Psychiatric Meds - Week 7 PDF

**Psychiatric Meds- Week 7** 1\. Discuss factors contributing to anxiety, sleep disorders, depression, bipolar disorder, ADHD, and psychoses including schizophrenia. -Carmelle 2\. Describe nonpharmacologic therapies used to manage these disorders. - Carmelle 2\. Discuss the pharmacologic approach...

**Psychiatric Meds- Week 7** 1\. Discuss factors contributing to anxiety, sleep disorders, depression, bipolar disorder, ADHD, and psychoses including schizophrenia. -Carmelle 2\. Describe nonpharmacologic therapies used to manage these disorders. - Carmelle 2\. Discuss the pharmacologic approach to managing patients with behavioral and mental health disorders. - Sabrina 3\. [For each of the following drug classes, and representative drug examples, describe the mechanism of action, primary actions and therapeutic uses, special considerations, and important adverse effects (may be beneficial to categorize psychopharmacologic drugs used based on their classification and mechanism of action).] \-\-\--EVERYONE PSYCHIATRIC MEDS CHART +-------------+-------------+-------------+-------------+-------------+ | **Name/Type | **MOA** | **Indicatio | **SE** | **Considera | | ** | | ns** | | tions** | +=============+=============+=============+=============+=============+ | Benzodiazep | Increase | -not for | -use with | -all are | | ines | the | chronic | ETOH can | metabolized | | | frequency | management | cause | through the | | -antidote | of GABA | (except | synergistic | liver, | | is | receptor | Clonazepam) | effect on | liver | | flumazenil | opening | | respiratory | disease | | (competitiv | thereby | -epilepsy | depression | increases | | e | causing the | | | half life | | antagonist | calcium | -muscle | -sedation | of drug | | to GABA | channels to | spasms | | | | receptor) | open in the | | -hypnosis | -cannot | | | postsynapti | -insomnia | | abruptly | | | c | | -respirator | stop | | | GABA | IBS | y | medication | | | receptor | | depression | as people | | | and | Chemo | | who take it | | | hyperpolari | induced | Paradoxical | daily can | | | ze | nausea and | anxiety | become | | | (make more | vomiting | | physically | | | negative on | | Dizziness | dependent | | | the inside) | -preanesthe | | and | | | the | sia | Confusion | experience | | | neuronal | sedation | | withdrawal | | | membrane | | Blurry | | | | which makes | -RLS | vision | -contraindi | | | it more | | | cated | | | resistant | | hypotension | in | | | to | | | pregnancy | | | receiving | | | | | | an action | | | | | | potential, | | | | | | slows down | | | | | | nerve | | | | | | conduction, | | | | | | causes CNS | | | | | | depression | | | | | | | | | | | | \~ | | | | | | increases | | | | | | action of | | | | | | GABA, an | | | | | | inhibitory | | | | | | NT | | | | | | decreasing | | | | | | neuronal | | | | | | excitement. | | | | +-------------+-------------+-------------+-------------+-------------+ | Intermitten | | | | | | t | | | | | | acting: | | | | | | lasts 10-24 | | | | | | hours | | | | | | | | | | | | \*\* due to | | | | | | 3A4 | | | | | | metabolism, | | | | | | highly | | | | | | prone to | | | | | | drug-drug | | | | | | interaction | | | | | | s | | | | | | in patients | | | | | | with severe | | | | | | liver | | | | | | failure | | | | | +-------------+-------------+-------------+-------------+-------------+ | Alprazolam | | -anxiety | | undergo | | (xanax) | | | | glucuronida | | | | -anxiety | | tion | | | | with | | into | | | | depression | | "inactive" | | | | | | metabolites | | | | -panic | | - | | | | disorder | | May be | | | | | | better for | | | | | | the elderly | | | | | | where | | | | | | accumulatio | | | | | | n | | | | | | is more | | | | | | | | | | | | likely to | | | | | | occur or in | | | | | | patients | | | | | | with renal | | | | | | dysfunction | +-------------+-------------+-------------+-------------+-------------+ | Clonazepam | | -burning | can | | | (klonopin) | | mouth | increase | | | | | syndrome | salivation | | | | | | | | | | | -seizures | | | | | | | | | | | | -panic | | | | | | disorder | | | +-------------+-------------+-------------+-------------+-------------+ | Lorazepam | | -Anxiety/Se | | undergo | | (ativan) | | dation | | glucuronida | | | | | | tion | | UGT | | -Insomnia | | into | | metabolism | | -Status | | "inactive" | | | | epilepticus | | metabolites | | | | -Antiemetic | | -May | | | | | | be better | | | | | | for the | | | | | | elderly | | | | | | where | | | | | | accumulatio | | | | | | n | | | | | | is more | | | | | | | | | | | | likely to | | | | | | occur or in | | | | | | patients | | | | | | with renal | | | | | | dysfunction | +-------------+-------------+-------------+-------------+-------------+ | Long | | | | | | acting: | | | | | | last longer | | | | | | than 24 | | | | | | hours | | | | | +-------------+-------------+-------------+-------------+-------------+ | Diazepam | | -anxiety | | | | (valium, | | | | | | diastat) | | -acute | | | | | | seizures | | | | -2c19 and | | | | | | 3A4 | | -muscle | | | | metabolism | | spasm | | | | | | | | | | | | -ETOH | | | | | | withdrawal | | | | | | | | | | | | Status | | | | | | epileptic | | | | | | -treatment | | | | | | of choice | | | +-------------+-------------+-------------+-------------+-------------+ | **[Non-Benz | | | | | | odiazepine | | | | | | Anxiolytic] | | | | | | {.underline | | | | | | }** | | | | | +-------------+-------------+-------------+-------------+-------------+ | Buspirone | -exact MOA | -generalize | -nausea | -delayed | | \[BuSpar\] | unknown | d | | onset of | | | | anxiety | -headache | 2-3 weeks, | | Serotonergi | -act as | disorder | | not for | | c | partial | | -nervousnes | acute | | | agonist to | Depression | s | treatment | | Azapirone | 5HT1A | with an | | -up to six | | | receptor | overlay of | -lightheade | weeks for | | | | anxiety | dness | maximum | | | -increase | | | effects | | | norepinephr | Situation | Insomnia, | | | | ine | anxiety | | -pregnancy | | | firing from | | Dry mouth | category B | | | locus | | | (can use) | | | coeruleus | | | | | | | | | -Contraindi | | | -selectivel | | | cated | | | y | | | in patients | | | inhibit | | | with known | | | certain | | | hypersensit | | | dopamine | | | ivity | | | receptors | | | or in those | | | d2 | | | with severe | | | | | | hepatic | | | | | | renal | | | | | | disease | | | | | | | | | | | | -frequently | | | | | | used | | | | | | adjunctive | | | | | | with SSRI | | | | | | in | | | | | | treatment-r | | | | | | esistant | | | | | | depression | +-------------+-------------+-------------+-------------+-------------+ | SSRIs | | | | | | Antidepress | | | | | | ants | | | | | +-------------+-------------+-------------+-------------+-------------+ | | MOA: | major | Headache -- | Abrupt | | | selectively | depressive | Diarrhea -- | withdrawal | | | inhibit | disorder, | Drowsiness | can cause | | | reuptake of | panic | or insomnia | w/d | | | serotonin, | disorder, | -- | symptoms | | | desensitize | obsessive | Agitation | and rebound | | | presynaptic | compulsive | and/or | depression. | | | serotonin | disorder, | anxiety | This is | | | receptors | social | (early on; | more of | | | in a | anxiety | also why | problem | | | negative | disorder, | start at | with short | | | feedback | generalized | lower doses | half-life | | | loop that | anxiety | when | SSRIs -- | | | normally | disorder, | treating | Once daily | | | inhibits | premenstrua | anxiety | dosing-- | | | serotonin | l | disorders) | Not very | | | release | dysphoric | -- Sexual | lethal in | | | which then | disorder, | dysfunction | overdoses | | | increases | post | : | as seen | | | serotonin | traumatic | can switch | with | | | levels | stress | to another | tricyclic | | | | disorder, | agent or | antidepress | | | | bulimia | could | ants | | | | nervosa, | consider | (TCA's) | | | | kleptomania | addition of | | | | | (pathologic | low dose | -pts need | | | | stealing | bupropion | to be | | | | when no | Syndrome of | monitored | | | | need); | inappropria | closely for | | | | trichotillo | te | the for 2-3 | | | | mania | antidiureti | weeks of | | | | (pulling | c | initiation | | | | out of | hormone | of SSRI | | | | hair) | (SIADH- | including | | | | | Most common | Suicide | | | | | in elderly | risk | | | | | and | assessment. | | | | | reverses | | | | | | with | \- can take | | | | | discontinua | 3-4 weeks | | | | | tion)-- | to work | | | | | Serotonin | | | | | | syndrome( | | | | | | especially | | | | | | coadministe | | | | | | red | | | | | | with | | | | | | tramadol, | | | | | | meperidine, | | | | | | and/or MAO | | | | | | inhibitor)- | | | | | | - | | | | | | SSRI | | | | | | discontinua | | | | | | tion | | | | | | syndrome | | | | | | (not an | | | | | | actual | | | | | | withdraw, | | | | | | but effects | | | | | | from missed | | | | | | doses of | | | | | | short | | | | | | acting | | | | | | agents)-- | | | | | | Persistent | | | | | | pulmonary | | | | | | hypertensio | | | | | | n | | | | | | (Exposure | | | | | | during | | | | | | pregnancy | | | | | | especially | | | | | | after 20 | | | | | | weeks of | | | | | | gestation; | | | | | | possibly | | | | | | more common | | | | | | with | | | | | | paroxetine) | | +-------------+-------------+-------------+-------------+-------------+ | Citalopram | Primary | -depression | | -not | | (celexa) | receptor: | | | approved | | | | -anxiety(Of | | for use in | | | Serotonin | f | | children | | | | label) | | | | | Secondary: | | | -Limit max | | | | | | dose to 20 | | | Noriepi and | | | mg/d in | | | Dopa | | | poor | | | | | | metabolizer | | | | | | s | | | | | | of 2C19 or | | | | | | inhibitors | | | | | | of 2C19 and | | | | | | in hepatic | | | | | | impairment | | | | | | due to | | | | | | concerns | | | | | | for | | | | | | concentrati | | | | | | on | | | | | | dependent | | | | | | QT | | | | | | | | | | | | prolongatio | | | | | | n | | | | | | (especially | | | | | | in | | | | | | overdose) | | | | | | | | | | | | -least | | | | | | likely to | | | | | | have | | | | | | interaction | | | | | | s | | | | | | with CYP450 | | | | | | enzymes | | | | | | | | | | | | -Risk of | | | | | | prolonged | | | | | | QT interval | | | | | | with | | | | | | co-administ | | | | | | ration | | | | | | with OCP in | | | | | | doses of | | | | | | 30mg or \> | +-------------+-------------+-------------+-------------+-------------+ | Escitalopra | Primary | -MDD | | -Avoid | | m | receptor: | | | within 2 | | (lexapro) | | -GAD | | weeks of an | | | Serotonin | | | MAO | | | | | | inhibitor | | | | | | | | | | | | \- CrCl \< | | | | | | 30 mL/min; | | | | | | use with | | | | | | caution | | | | | | (renal dose | | | | | | adjustment | | | | | | needed) | | | | | | | | | | | | \- the | | | | | | s-enantiome | | | | | | r | | | | | | of racemic | | | | | | citalopram | | | | | | (20 mg is | | | | | | equal to | | | | | | citalopram | | | | | | 40 mg) | | | | | | | | | | | | -least | | | | | | likely to | | | | | | have | | | | | | interaction | | | | | | s | | | | | | with CYP450 | | | | | | enzymes | +-------------+-------------+-------------+-------------+-------------+ | Fluoxetine | Primary: | -Depression | | -gets | | (prozac) | Serotonin | (down to 8 | | metabolized | | | | yrs of age) | | to | | | Secondary: | -OCD (down | | norfluoxeti | | | Norepi | to 7 yrs of | | ne | | | | age) | | which has a | | | | -Premenstru | | half life | | | | al | | of 4-6 days | | | | dysphoric | | | | | | disorder | | -Stop MAO | | | | | | inhibitor | | | | -Bulimia | | 14 wks | | | | | | before or | | | | -fibromyalg | | start MAO | | | | ia | | inhibitor 5 | | | | | | weeks after | | | | -panic | | stopping | | | | disorder | | fluoxetine | | | | | | due to high | | | | \- PTSD, | | risk for | | | | Raynaud's | | serotonin | | | | phenomena | | syndrome | | | | | | | | | | -social | | | | | | anxiety | | | | | | disorder | | | | | | | | | | | | \- Bipolar | | | | | | depression | | | | | | (when | | | | | | combined | | | | | | with | | | | | | olanzapine) | | | | | | | | | | | | \- Severe | | | | | | mutism | | | +-------------+-------------+-------------+-------------+-------------+ | Paroxetine | Primary: | -Depression | | -May be one | | (paxil) | Serotonin | | | of the most | | | | -GAD | | sedating | | | Secondary: | | | and | | | Norepi | -OCD | | anticholine | | | | | | rgic | | | | \- Panic | | SSRI and | | | | disorder | | could | | | | | | result in a | | | | \- | | greater | | | | Premenstrua | | | | | | l | | likelihood | | | | dysphoric | | of | | | | disorder | | discontinua | | | | | | tion | | | | \- PTSD | | syndrome | | | | | | that is | | | | \- SAD | | | | | | | | severe. | | | | | | | | | | | | -more | | | | | | associated | | | | | | with long | | | | | | term weight | | | | | | gain vs | | | | | | other SSRIs | | | | | | | | | | | | -Limit dose | | | | | | if CrCl \< | | | | | | 30 or | | | | | | hepatic | | | | | | impairment | | | | | | | | | | | | -OCD and | | | | | | SAD have | | | | | | been | | | | | | studied | | | | | | down to 8 | | | | | | yrs of | | | | | | | | | | | | age but not | | | | | | FDA | | | | | | approved | | | | | | | | | | | | \- Preg | | | | | | risk factor | | | | | | = D\* | | | | | | (avoid use) | | | | | | | | | | | | -\>/= 8 | | | | | | years for | | | | | | depression; | | | | | | \>/= 7 | | | | | | years for | | | | | | OCD | | | | | | | | | | | | -Risk of | | | | | | prolonged | | | | | | QT interval | | | | | | with | | | | | | co-administ | | | | | | ration | | | | | | with OCP in | | | | | | doses of | | | | | | 30mg or \> | +-------------+-------------+-------------+-------------+-------------+ | Sertraline | Primary: | -Depression | | No renal | | (zoloft) | Serotonin | | | dosing; | | | | -OCD | | reduce dose | | | Secondary: | | | for liver | | | Norepi | -GAD, SAD, | | impairment | | | | panic | | | | | | | | -May cause | | | | \- PTSD | | false + for | | | | | | benzos on | | | | \- | | UDS | | | | Premenstrua | | | | | | l | | \- Studied | | | | dysphoric | | in peds for | | | | disorder | | OCD down to | | | | | | 6 yrs of | | | | | | age | | | | | | | | | | | | \- has one | | | | | | of the | | | | | | better SE | | | | | | profiles | | | | | | making | | | | | | useful