psychdrugs.txt

• block D2 receptor (typicals only D2, atypicals 5HT2A also)
• lower seizure threshold (only clozapine known to induce seizures)
• potentially prolong QTc
• atypicals augment partial responders to SSRI's

weight gain, sedation

orthostasis, cardiac arrhythmias

delirium, blurred vision, xerostomia (dry mouth), constipation, urinary retention

(remember: mad as a hatter, blind as a bat, dry as a bone, red as a beet, hot as a hare)

nigrostriatal pathway, too little DA

• acute dystonia
• akathisias (subjective sense of restlessness)
• parkinsonism
• tardive dyskinesia
• neuroleptic malignant syndrome (NMS- altered MS, rigidity, hyperthermia, autonomic dysfunction)

relief of depression and anxiety

decrease libido (long-term), insomnia (long-term), headache and jitteriness (temporary)

GI upset (N/V/D) - temporary

sustained muscle contractions causing twisting and repetitive movements or abnormal postures (1 week)

• Benztropine (Cogentin) -anti-cholinergic
• Diphenhydramine (Benadryl)- anticholinergic

Subjective sense of restlessness, need to move

• beta blockers (propranolol)
• Benzos (calming effect)
• anti-cholinergic

bradykinesia, rigidity, tremor, postural instability (couple weeks)

change offending medication

involuntary movements usually the mouth (3-6 months)

none (might be permanent), switch meds

altered MS, rigidity, hperthermia, autonomic dysfunction, increased CK

IV fluids (supportive), dantrolene (muscle relaxant), bromocriptine (DA agonist)

• Haldol
• Typical, first generation
• High potency, low HAM action
• high incidence of EPS
• available in decanoate shots

• Prolixin
• Typical, 1st gen
• High potency, low HAM
• high incidence of EPS
• available in decanoate shots

• Trilafon
• Typical, 1st gen
• Mid potency, mix of SE's
• (not really important to know details)

• Thorazine
• Typical, 1st gen
• Low potency, high HAM (orthostasis, sedating)
• avoid in elderly (falls)

• Zyprexa
• Atypical, 2nd gen
• worst for metobolic SE, sedating

• Risperdal
• Atypical, 2nd gen
• binds tightly (most "typical" of atypicals)- EPS
• 2nd worst for metabolic syndrome (of our list)
• available in decanoate (Risperdal Consta)

• Seroquel
• Atypical, 2nd gen
• extremely sedating, causes orthostasis
• middle of the pack as far as metabolic SE's
• used for sleep also

• Geodon
• Atypical, 2nd gen
• specifically worry about QT prolongation
• least metabolic SE's

• Abilify
• Atypical, 2nd gen
• partial D2 agonist (novel MOA)
• least metabolic SE's

• Clozaril
• Atypical, 2nd gen
• most effective and most dangerous
• risks: aplastic anemia, seizures, cardiomyopathy, hypotension (also drooling)
• good for TD
• (this and lithium are the only two drugs known to decrease suicide)

• MAOI A&B
• very powerful
• drug-drug interactions
• too much NE--> malignant HTN (drug-food interactions, avoid tyramine)
• too much 5HT--> serotonin syndrome (2 wk wash out from other anti-depressants)
• (don't use with demerol)

• MAOI B
• very powerful
• drug-drug interactions
• available as a patch
• too much NE--> malignant HTN (drug-food interactions, avoid tyramine)
• too much 5HT--> serotonin syndrome (2 wk wash out from other anti-depressants)
• (don't use with demerol)

• Clinical presentation (Usually present with 6 hours of administration or change of drug):
• Mental status changes: anxiety, delirium, restlessness, and disorientation.
• Autonomic changes: diaphoresis, tachycardia, hyperthermia, hypertension, vomiting,
• diarrhea.
• Neuromuscular hyperactivity: tremor, muscle rigidity, myoclonus, hyperreflexia,
• bilateral babinski.
• Lab features: Elevated WBCs, elevated CPK, decreased serum bicarb. Rarely may
• progress to DIC, rhabdomyolysis, metabolic acidosis, renal failure, ARDS.

