFX

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Mirtazapine

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alpha2-antagonist (incr release of NE, Serotonin) and potent 5-HT2/3 antagonist.

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Mirtazapine toxicity?

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sedation (may be nice for insomniac depressed pts), incr appetite, weight gain (may be nice for anorexic elderly patients), dry mouth

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Maprotiline

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NE reuptake inhibitor, ORTHO-HTN, Sedation

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Trazodone

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TRAZOBONE. Priapism. Blocks 5-HT reuptake. Used for insomnia as high doses are needed for antidepressant efx.

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Tox: trazobone

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sedation, nausea, priapism, Postural hypotension