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List of psychiatric medications
Psychiatric medications used for mental illness or distress. Prescription information including Drugs class (i.e Mood Stabilizers), uses, mechanism and side-effects.
Drug Name | Class | Examples | Mechanism | Uses | Side Effects | Notes |
---|---|---|---|---|---|---|
Monoamine Oxidase Inhibitors (rarely used) | Antidepressants (60% 1st response) | Phenelzine, Tranylcypromine | Irreversible inhibition of MAO; increases norepinephrine, dopamine, serotonin | Depression | Orthostatic hypotension, hypertensive reaction to tyramine, sexual dysfunction, GI problems, edema | Iproniazid for TB, withdrawn due to hepatotox; must low tyramine diet, NO OTC cold medicines (hypertensive crises), take off other a-Depression drugs 1-2 wks, lethal OD |
Tricyclics (not used as much) | Antidepressants (60% 1st response) | Imipramine, Amitriptyine, Nortriptyline (can get bld levels), desipramine | Block reuptake of norepinephrine and serotonin only | Depression | Sedation, orthostatic hypotension, EKG changes, dry mouth, constipation (start metamucil), lethal in OD, uniquely effective in some old ppl | use after SSRI, SNRI, maybe used for chronic pain |
SSRIs | Antidepressants (60% 1st response) | Fluoxetine, Sertraline, Paroxetine, Fluvoxamine, Citalopram, Escitalopram | Block reuptake of serotonin | Depression | Headaches, GI upset, delayed ejaculation (sexual dysfunction), sedation, activation (sleep, anxiety) | 1st line of treatment, once a day dose, NOT lethal in OD |
Dual Action (SNRIs) | Antidepressants (60% 1st response) | Venlafaxine, Duloxetine, nefazodone, Bupropion (little sexual dysfxn), Mirtazapine | Block reuptake of norepinephrine, serotonin, +/- dopamine | Depression, SSRIs first, Dual action second, SSRIs - anxiety, TCAs - chronic pain | Venlafaxine (increased diastolic BP, GI distress, withdraw, stim/anxiety), Duloxetine (Gi distress, sedation, dizziness), Bupropion (stimulating, lowers seizure threshold, tachycardia/HTN, no sex dysfxn), Mirtazapine (sedating, fatness, low sex SE) | use in pts who don't respond to SSRI |
ECT | Antidepressants (60% 1st response) | increased Glu, decreased NMDA receptor fxn |   |   |   |   |
*all work via Inositol depletion, GSK-3/Wnt signaling? | Mood Stabilizers | Lithium (dec inositol) | Unknown | Acute mania, prophylaxis of mania/depression, antidepressant augmentation, maintenance | Thirst, polyuria, tremor, weight gain, hypothyroidism, interstitial nephritis, high levels (delerium, seizures, RF, dysarthria, ataxia) | measure bld lvls, NSAIDs, Thiazides increase Li level |
Anticonvulsants, Lamotrigine | Mood Stabilizers | Lamotrigine | Not given | Bipolar depression, prophylaxis of depression>mania, MAINTENANCE | Rash, Stevens-Johnson | slowly titrate drug |
Anticonvulsants, Divalproex (dec inositol) | Mood Stabilizers | Divalproex (dec inositol) | Valproic acid x 2, cleaved when ingested | Acute mania, no use in maintenance | Nausea, diarrhea, tremor, sedation, ataxia, alopecia, weight gain | measure bld levels |
Anticonvulsants, Carbamazepine (dec insotitol) | Mood Stabilizers | Carbamazepine (dec insotitol) | Tricyclic structure, unique absorption (erratic) | Acute mania, prophylaxis against relapse | Vertigo, nystagmus, ataxia, blood dyscrasias (agranulocytosis, aplastic anemia), hepatic failure, pancreatitis | measure blood levels, as autoinduces metabolism of itself, lethal od |