Treatment:Discontinue all serotonergic agents, stabilize vitals, Sedate with benzos, Give serotonin antagonist (cyproheptadine)

• Elavil
• TCA
• 5HT and NE
• most lethal in overdose (TdP, cardiotoxicity)
• high SE profile (*anti-cholinergic*, anti-histamine)
• pain syndromes

• TCA
• mostly 5HT
• lethal in overdose (TdP, cardiotoxicity)
• high SE profile (*anti-cholinergic*, anti-histamine)
• OCD

• TCA
• Mostly 5HT
• lethal in overdose (TdP, cardiotoxicity)
• high SE profile (*anti-cholinergic*, anti-histamine)
• enuresis

• TCA
• mostly NE
• lethal in overdose (TdP, cardiotoxicity)
• high SE profile (*anti-cholinergic*, anti-histamine)
• elderly depression

• Effexor
• SNRI
• Pro-5HT at doses up to 150mg; Pro-NE btwn 150-300mg
• SE's of 5HT (GI, etc) and NE (HTN)
• lowest protein binding
• good for comorbid pain syndromes

• Cybalta
• SNRI
• (equal increase in 5HT and NE with increasing dose, unlike venlafaxine)
• SE's of 5HT (GI, etc) and NE (HTN)
• good for comorbid pain syndromes

• Celexa
• SSRI
• 5HT SE's (2A/C (Sexual dysfunction, insomnia), 3/4(GI))

• Lexapro
• SSRI
• 5HT SE's (2A/C (Sexual dysfunction, insomnia), 3/4(GI))

• Prozac
• SSRI
• 5HT SE's (2A/C (Sexual dysfunction, insomnia), 3/4(GI))
• Longest 1/2 life (least risk of discontinuation syndrome)

• Luvox
• SSRI
• 5HT SE's (2A/C (Sexual dysfunction, insomnia), 3/4(GI))
• Hepatic Failure

• Paxil
• SSRI
• 5HT SE's (2A/C (Sexual dysfunction, insomnia), 3/4(GI))
• shortest 1/2 life (high risk of discontinuation)

• Zoloft
• SSRI
• 5HT SE's (2A/C (Sexual dysfunction, insomnia), 3/4(GI))

• BuSpar
• partial 5HT1A agonist
• primarily for GAD, also as adjunctive to primary antidepressant

• Wellbutrin, Zyban
• NDRI
• lowers seizure threshold
• potentially makes anxious/jittery
• good for craving, bad for psychosis, no sexual SE's

• Remeron
• alpha2 antagonist
• acts by modulating 5HT and NE via autoreceptors
• only med that increases secretion of monoamines
• very H1 at low doses (good for sleep)
• no sexual SE's, significant weight gain (good for low appetite)

• Serzone
• SARI (5HT antagonist and reuptake inhibitor)
• 5HT2 antagonist , partial 5HT1A agonist
• fatal hepatitis

• SARI (5HT antagonist and reuptake inhibitor)
• 5HT2 antagonist , partial 5HT1A agonist
• dose too high for antidepressant effects so used as a sleeping agent
• priapism

• Mood Stabilizer
• therapeutic range= .8-1.2
• SEs: neurotoxicity, hypothyroid, DI, leukocytosis, GI, tremor
• Teratogenicity: Ebsteins Anomaly
• Metabolism: Renal

• Mood Stabilizer
• therapeutic range= 8-12
• SEs: Autoinducer at liver (increase cyp3A4), S/J rash, CBC abnl, acute hepatitis
• Teratogenicity: Craniofacial Defects
• Metabolism: Hepatic

• Mood Stabilizer
• therapeutic range= 80-120
• SEs: hepatitis, CBC abnl (decr platelets), sedation, wt gain, acute pancreatitis, acne, alopecia
• Teratogenicity: Ebsteins Anomaly
• Metabolism: Neural Tube Defects

• Lamictal
• good for prevention of depression in Bipolar
• no level needed
• S/J rash

• Xanax
• Benzo (short t1/2 6-12hrs)
• another short acting- midazolam (versed)

• Ativan
• Benzo, intermediate t1/2
• liver safe

• Serax
• Benzo, short t1/2
• liver safe

• Restoril
• Benzo, short t1/2
• liver safe

• Klonopin
• Benzo, long t1/2

• Valium
• Benzo, long t1/2
• active metabolites

• Benzo receptor antagonist
• good for benzo OD