in | | | | | | elderly | | | | | | | | | | | | -- the | | | | | | exception | | | | | | is with GI | | | | | | SE (may be | | | | | | the worst | | | | | | of SSRI) | | | | | | | | | | | | \- Preg | | | | | | risk factor | | | | | | = C | +-------------+-------------+-------------+-------------+-------------+ | | | | | | +-------------+-------------+-------------+-------------+-------------+ | SSRI/5-HT1A | Unique | | | -pregnancy | | receptor | Mechanism: | | | category C | | partial | An SSRI | | | | | agonist: | that is | | | | | vilazodone | also a | | | | | (viibryd) | partial | | | | | | 5-HT1A | | | | | | agonist | | | | +-------------+-------------+-------------+-------------+-------------+ | | | | | | +-------------+-------------+-------------+-------------+-------------+ | TCAs | Act on | Depression | -standard | -have to | | | neurotransm | | anticholine | monitor | | Amitriptyli | itters | Insomnia | rgic | drug levels | | ne | norepinephr | | side | | | | ine | OCD | effects: | -Caution | | Doxepin | and | | (­Increased | should also | | | serotonin | | intraocular | be used in | | Amoxapine | by | | pressure, | pts with | | | inhibiting | | difficulty | heart | | | their | | urinating, | disease | | | reuptake at | | dry mouth, | contraindic | | | the | | | ated | | | presynaptic | | constipatio | in patients | | | neuron, | | n) | with heart | | | they also | | | disease due | | | act on | | Sedation | to alpha | | | histamine | | | adrenergic | | | and | | Orthostatic | blocking | | | acetylcholi | | hypotension | effect | | | ne | | , | | | | repecptors | | weight | or seizures | | | | | gain, | -- may need | | | | | nausea, | a baseline | | | | | vomiting, | EKG to | | | | | gynecomasti | assess the | | | | | a, | | | | | | and changes | QT interval | | | | | in libido | | | | | | | -due to | | | | | | acetylcholi | | | | | | ne | | | | | | blocking | | | | | | effect they | | | | | | should be | | | | | | used in | | | | | | caution, | | | | | | and those | | | | | | who have | | | | | | glaucoma | | | | | | prostatic | | | | | | hypertrophy | | | | | | a urinary | | | | | | incontinenc | | | | | | e | | | | | | | | | | | | Avoid in | | | | | | MAOI | +-------------+-------------+-------------+-------------+-------------+ | SNRIs | Block the | Indications | | | | | serotonin | : | | | | | and norepi | Major | | | | | transporter | Depressive | | | | | s | Disorder-- | | | | | thereby | Generalized | | | | | inhibiting | Anxiety | | | | | the | Disorder | | | | | reuptake of | (GAD)-- | | | | | the NT and | ADHD-- | | | | | increasing | Fibromyalgi | | | | | the | a( | | | | | availabilit | Only | | | | | y | duloxetine | | | | | to bind | & | | | | | with the | milnacipran | | | | | polysnyapti | )-- | | | | | c | Neuropathic | | | | | receptors | pain | | | | | | syndromes( | | | | | | TCA use for | | | | | | neuropathic | | | | | | pain is in | | | | | | low doses | | | | | | (\ 150 mg) | 14 days of | | | pump | -Max dose | | an MAO | | | | 300mg for | -less | inhibitor | | | Increase | children | sexual | | | | (D) in the | with ADHD | dysfunction | -\*\*Use | | | prefrontal | | than SSRI | cautiously | | | cortex | | | with | | | | | -insomnia | Atomoxetine | | | Block the | | | due to | | | (D) | | -nervousnes | increasing | | | reuptake | | s | levels | | | pump | | | | | | | | -wt loss | -May be | | | Does not | | | beneficial | | | work on | | Dry mouth, | for use | | | serotonin | | constipatio | with SSRI | | | or MAOs | | n, | in treating | | | receptors | | nausea, | comorbid | | | | | weight | depression | | | | | loss, | | | | | | anorexia, | | | | | | myalgia | | | | | | | | | | | | Tachycardia | | +-------------+-------------+-------------+-------------+-------------+ | **[Centrall | -antagonist | MDD | -Hepatic | -consider | | y | to central | | failure | lower doses | | acting | presynaptic | PTSD (not | | if CrCl \< | | Alpha-2 | alpha 2 | FDA | -orthostasi | 40 mL/min | | Receptor | adrenergic | approved) | s | | | Antagonist: | receptors | | | -pregnancy | | ]{.underlin | which | | -sedation | category C | | e}** | results in | | | | | Mirtazapine | enhance | | -confusion | -Avoid | | \[Remeron\] | central | | | within 14 | | | noradrenerg | | -wt | days of MAO | | | ic | | gain\*\* | inhibitor | | | and | | | | | | serotonin | | -decreased | -Can worsen | | | activity. | | lipids | lipids. | | | Mirtazapine | | | | | | is an | | -GI adverse | -Monitor | | | antagonist | | affects- | AST/ALT & | | | of 5-HT2, | | xerostomia, | increased | | | 5-HT3, and | | increased | ­wt. | | | H1 | | appetite, | | | | receptors. | | constipatio | \- Less | | | | | n, | sexual | | | | | abd pain, | dysfunction | | | | | anorexia, | | | | | | vomiting | than SSRI. | +-------------+-------------+-------------+-------------+-------------+ | **[Antipsyc | | | | | | hotics | | | | | | ]{.underlin | | | | | | e}** | | | | | +-------------+-------------+-------------+-------------+-------------+ | | | | | **[\*]{.und | | | | | | erline}**\* | | | | | | \*All | | | | | | agents | | | | | | prolong the | | | | | | QT | | | | | | interval, | | | | | | many will | | | | | | cause | | | | | | metabolic | | | | | | complicatio | | | | | | ns | | | | | | (wt gain, | | | | | | insulin | | | | | | resistance, | | | | | | sexual | | | | | | dysfunction | | | | | | , | | | | | | etc).Black | | | | | | box | | | | | | warning: | | | | | | Elderly | | | | | | patients | | | | | | with | | | | | | dementia-re | | | | | | lated | | | | | | psychosis | | | | | | and treated | | | | | | with | | | | | | antipsychot | | | | | | ics | | | | | | are at | | | | | | increased | | | | | | risk of | | | | | | death | | | | | | usually | | | | | | from CVD or | | | | | | pneumonia. | | | | | | antipsychot | | | | | | ics | | | | | | can worsen | | | | | | dementia in | | | | | | patients | | | | | | with | | | | | | dementia | | | | | | from Lewy | | | | | | bodies | | | | | | | | | | | | Discontinua | | | | | | tion | | | | | | recommendat | | | | | | ions: | | | | | | Recommend | | | | | | taper to | | | | | | avoid | | | | | | withdrawal | | | | | | & reduce | | | | | | risk of | | | | | | relapse -- | | | | | | Taper over | | | | | | 6-24 months | | | | | | [or | | | | | | decrease | | | | | | dose by 10% | | | | | | each months | | | | | | -- If | | | | | | switching | | | | | | drugs, | | | | | | consider | | | | | | taper and | | | | | | gradual | | | | | | titration]{ | | | | | |.underline} | +-------------+-------------+-------------+-------------+-------------+ | **[Typical | -Predominat | -works | -associated | -Potential | | Anti-psycho | ely | primarily | with | liver | | tics:]{.und | antagonisti | to treat | tardive | toxicity | | erline}** | c | positive | dyskinesia | | | | occupancy | symptoms | (a | \- QT | | | of the | (AVH) | choreoathet | prolongatio | | | D2-receptor | | oid | n | | | | | (writhing) | | | | and almost | | movements | -can cause | | | no D1 | | | weight gain | | | receptor | | involving | | | | antagonism | | the mouth | | | | | | and tongue) | | | | | | and | | | | | | extrapyrami | | | | | | dal | | | | | | symptoms- | | | | | | especially | | | | | | high | | | | | | potency | | | | | | agents | | | | | | | | | | | | -Antidopami | | | | | | nergic | | | | | | Effects: | | | | | | Associated | | | | | | with | | | | | | extrapyrami | | | | | | dal | | | | | | | | | | | | symptoms | | | | | | (EPS) | | | | | | | | | | | | -Parkinsoni | | | | | | sm, | | | | | | akathisia | | | | | | (restless | | | | | | +/- | | | | | | anxiety), | | | | | | dystonia (a | | | | | | sustained | | | | | | | | | | | | muscle | | | | | | contraction | | | | | | of eye | | | | | | (called an | | | | | | oculogyric | | | | | | crisis and | | | | | | can be very | | | | | | | | | | | | painful), | | | | | | neck | | | | | | (called | | | | | | torticollis | | | | | | ), | | | | | | diaphragm | | | | | | (can be | | | | | | life | | | | | | threatening | | | | | | ) | | | | | | | | | | | | -increased | | | | | | prolactin | | | | | | levels | | | | | | (amenorrhea | | | | | | , | | | | | | galactorrhe | | | | | | a, | | | | | | | | | | | | gynecomasti | | | | | | a, | | | | | | decreased | | | | | | libido, | | | | | | impotence) | | | | | | | | | | | | -polydipsia | | | | | | resulting | | | | | | in | | | | | | hyponatremi | | | | | | a | | | | | | | | | | | | -- | | | | | | Antihistami | | | | | | nergic/chol | | | | | | inergic | | | | | | Effects: | | | | | | Results in | | | | | | sedation | | | | | | and ­ | | | | | | appetite | | | | | | (antihistam | | | | | | inic | | | | | | effect); | | | | | | blurry | | | | | | | | | | | | vision, dry | | | | | | mouth, | | | | | | urinary | | | | | | retention, | | | | | | constipatio | | | | | | n, | | | | | | and | | | | | | possibly | | | | | | | | | | | | tachycardia | | | | | | (anticholin | | | | | | ergic | | | | | | effect) | | | | | | | | | | | | -- | | | | | | Inhibition | | | | | | of | | | | | | Alpha-recep | | | | | | tors: | | | | | | Result in | | | | | | orthostasis | | | | | | , | | | | | | Can | | | | | | contribute | | | | | | to sexual | | | | | | dysfunction | | | | | | | | | | | | -- Lowering | | | | | | of Seizure | | | | | | Threshold: | | | | | | Need to be | | | | | | cautious in | | | | | | patients | | | | | | with | | | | | | uncontrolle | | | | | | d | | | | | | epilepsy or | | | | | | in | | | | | | | | | | | | patients on | | | | | | other | | | | | | medications | | | | | | known to | | | | | | increase | | | | | | seizure | | | | | | risk | | +-------------+-------------+-------------+-------------+-------------+ | Low | | -Schizophre | -Have more | -Develop | | Potency: | | nia | anticholine | the | | Chlorpromaz | | -Nausea/vom | rgic | "Thorazine | | ine | | iting | effects | | | \[Thorazine | | | than risk | Shuffle"-EP | | \] | | -Restless | of EPS due | S | | | | leg | to low | feature | | | | syndrome | potency | | | | | -Intractabl | | | | | | e | -Sedating | | | | | hiccups | | | | | | | -weight | | | | | Psychosis | gain | | | | | | | | | | | Acute | -orthostasi | | | | | severe | s | | | | | agitation | due to | | | | | | alpha | | | | | | blocking | | | | | | properties | | | | | | | | | | | | -blue-gray | | | | | | skin | | | | | | discolorati | | | | | | on | | +-------------+-------------+-------------+-------------+-------------+ | High | | -Schizophre | | -greater | | Potency: | | nia | | risk of EPS | | Haloperidol | | | | due to high | | \[Haldol\] | | Psychosis | | potency | | | | | | than | | | | -Tics & | | anticholine | | | | Vocal | | rgic | | | | Utterances | | effects | | | | for | | | | | | Tourette's | | | | | | Disorder | | | | | | -Delirium | | | | | | in ICU | | | | | | -Severe | | | | | | Agitation | | | +-------------+-------------+-------------+-------------+-------------+ | **[Atypical | | | | | | Anti-psycho | | | | | | tics | | | | | | 2nd | | | | | | Generation] | | | | | | {.underline | | | | | | }** | | | | | | | | | | | | **[MOA: | | | | | | Antagonisti | | | | | | c | | | | | | occupancy | | | | | | of the D2 | | | | | | receptor | | | | | | and some | | | | | | occupancy | | | | | | of D1, and | | | | | | modulates | | | | | | activity of | | | | | | 5-HT2 | | | | | | receptors]{ | | | | | |.underline} | | | | | | ** | | | | | | | | | | | | **[Indicati | | | | | | ons: | | | | | | treats | | | | | | mainly | | | | | | positive | | | | | | symptoms | | | | | | but can | | | | | | improve | | | | | | negative | | | | | | symptoms, | | | | | | preferred | | | | | | drug of | | | | | | choice in | | | | | | schizophren | | | | | | ia | | | | | | and can be | | | | | | used as | | | | | | mood | | | | | | stabilizer | | | | | | in bipolar | | | | | | disorder, | | | | | | first line | | | | | | agents in | | | | | | treating | | | | | | negative | | | | | | symptoms | | | | | | ]{.underlin | | | | | | e}** | | | | | | | | | | | | **[SE: Less | | | | | | EPS and TD | | | | | | seen | | | | | | (exception | | | | | | is with | | | | | | higher dose | | | | | | risperidone | | | | | | ), | | | | | | some | | | | | | seizure | | | | | | threshold | | | | | | lowering | | | | | | potential; | | | | | | akathisia | | | | | | (restlessne | | | | | | ss | | | | | | +/- | | | | | | anxiety) | | | | | | risk | | | | | | appears to | | | | | | be most | | | | | | with | | | | | | aripiprazol | | | | | | e]{.underli | | | | | | ne}** | | | | | | | | | | | | **[-- | | | | | | Hyperprolac | | | | | | tinemia: | | | | | | Amenorrhea, | | | | | | galactorrhe | | | | | | a, | | | | | | gynecomasti | | | | | | a, | | | | | | decreased | | | | | | libido, | | | | | | impotence; | | | | | | possibly | | | | | | less with | | | | | | clozapine | | | | | | due to | | | | | | lower D2 | | | | | | antagonist | | | | | | activity]{. | | | | | | underline}* | | | | | | * | | | | | | | | | | | | **[-- | | | | | | Anti-Histam | | | | | | inergic/Cho | | | | | | linergic | | | | | | Effects: | | | | | | Sedation, | | | | | | blurry | | | | | | vision, dry | | | | | | mouth, | | | | | | urinary | | | | | | retention, | | | | | | constipatio | | | | | | n, | | | | | | and | | | | | | possibly | | | | | | tachycardia | | | | | | ]{.underlin | | | | | | e}** | | | | | | | | | | | | **[-- QT | | | | | | prolongatio | | | | | | n: | | | | | | As | | | | | | monotherapy | | | | | | in patient | | | | | | without | | | | | | structural | | | | | | heart | | | | | | disease | | | | | | risk is | | | | | | minimal]{.u | | | | | | nderline}** | | | | | | | | | | | | **[Consider | | | | | | ations: | | | | | | causes | | | | | | weight gain | | | | | | and | | | | | | increases | | | | | | risk for | | | | | | hyperlipide | | | | | | mia | | | | | | and | | | | | | diabetes | | | | | | mellitus | | | | | | ]{.underlin | | | | | | e}** | | | | | | | | | | | | **[Weight | | | | | | gain (worst | | | | | | to least): | | | | | | clozapine | | | | | | \> | | | | | | olanzapine | | | | | | \> | | | | | | risperidone | | | | | | , | | | | | | paliperidon | | | | | | e, | | | | | | iloperidone | | | | | | & | | | | | | quetiapine | | | | | | \> | | | | | | ziprasidone | | | | | | & | | | | | | aripiprazol | | | | | | e]{.underli | | | | | | ne}** | | | | | +-------------+-------------+-------------+-------------+-------------+ | Clozapine | Antagonist | -Refractory | -Agranulocy | -Contraindi | | \[Clozaril, | to: D2 | | tosis: | cated | | FazaClo\] | (100-fold | schizophren | ( if WBC | in | | | less than | ia | drop to \< | myeloprolif | | | Haldol), | | 3000 or ANC | erative | | | 5-HT2, | -Suicidal | \ 48 | | | | | glucose | hrs, start | | | | | | over with | | | | | -dyslipidem | dose | | | | | ia | titration | +-------------+-------------+-------------+-------------+-------------+ | Aripiprazol | Also has | -bipolar | Akathisia, | -Weight | | e | some | disorder | HA, | neutral for | | \[Abilify\] | | | sedation, | most | | | partial | -schizophre | | | | | agonist | nia | EPS, N/V | -pregnancy | | | | | | category C | | | activity on | -MDD | | | | | 5-HT1A | | | -reduces | | | | -Irritabili | | irritabilit | | | | ty | | y, | | | | Associated | | approved | | | | with Autism | | for use in | | | | | | children | +-------------+-------------+-------------+-------------+-------------+ | Olanzapine | Similar to | -Schizophre | -EPS (up to | -Avoid use | | \[Zyprexa\] | clozapine. | nia | 32% of | of benzos | | | Structure | -Acute | patients) | (e.g., IM | | | similaritie | Mania in | | ativan) | | | s | Bipolar | -wt gain | within 60 | | | | -Agitation | | min of | | | | -Depression | -Diabetes | injections | | | | in Bipolar | | -- | | | | -Resistant | -dyslipidem | cardiopulmo | | | | Depression | ia | nary | | | | | (mainly TG) | depressant | | | | | | risks. | | | | | -anticholin | | | | | | ergic | | | | | | effects | | | | | | (especially | | | | | | sedation, | | | | | | xerostomia) | | | | | | , | | | | | | -hyperprola | | | | | | ctinemia | | | | | | (amenorrhea | | | | | | , | | | | | | galactorrhe | | | | | | a, | | | | | | gynecomasti | | | | | | a, | | | | | | decreased | | | | | | libido, | | | | | | impotence) | | +-------------+-------------+-------------+-------------+-------------+ | Olanzapine | Similar to | Bipolar | | | | + | clozapine. | depression | | | | fluoxetine | Structure | | | | | \[Symbyax\] | similaritie | | | | | | s | | | | +-------------+-------------+-------------+-------------+-------------+ | Quetiapine | Up to the | -Schizophre | \- Sedation | -associated | | \[Seroquel, | first 200 | nia | | with | | XR\] | mg mainly | | -increased | cataracts | | | histamine | -Acute | appetite. | in beagle | | | receptor | Manic | | dogs only | | | antagonism | | | so slit | | | (causes the | or Mixed | | examination | | | sedation); | | | is | | | after 200 | Episodes | | recommended | | | mg see D1 & | with | | every 6 | | | D2 | | | months | | | blockade. | Bipolar | | | | | | | | -Only one | | | | \- MDD | | approved | | | | | | for ICU | | | | -ICU | | delirium | | | | Delirium | | even though | | | | | | haloperidol | | | | | | is also | | | | | | effective | | | | | | | | | | | | -Metabolite | | | | | | , | | | | | | norquetiapi | | | | | | ne | | | | | | has high | | | | | | affinity | | | | | | for the M1 | | | | | | muscarinic | | | | | | receptor | | | | | | but overall | | | | | | anticholine | | | | | | rgic | | | | | | activity is | | | | | | low which | | | | | | is why it | | | | | | can be used | | | | | | in ICU | | | | | | delirium | | | | | | | | | | | | -Preg C | +-------------+-------------+-------------+-------------+-------------+ | Risperidone | More D2 | -bipolar | -Tardive | -Avoid | | \[Risperdal | antagonism | disorder | dyskinesia | M-Tabs in | | \] | but not as | | (esp with | pts with | | | much as | -schizophre | | PKU | | | first | nia | doses \> 6 | | | | generation | | mg/d), | -Pregnancy | | | agents. | -Irritabili | | category C | | | | ty | -wt gain | | | | | Assoc. with | | -approved | | | | Autism | \- DM | in children | | | | | | | | | | | \- HLD, | | | | | | | | | | | | -hyperprola | | | | | | ctinemia | | | | | | (amenorrhea | | | | | | , | | | | | | | | | | | | galactorrhe | | | | | | a, | | | | | | gynecomasti | | | | | | a, | | | | | | | | | | | | impotence) | | | | | | | | | | | | -rash | | | | | | (\~11% of | | | | | | | | | | | | children), | | | | | | | | | | | | \- increase | | | | | | appetite | | | | | | (mainly | | | | | | | | | | | | children) | | | | | | | | | | | | \- | | | | | | polydipsia | | | | | | associated | | | | | | hyponatremi | | | | | | a. | | +-------------+-------------+-------------+-------------+-------------+ | **[ADHD | | | | | | Medications | | | | | | ]{.underlin | | | | | | e}** | | | | | +-------------+-------------+-------------+-------------+-------------+ | **[Stimulan | | | | | | ts]{.underl | | | | | | ine}** | | | | | +-------------+-------------+-------------+-------------+-------------+ | Methylpheni | Stimulant - | ADHD | Decreased | Can give to | | dates | increase | | appetite | Children | | | norepinephr | | | 6-17 years | | | ine/dopamin | | Palpitation | of age | | | e | | s | | | | by blocking | | | Adults | | | their | | Headaches | | | | reuptake. | | | \*\*Drug | | | | | Insomnia | interaction | | | Enhancement | | | s\*\* | | | in the | | Increased | | | | dorsolatera | | drug | Inhibit | | | l | | seeking | metabolism | | | prefrontal | | | of SSRI | | | cortex | | 12-hour max | | | | | | | Enhanced | | | may improve | | Food may | cardiovascu | | | attention, | | delay peak | lar | | | concentrati | | action 2-3 | effects | | | on, | | hours | when | | | executive | | | combined | | | function | | May work up | with | | | and | | to 3 hours | Atomoxetine | | | wakefulness | | after | & Tricyclic | | | | | | Antidepress | | | Enhancement | | Contact | ants | | | of dopamine | | sensitizati | | | | in the | | on | Theoretical | | | basal | | | ly-cancels | | | ganglia may | | | effects of | | | decrease | | | antipsychot | | | hyperactivi | | | ics | | | ty | | | | +-------------+-------------+-------------+-------------+-------------+ | Concerta -- | | | | | | has several | | | | | | generics | | | | | | that are | | | | | | not created | | | | | | equal. | | | | | | Several can | | | | | | no longer | | | | | | be | | | | | | substituted | | | | | | because | | | | | | they are \> | | | | | | 30% | | | | | | different. | | | | | +-------------+-------------+-------------+-------------+-------------+ | Quillivant | | | | | | XR: liquid | | | | | | extended | | | | | | release -- | | | | | | first of | | | | | | its kind | | | | | +-------------+-------------+-------------+-------------+-------------+ | Daytrana: | | | | Apply 2 | | topical | | | | hours | | patch -- 9+ | | | | before | | hour during | | | | desired | | | | | | effect and | | | | | | wear for a | | | | | | total of 9 | | | | | | hours | | | | | | | | | | | | Extended | | | | | | half-life | +-------------+-------------+-------------+-------------+-------------+ | Jornay PM | Blocks | ADHD | Nervousness | Ages 6 and | | -- given at | reuptake | | | up | | 8PM and | and | | Insomnia | | | starts | increases | | | | | releasing | release of | | Anorexia | | | at 6AM so | norepinephr | | | | | it is | ine | | Abdominal | | | onboard | and | | pain | | | when the | dopamine in | | | | | child | extraneuron | | Tachycardia | | | wakes. | al | | | | | | space | | BP/HR | | | | (sympathomi | | changes | | | | metic) | | | | | | | | 11-hour | | | | Excreted in | | duration, | | | | urine | | smooth | | | | 78-97%. | | transition | | | | Feces 1-3% | | | | +-------------+-------------+-------------+-------------+-------------+ | **Stimulant | | | | | | s | | | | | | continued, | | | | | | not | | | | | | Methylpheni | | | | | | dates** | | | | | +-------------+-------------+-------------+-------------+-------------+ | Lisdexamfet | Prodrug-not | ADHD | Decreased | \*\*Drug | | amine | active | | appetite | | | \[Vyvanse\] | until it is | | | interaction | | : | absorbed in | | Palpitation | s\*\* | | over an | the | | s | | | hour to | intestine | | | Inhibit | | onset, | and | | Headaches | metabolism | | cannot be | converted | | | of SSRI | | taken with | to | | Insomnia | | | citrus | dextro-amph | | | Enhanced | | | etamine. | | Exacerbatio | cardiovascu | | | | | n | lar | | | Blocks | | of tics | effects | | | reuptake of | | | when | | | Dopamine | | | combined | | | and | | | with | | | Norepinephr | | | Atomoxetine | | | ine | | | & Tricyclic | | | and | | | Antidepress | | | facilitates | | | ants | | | their | | | | | | release | | | Theoretical | | | | | | ly-cancels | | | | | | effects of | | | | | | antipsychot | | | | | | ics | | | | | | | | | | | | -Ages 6-12 | | | | | | years & | | | | | | Adults | | | | | | | | | | | | 10-12 hours | | | | | | of clinical | | | | | | duration | | | | | | | | | | | | Capsule may | | | | | | be opened, | | | | | | dissolved | | | | | | in water. | | | | | | | | | | | | Do not take | | | | | | with citric | | | | | | juices | | | | | | | | | | | | 1 hour to | | | | | | max | | | | | | concentrati | | | | | | on; | | | | | | 3 hour to | | | | | | max | | | | | | concentrati | | | | | | on | | | | | | of | | | | | | dextro-amph | | | | | | etamine | +-------------+-------------+-------------+-------------+-------------+ | Amphetamine | Enhancement | ADHD | Decreased | Ages 3 and | | \[Adderall\ | in the | | appetite | up | | ]: | dorsolatera | | | (short-acti | | high risk | l | | Palpitation | ng) | | of IR in | prefrontal | | s | | | substance | cortex | | | Ages 6-12 | | use -- | | | Headaches | years & 13+ | | increased | may improve | | | Adults | | street | attention, | | Insomnia | (amphetamin | | value | concentrati | | | e | | | on, | | Exacerbatio | ER) | | | executive | | n | | | | function | | of tics | Do not | | | and | | | administer | | | wakefulness | | | with fruit