Classic (phenothiazine) | Neuroleptics (antipsychotics) | Fluphenazine (piperazine), Chloropromazine (some anti-hist, Cl+alkyl), Haloperidol (Pure D2 blocker, no fatness), Promazine (no Cl, Alkyl) | Blockade of dopamine receptors (extrapyramidal regions, limbic regions, hypothalamic sites) | Schizophrenia, Mania? | Parkinsonian, akathesia, tardive dyskinesia, othostatic hypotension+sedation (most in alkyl drugs, from block of a adrenergic R), weight gain | only affects positive sx's, neuroleptics with more anti-cholinergic activity are LESS likely to cause extrapyramidal effects, piperazine+halo/risperid (less anti-Ach) have high EP SE's |
Atypical | Neuroleptics (antipsychotics) | Clozapine, Olanzapine, Risperidone, quetiapine, ziprasidone (inc QT interval), Aripiprazole (inhibits DA release pre-synaptically, less fatness) | Blockage of dopamine receptors, blockage of 5HT2 serotonin receptors | Schizophrenia, Mania? Do NOT use in AD, causes inc mortality | Lesser extrapyramidal side effects, benefit negative symptoms, Clozapine (no tardive dyskinesia, v sedating, anti-cholinergic, big weight gain b/c block Hist1 R, agranulocytosis, drooling), Others (less sedating) | benefits neg + positive sx's, clozapine and olanzapine both have rare EP SE's are very antiAch, but are very sedative and hypotensive |
Benzodiazepines | Sedatives | Short (oxazepam, temazepam, lorazepam), close to glucuronide rxn in liver), Int, Long | Binds BZD receptor (near GABA), opens Cl- channel, suppresses postsynaptic neuron | Short-term sleep | Don't use with alcohol or other CNS stimulants, as age goes up, use less BZD; ONLY use as short tern hypnotic b/c tolerance develops (awake during last part of night) | oxazepam, temazepam, lorazepam, NOT metabolized by 1st pass enzymes, lethal overdose very rare, UNLESS with EtOH |
Imidazobenzodiazepine | Sedatives | Flumazenil | Displaces BZD from receptor, no effect on GABA transmission, specific for CNS | BZD overdose | Seizures (chronics BZD users), resedation | VERY short acting |
Z Drugs, Zolpidem NON BZD | Sedatives | Zolpidem NON BZD | Binds BZDR, less effect on stages of sleep | Sleep? | Few anxiolytic, anticonvulsant, muscle relaxant effects, BZD side effects | VERY long acting, along with diazepam, so if OD need to constantly give flumazenil |
Z Drugs, Zalepon NON BZD | Sedatives | Zalepon NON BZD | Binds BZDR | Sleep? - low potential for abuse | Next day somnolence, anterograde amnesia, withdraw (seizures), rebound insomnia (high doses) |   |
Z Drugs, Eszopiclone NON BZD | Sedatives | Eszopiclone NON BZD | Binds BZDR | Sleep? | Same as BZD |   |
Barbituates | Sedatives | None | Bind near GABA, not same site as BZD, increased duration BUT NOT frequency of openings of Cl- channel | Rarely used | more addicting, more withdrawl sx's than BZD | rarely used as sedative and hypnotic |
Melatonin Mimics | Sedatives | Ramelteon | Melatonin receptor agonist, selective for M1/2 (circadian), NOT M3 | Sleep | Hormonal problems (prolactin), Don’t give with CYPA12 or CYP3A4 inhibitors such as fluvoxamine (SSRI) and ciprofloxacin, teratogenic, high-fat meals impair absorption, rifampin induces metabolism | M1 regulates sleepiness, M2 is for biological clock |
Antihistamines | Sedatives | Diphenhydramine | N/A | Sleep | Tolerance develops rapidly, next day sedation, dry mouth, urinary retention |   |
Antidepressants , trazodone | Sedatives | trazodone | sedative |   |   |   |
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