Usmle - Psych Drugs

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Methylphenidate

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Ritalin; increases presynaptic NE vesicular release (like amphetamines). However, the mechanism for relieving ADHD symptoms is unknown.

Used clinically for ADHD.

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Clonidine

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Alpha 2 adrenergic antagonist usually used to lower blood pressure; given to ADHD patients on methylphenidate if they cannot sleep at night.

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Modafinil

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Stimulant used for narcolepsy.

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Haloperidol

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High potency antipsychotic; blocks dopamine D2 receptors (increases cAMP).

Clinically used for schizophrenia (primarily positive symptoms), psychosis, acute mania, Tourette's syndrome, delirium, dementia, PCP or other drug toxicities to decrease agitation.

Toxicity includes extrapyramidal system side effects, endocrine side effects (galactorrhea), side effects arising from blocking muscarinic (dry mouth, constipation), alpha (hypotension), and histamine (sedation) receptors. Neuroleptic malignant syndrome and tardive dyskinesia.

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Trifluoperazine

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High potency antipsychotic; blocks dopamine D2 receptors (increases cAMP).

Clinically used for schizophrenia (primarily positive symptoms), psychosis, acute mania, Tourette's syndrome, delirium, dementia, PCP or other drug toxicities to decrease agitation.

Toxicity includes extrapyramidal system side effects, endocrine side effects (galactorrhea), side effects arising from blocking muscarinic (dry mouth, constipation), alpha (hypotension), and histamine (sedation) receptors. Neuroleptic malignant syndrome and tardive dyskinesia.

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Fluphenazine

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High potency antipsychotic; blocks dopamine D2 receptors (increases cAMP).

Clinically used for schizophrenia (primarily positive symptoms), psychosis, acute mania, Tourette's syndrome, delirium, dementia, PCP or other drug toxicities to decrease agitation.

Toxicity includes extrapyramidal system side effects, endocrine side effects (galactorrhea), side effects arising from blocking muscarinic (dry mouth, constipation), alpha (hypotension), and histamine (sedation) receptors. Neuroleptic malignant syndrome and tardive dyskinesia.

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Thiothixene

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High potency antipsychotic; blocks dopamine D2 receptors (increases cAMP).

Clinically used for schizophrenia (primarily positive symptoms), psychosis, acute mania, Tourette's syndrome, delirium, dementia, PCP or other drug toxicities to decrease agitation.

Toxicity includes extrapyramidal system side effects, endocrine side effects (galactorrhea), side effects arising from blocking muscarinic (dry mouth, constipation), alpha (hypotension), and histamine (sedation) receptors. Neuroleptic malignant syndrome and tardive dyskinesia.

CAN CAUSE RETINAL DEPOSITS THAT RESEMBLE RETINITIS PIGMENTOSA.

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Thioridazine

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Low potency antipsychotic; blocks dopamine D2 receptors (increases cAMP).

Clinically used for schizophrenia (primarily positive symptoms), psychosis, acute mania, Tourette's syndrome, delirium, dementia, PCP or other drug toxicities to decrease agitation.

Toxicity includes extrapyramidal system side effects, endocrine side effects (galactorrhea), side effects arising from blocking muscarinic (dry mouth, constipation), alpha (hypotension), and histamine (sedation) receptors. Neuroleptic malignant syndrome and tardive dyskinesia.

RETINAL DEPOSITS

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Chlorpromazine

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Low potency antipsychotic; blocks dopamine D2 receptors (increases cAMP).

Clinically used for schizophrenia (primarily positive symptoms), psychosis, acute mania, Tourette's syndrome, delirium, dementia, PCP or other drug toxicities to decrease agitation.

Toxicity includes extrapyramidal system side effects, endocrine side effects (galactorrhea), side effects arising from blocking muscarinic (dry mouth, constipation), alpha (hypotension), and histamine (sedation) receptors. Neuroleptic malignant syndrome and tardive dyskinesia.

CORNEAL DEPOSITS

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Olanzapine

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Atypical antipsychotic; block 5-HT2, alpha, H1, and dopamine receptors.

Clinically used for schizophrenia (useful for both positive and negative symptoms). ALSO USED FOR OCD, ANXIETY DISORDER, DEPRESSION, MANIA, AND TOURETTE'S SYNDROME.

