Notes for psych pharmacology

Benzodiazepines
Action Uses Side Effects Contraindications Interactions Drugs Note: most end in pam or lam Enhances inhibitory effect of GABA in CNS Anxiety, seizures, insomnia, muscle spasm, alcohol withdrawal, anesthesia CNS depression, amnesia, withdrawal of Benzos result in anxiety, tremors Respiratory depression, liver disease, hx of sub abuse Alcohol, barbiturates, opioids cause respiratory depression Alprazolam(Xanax) Lorazepam (Ativan) Chlordiapoxide (Librium) Oxazepam (Klonopin) Diazepam (Valium)

Atypical Anxiolytic/Nonbarbiturate anxiolytics

Action Uses Side effects Contraindications Interactions Drugs Unknown, does bind to serotonin and dopamine receptors(increases the effects) Panic, OCD, Social anxiety, PTSD Dizziness, nausea, h/a, light headedness, agitation (all CNS effects) Nursing mothers, liver/renal, MAOI use (hypertensive crisis results) Erythromycin, ketoconazole, grapefruit juice increase effects of anxiolytic Buspirone (BuSpar)

Selective Serotonin Reuptake Inhibitors (SSRIs)

Action Uses Side effects Inhibits serotonin uptake, increases the serotonin available Depression, Anxiety, Panic, OCD, Social anxiety, PTSD, Nausea, diaphoresis, tremor, sexual dysfunction, weight gain, GI bleeds, hyponatremia Important: Serotonin syndrome: agitation, confusion, hallucinations, hyperreflexia, fever, diaphoresis, usually begins 2 to 72 hours have initiation, this is lethal! Liver, renal, seziures, hx of GI bleed MAOIs or TCAs, St. johns wart all cause serotonin syndrome! Sertraline (Zoloft) Escitalopram (Lexapro) Fluoxetine (Prozac) Fluvoxamine (Luvox) Duloxetine (Cymbalta)

Contraindications Interactions Drugs

Tricyclic Antidepressants (TCAs)

Action Uses Side Effects Block reuptake of norepinephrine, serotonin (increases effects of these) Depression, depressive episodes of bipolar , chronic pain, enuresis Hypotension, anticholinergic effects(dry mouth, blurred vision, tachycardia), sedation, toxicity results in cholinergic blockade(dysrhythmias, confusion, agitation) Seizures, CAD, DM, liver/kidney, respiratory disorders, BPH, hyperthyroidism MAOIs use(cause hypertension), Antihistamines(cause added anticholinergic effects) Imipramine (Tofranil) Doxepin (Sinequan) Nortriptyline (Aventyl) Amoxapine (Asedin) Trimipramine (surmontil) Amitriptyline (Elavil)

Contraindications Interactions Drugs

Monoamine Oxidase Inhibitors (MAOIs)

Action Uses Side Effects Contraindications Interactions Drugs Block MAOA in brain, increases amount of norepinephrine, dopamine, serotonin, Atypical depression, Bulimia Nervosa, OCD CNS stimulation: anxiety, agitation, hypomania, mania. Hypotension SSRIs, Heart failure, CAD, liver/renal, Tegretol and Trileptal Dietary tyramine, ephedrine, TCAs all lead to hypertensive crisis( H/A, nausea, increased HR, increased BP) Isocarboxazid (Marplan) Tranycypromine (Parnate) Selegiline (Emsam) Phenelzine (Nardil)

Atypical Antidepressants
Action Uses Side Effects Contraindications Interactions Drugs Inhibits dopamine uptake (increases amount of dopamine), some inhibit reuptake of norepi and serotonin Depression, alternative to SSRIs, quitting smoking, SAD H/A, dry mouth, increased HR, Nausea, restlessness, insomnia Seizures, MAOIs MAOIs such as Nardil increase risk for toxicity Bupropion (Wellbutrin) Venlafaxine (Effexor) Duloxetine (Cymbalta) Mirtazapine (Remeron) Reboxetine (Edronax) Trazodone (Desyrel)

Mood Stabilizer (for bipolar)

