Psych Pharm

  1. TCAs - actions / uses
    inhibit the reuptake of NE and 5HT. rarely 1st line because of SE and lethality of OD

    Used in: OCD, Panic, PTSD, IBS, Neuropathic pain, Migraines, insomnia
  2. TCA examples
    Imipramine (Tofranil), Amitriptykine (Elavil), Trimipramine (Sumontil), Doxepin (sinequan)
  3. TCA SEs
    • (anti HAM)
    • 1. antiHistamine -> sedation
    • 2. antiAdrenergic -> CV, orthostatic hypoTN (most life threatening), tachycardia, arrhythmias
    • 3. antiMuscarinic -> dry mouth , constipation, urinary retention, blurred vision, tachy
    • 4. Weight gain
    • 5. Lethal OD
    • Major complications - 3C's: convulsions, coma, cardiotoxicity
  4. TCA toxicity
    WIDENED QRS (>100 msec)

    tx OD = IV sodium bicarb
  5. Nortriptyline (Pamelor)
    TCA, least likely to cause orthostatic HypoTN
  6. Desipramine (Norpramin)
    TCA - least sedating, least anticholinergic SEs
  7. Clomipramine (Anafranil)
    TCA - most serotonin specific -> used in tx of OCD
  8. MAOI's - actions
    • prevent inactivation of amines like NE, 5HT, DA, tyramine (tyrosine -> NE)
    • MAOI -A deactivates 5HT
    • MAOI-B deactivates NE/Epi
    • Both deactivate DA/tyramine
  9. MAOI's - uses
    • Panic d/o
    • Eating d/o
    • Social Phobia
  10. MAOI's - examples
    Phenelzine (Nardil), tranylcypromine (Parnate) isocarboxazid (marplan)
  11. MAOI's - SEs
    • 1. common = orthostatic hypotn, drowsiness, weight gain, sexual dysfunctions, dry mouth, sleep dysfunctions
    • 2. Serotonin syndrome
    • 3. HYPERTENSIVE CRISIS = MAOI's + sympathomimetics OR tyramine rich foods (wine/cheese/meat) cause an increase in stored catecholamines,
  12. serotonin syndrome
    SSRI + MAOI -> lethargy, restlessness, confusion, flushing, diaphoresis, tremor, myoclonic jerks...

    can progress to hyperthermia, hypertonicity, rhabdo, renal failure, convulsions, coma, death

    ***why you should wait 2 wks before switching from SSRI to MAOI
  13. SSRI's - action and uses
    inhibit presynaptic serotonin pumps

    • most commonly used because of decreased SE's , no food restrictions, safer in OD
    • OCD, Panic, Eating d/o. Dysthymia, social phobia, PTSD, IBS, Migraines, Autism, PMDD, Depression in manic depression
  14. Fluoxetine (Prozac)
    SSRI's - longest half-life with active half-life, don't need to taper
  15. Sertraline (Zoloft)
    highest risk for GI disturbances
  16. Paroxetine (Paxil)
    SSRI's - serotonin specific, most activating (stimulant)
  17. Fluvoxamine (Luvox)
    SSRI - only OCD
  18. Citalopram (Celexa)
    SSRI, also Escitalopram (Lexapro)
  19. SSRI's -SE
    Fewer because 5HT specific:

    Sexual dysfunction (25-30%), GI, Insomnia, HA, Anorexia, weight loss, serotonin syndrome (w/ MAOI's)
  20. Venlafaxine (Effexor)
    SNRI's - treat refractory depression and CAP

    SE's like SSRI's plus increase BP

    w/drawl sxs - seen with 1-3 missed doses = flu-like sxs and electric shocks/zaps
  21. Bupropion (Wellbutrin)
    NDRI's - tx seasonal affective d/o, ADHD

    SE's + like SSRI's plus increased sweating and increase risk seizures and psychosis. (+) no sexual SE's

    not in pts with seizures, actie eating d/o, on MAOI's
  22. Nefazodone (Serzone) and Trazodone (Desyrel)
    SARI's - tx refractory depression, major depression with anxiety, and insomnia

    SE's = nausea, dizziness, orthostatic hypotn, cardiac arrythmias, sedation, priapism
  23. Mirtazapine (Remeron)
    NASA - (NE and 5HT antagonist) - tx refractory major depression (esp if pt needs weight gain)

    SE - sedation, weight gain, dizziness, somnolence, tremor, agranulocytosis

    Dosage - max sedation at < 15 mg (> 15 = NE effects)
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Psych Pharm
Psych Pharm