Fewer extrapyramidal and antiACh side effects than traditional antipsychotics. H1 blocking can cause sedation and weight gain. Alpha blocking can cause hypotension, sedation, and dizziness. MAY CAUSE SIGNIFICANT WEIGHT GAIN.

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Clozapine

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Atypical antipsychotic; block 5-HT2, alpha, H1, and dopamine receptors.

Clinically used for schizophrenia (useful for both positive and negative symptoms).

Fewer extrapyramidal and antiACh side effects than traditional antipsychotics. H1 blocking can cause sedation and weight gain. Alpha blocking can cause hypotension, sedation, and dizziness. MAY CAUSE SIGNIFICANT WEIGHT GAIN. MAY ALSO CAUSE AGRANULOCYTOSIS (REQUIRES WEEKLY WBC MONITORING; THIRD LINE THERAPY BECAUSE OF THIS).

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Quetiapine

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Atypical antipsychotic; block 5-HT2, alpha, H1, and dopamine receptors.

Clinically used for schizophrenia (useful for both positive and negative symptoms).

Fewer extrapyramidal and antiACh side effects than traditional antipsychotics. H1 blocking can cause sedation and weight gain. Alpha blocking can cause hypotension, sedation, and dizziness. MAY CAUSE SIGNIFICANT WEIGHT GAIN.

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Risperidone

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Atypical antipsychotic; block 5-HT2, alpha, H1, and dopamine receptors.

Clinically used for schizophrenia (useful for both positive and negative symptoms).

Fewer extrapyramidal and antiACh side effects than traditional antipsychotics. H1 blocking can cause sedation and weight gain. Alpha blocking can cause hypotension, sedation, and dizziness.

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Aripiprazole

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Atypical antipsychotic; block 5-HT2, alpha, H1, and dopamine receptors.

Clinically used for schizophrenia (useful for both positive and negative symptoms).

Fewer extrapyramidal and antiACh side effects than traditional antipsychotics. H1 blocking can cause sedation and weight gain. Alpha blocking can cause hypotension, sedation, and dizziness.

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Ziprasidone

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Atypical antipsychotic; block 5-HT2, alpha, H1, and dopamine receptors.

Clinically used for schizophrenia (useful for both positive and negative symptoms).

Fewer extrapyramidal and antiACh side effects than traditional antipsychotics. H1 blocking can cause sedation and weight gain. Alpha blocking can cause hypotension, sedation, and dizziness.

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Lithium

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Mechanism not established; possibly related to inhibition of phosphoinositol cascade (second messenger system).

Drug of choice for bipolar or mania. Mood stabilizer for bipolar disorder; blocks relapse and acute manic events. Also SIADH (due to nephrogenic diabetes insipidus effects).

Toxicity includes tremor, sedation, edema, heart block, hypothyroidism, polyuria (ADH antagonist), teratogenesis (Epstein's anomally). Narrow therapeutic window requires close watching of serum levels.

LMNOP - Lithium side effects are Movement (tremor), Nephrogenic diabetes insipidus, hypOthyroidism, and Pregnancy problems.

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Buspirone

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Stimulates 5-HT1a receptors.

Clinically used only for generalized anxiety disorder.

Does not cause sedation, addiction, or tolerance. Does not interact with alcohol. Not many side effects.

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Imipramine

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Tricyclic antidepressant; block reuptake of NE and serotonin.

Clinically used for BEDWETTING, major depression, fibromyalgia.

Side effects include sedation, alpha blocking effects, anti-ACh effects (tachycardia, urinary retention).

Toxicity includes 3 Cs: Convulsions, coma, and cardiotoxicity (arrhythmias); also respiratory depression, hyperpyrexia. Confusion and hallucinations in elderly due to antiACh side effects. CV side effects can be treated with NaHCO3.

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Amitriptyline

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Tricyclic antidepressant; block reuptake of NE and serotonin.

Clinically used for major depression, fibromyalgia.

Side effects include sedation, alpha blocking effects, anti-ACh effects (tachycardia, urinary retention).