Action Uses Serotonin receptor blockage Bipolar, acute mania, prevent returns of mania or depression, alcoholism, bulimia, schizophrenia Side Effects GI distress, Polyuria, weight gain, renal toxicity, goiter and hypothyroidism, hypotension Contraindications Breastfeeding, renal, heart disease, sodium depletion Interactions Caution with diuretics, NSAIDs lead to renal toxicity, Drugs Lithium carbonate Mood Stabilizer Carbamazepine (Tegretol) Antiepleptic drugs: Valproic acid (Depakote) Lamotrigine (Lamictal) Various actions: sodium and calcium movement in neuron and GABA inhibitory effects

Typical Antipsychotics
Action Uses Side Effects Contraindications Interactions Block dopamine, acetylcholine, histamine, norepinephrine receptors Acute and chronic psychosis, schizophrenia, bipolar, delusional and schizoaffective disorder, dementia, prevention of nausea Dystonia, parkinsonism, akathisia, extrapyramidal side effects, neuroleptic malignant syndrome, sedation, seizures, agranulocytosis, Older adults, glaucoma, paralytic ileus, prostate enlargement, CAD, liver/kidney Increase of anticholinergic effects in anticholinergic agents, increase CNS depression in CNS depressants, Levodopa: counteracts antipsychotic agents. (bc levodopa increases dopamine) Chlorpromazine (Thorazine) Haloperiodol (Haldol) Fluphenazine (Prolixin) Molindone (Moban) Loxapine (Loxitaine) Thioridazine (Mellaril) Thiothixene (Navane)

Drugs

Atypical Antipsychotics
Action Uses Side effects Contraindications Interactions Drugs Block serotonin, and to a lesser degree, dopamine. Also block norepi, histamine, and acetylcholine Negative and positive symptoms of schizophrenia, psychosis induced by levodopa therapy Weight gain, hypotension, anticholinergic effects, agitation, mild EPS Alcohol, caution in CV disease, blood glucose monitored closely Immunosuppressive meds can further suppress, levodopa counteracts antipsychotic agents, TCAs: dysrhythmias Risperidone (Risperdal) Olanzapine (zyprexa)

Quetiapine (Seroquel) Aripiprazole (Abilify) Ziprasidone (Geodon) Clozepine (Clozaril)

CNS stimulants
Action Uses Side Effects Contraindications Interactions Drugs Increase levels of norepinephrine, serotonin, dopamine, ADHD in children, Conduct disorder (effectiveness is evidenced by decreased hyperactivity) Insomnia, restlessness, weight loss, CV effects, hallucinations Hx of drug abuse, CV disorders, severe anxiety, psychosis MAOIs: hypertensive crisis, Caffeine: increased effects, increased serum levels of Dilantin and warfarin, OTC cold meds increase CNS stimulation Methylphenidate (Ritalin, Methylin) Dexmethylphenidate (Foxalin) Dextroamphetamine (dexdrine) Amphetamine Mixture (Adderall)

Norepinephrine Selective Reuptake Inhibitor

Action Uses Side Effects Contraindications Interactions Drugs Blocks reuptake of Norepi ADHD in children Appetite suppression, GI effects, Suicidal ideation, hepatoxicity CV disorders MAOIs: hypertensive crisis. Paxil, Prozac, quinidine, all inhibit metabolizing enzymes increasing amount of amoxetine toxic levels Atomoxetine (Strattera)

Drugs for Substance abuse

Alcohol withdrawal Benzos: Librium, Valium, Ativan (decrease risk of seizures and intensity of symptoms) Misc: Tegretol, Clonidine, Propranolol (decrease of seizures, depression of autonomic response, decrease in craving) Disulfiram (Antabuse): behavioral type therapy, acetaldehyde syndrome occurs when used with alcohol Naltrexone (ReVia): opioid antagonist that suppresses craving and pleasurable effects of alcohol Acamprostate (Campral): decreases withdrawal symptoms such as anxiety Methadone (Dolophine): opioid agonist that replaces the drugs Clonidine (Catapres): assists with withdrawal symptoms from autonomic hyperactivity Buprenorphine (Subutex): agonist-antagonist opioids for detox and maintenance, decrease cravings

Abstinence Maintenance from alcohol

Withdrawal/ Abstinence from Opioids

Withdrawal/ abstinence from Nicotine

Bupropion (Zyban): decreases cravings Nictotine replacement therapy: such as gum or patch