Toxicity includes 3 Cs: Convulsions, coma, and cardiotoxicity (arrhythmias); also respiratory depression, hyperpyrexia. Confusion and hallucinations in elderly due to antiACh side effects. CV side effects can be treated with NaHCO3.

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Desipramine

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Tricyclic antidepressant; block reuptake of NE and serotonin.

Clinically used for major depression, fibromyalgia.

Side effects include sedation, alpha blocking effects, anti-ACh effects (tachycardia, urinary retention). LEAST SEDATING AND LAST LOWER SEIZURE THRESHOLD THAT OTHER TCA.

Toxicity includes 3 Cs: Convulsions, coma, and cardiotoxicity (arrhythmias); also respiratory depression, hyperpyrexia. Confusion and hallucinations in elderly due to antiACh side effects. CV side effects can be treated with NaHCO3.

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Nortriptyline

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Tricyclic antidepressant; block reuptake of NE and serotonin.

Clinically used for major depression, fibromyalgia.

Side effects include sedation, alpha blocking effects, anti-ACh effects (tachycardia, urinary retention).

Toxicity includes 3 Cs: Convulsions, coma, and cardiotoxicity (arrhythmias); also respiratory depression, hyperpyrexia. Confusion and hallucinations in elderly due to antiACh side effects. CV side effects can be treated with NaHCO3. LESS ANTI-ACH ACTIVITY AND THEREFORE BETTER FOR ELDERLY.

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Clomipramine

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Tricyclic antidepressant; block reuptake of NE and serotonin.

Clinically used for OCD, major depression, fibromyalgia.

Side effects include sedation, alpha blocking effects, anti-ACh effects (tachycardia, urinary retention).

Toxicity includes 3 Cs: Convulsions, coma, and cardiotoxicity (arrhythmias); also respiratory depression, hyperpyrexia. Confusion and hallucinations in elderly due to antiACh side effects. CV side effects can be treated with NaHCO3.

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Doxepin

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Tricyclic antidepressant; block reuptake of NE and serotonin.

Clinically used for major depression, fibromyalgia.

Side effects include sedation, alpha blocking effects, anti-ACh effects (tachycardia, urinary retention).

Toxicity includes 3 Cs: Convulsions, coma, and cardiotoxicity (arrhythmias); also respiratory depression, hyperpyrexia. Confusion and hallucinations in elderly due to antiACh side effects. CV side effects can be treated with NaHCO3.

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Amoxapine

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Tricyclic antidepressant; block reuptake of NE and serotonin.

Clinically used for major depression, fibromyalgia.

Side effects include sedation, alpha blocking effects, anti-ACh effects (tachycardia, urinary retention).

Toxicity includes 3 Cs: Convulsions, coma, and cardiotoxicity (arrhythmias); also respiratory depression, hyperpyrexia. Confusion and hallucinations in elderly due to antiACh side effects. CV side effects can be treated with NaHCO3.

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Fluoxetine

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SSRI

Clinically used for depression, OCD, bulimia, and social phobias.

Fewer side effects than TCAs - GI side effects, sexual dysfunction, "serotonin syndrome" if taken with any drug that increases serotonin. Serotonin syndrome treatment is cooling, benzos, then cyproheptadine (5-HT2 receptor antagonist).

Normally takes 2-3 weeks for antidepressants to have an effect.

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Paroxetine

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SSRI

Clinically used for depression, OCD, bulimia, and social phobias.

Fewer side effects than TCAs - GI side effects, sexual dysfunction, "serotonin syndrome" if taken with any drug that increases serotonin. Serotonin syndrome treatment is cooling, benzos, then cyproheptadine (5-HT2 receptor antagonist).

Normally takes 2-3 weeks for antidepressants to have an effect.

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Sertaline

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SSRI

Clinically used for depression, OCD, bulimia, and social phobias.

Fewer side effects than TCAs - GI side effects, sexual dysfunction, "serotonin syndrome" if taken with any drug that increases serotonin. Serotonin syndrome treatment is cooling, benzos, then cyproheptadine (5-HT2 receptor antagonist).

Normally takes 2-3 weeks for antidepressants to have an effect.

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Citalopram

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SSRI

Clinically used for depression, OCD, bulimia, and social phobias.

Fewer side effects than TCAs - GI side effects, sexual dysfunction, "serotonin syndrome" if taken with any drug that increases serotonin. Serotonin syndrome treatment is cooling, benzos, then cyproheptadine (5-HT2 receptor antagonist).

Normally takes 2-3 weeks for antidepressants to have an effect.

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Fluroxamine

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SSRI

Clinically used for depression, OCD, bulimia, and social phobias.

Fewer side effects than TCAs - GI side effects, sexual dysfunction, "serotonin syndrome" if taken with any drug that increases serotonin. Serotonin syndrome treatment is cooling, benzos, then cyproheptadine (5-HT2 receptor antagonist).

Normally takes 2-3 weeks for antidepressants to have an effect.

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Venlafaxine

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Inhibits serotonin and NE reuptake.

Clinically used for depression. ALSO USED IN GENERALIZED ANXIETY DISORDER.

Increased blood pressure is most common toxicity; also has stimulant effects, sedation, nausea.

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Duloxetine

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Inhibits serotonin and NE reuptake. Duloxetine has greater effect on NE than Venlafaxine.

Clinically used for depression.

Increased blood pressure is most common toxicity; also has stimulant effects, sedation, nausea.

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Desvenlafaxine

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Inhibits serotonin and NE reuptake.

Clinically used for depression.

Increased blood pressure is most common toxicity; also has stimulant effects, sedation, nausea.

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Nefazodone

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Inhibits serotonin and NE reuptake.

Clinically used for depression.

Increased blood pressure is most common toxicity; also has stimulant effects, sedation, nausea. NO SEXUAL SIDE EFFECTS.

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Milnacipran

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Inhibits serotonin and NE reuptake.

Clinically used for depression.

Increased blood pressure is most common toxicity; also has stimulant effects, sedation, nausea.

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Sibutramine

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Inhibits serotonin and NE reuptake.

Clinically used for depression.

Increased blood pressure is most common toxicity; also has stimulant effects, sedation, nausea.

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Tranylcypromine

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Nonselective MAO inhibition - increases levels of amine neurotransmitters.

Clinically used for atypical depression, anxiety, and hypochondriasis.

Toxicity includes hypertensive crisis with tyramine ingestion (in many foods, such as wine and cheese) and beta agonists; CNS stimulation. Contraindicated with SSRIs or meperidine (to prevent serotonin syndrome).

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Phenelzine

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Nonselective MAO inhibition - increases levels of amine neurotransmitters.

Clinically used for atypical depression, anxiety, and hypochondriasis.

Toxicity includes hypertensive crisis with tyramine ingestion (in many foods, such as wine and cheese) and beta agonists; CNS stimulation. Contraindicated with SSRIs or meperidine (to prevent serotonin syndrome).

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Isocarboxazid

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Nonselective MAO inhibition - increases levels of amine neurotransmitters.

Clinically used for atypical depression, anxiety, and hypochondriasis.

Toxicity includes hypertensive crisis with tyramine ingestion (in many foods, such as wine and cheese) and beta agonists; CNS stimulation. Contraindicated with SSRIs or meperidine (to prevent serotonin syndrome).

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Bupropion

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Atypical antidepressant; also used for smoking cessation. Increased NE and dopamine via unknown mechanism.

Toxicity includes stimulant effects (tachycardia, insomnia), headache, seizure in bulimic patients. No sexual side effects. LOWERS THE SEIZURE THRESHOLD. Works great with SSRIs.

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Mirtazapine

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Tetracyclic antidepressant; alpha 2 antagonist (increased release of NE and serotonin) and potent 5-HT2 and 5-HT3 receptor antagonist. Helps with sleep.

Toxicity includes sedation, increased appetite, weight gain, and dry mouth.

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Maprotiline

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Atypical antidepressant; blocks NE reuptake.

Toxicity includes sedation, orthostatic hypotension.

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Trazodone

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Atypical antidepressant; primarily inhibits serotonin reuptake. Used for insomnia, as high doses are needed for antidepressant effects.

Toxicity includes sedation, nausea, priapism (persistent erection), postural hypotension.

Called TrazoBONE due to male specific side effects.

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Cyproheptadine

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Treatment for "serotonin syndrome". 5-HT2 receptor antagonist.