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This document summarizes psychiatric drugs by class and mechanism of action. It lists common generic and brand name drugs, their indications, and key adverse effects. The main drug classes covered are SSRIs, SNRIs, tricyclic antidepressants, MAOIs, mood stabilizers, benzodiazepines, typical and atypical antipsychotics. It also provides guidance on managing common psychiatric drug adverse effects.
This document summarizes psychiatric drugs by class and mechanism of action. It lists common generic and brand name drugs, their indications, and key adverse effects. The main drug classes covered are SSRIs, SNRIs, tricyclic antidepressants, MAOIs, mood stabilizers, benzodiazepines, typical and atypical antipsychotics. It also provides guidance on managing common psychiatric drug adverse effects.
This document summarizes psychiatric drugs by class and mechanism of action. It lists common generic and brand name drugs, their indications, and key adverse effects. The main drug classes covered are SSRIs, SNRIs, tricyclic antidepressants, MAOIs, mood stabilizers, benzodiazepines, typical and atypical antipsychotics. It also provides guidance on managing common psychiatric drug adverse effects.
Serotonin 2C (5-HT 2C ) Antagonists weight gain and associated risks Muscarinic (m 1 ) Class & MOA Generic Agent Brand FDA Info SSRIs: inhibit reuptake of serotonin as well as slight effects on histamine- R, 1-R, and muscarinic-R Fluoxetine Prozac
-Longest half-life = highest risk for serotonin syndrome -Many drug interactions -Most stimulating SSRI -Lowest weight gain = good for eating disorders
Escitalopram Lexapro Fluvoxamine Luvox OCD child/adles Sertraline Zoloft -Few drug interactions -Highest risk of GI problems MDD OCD Panic >6 y/o PTSD PMDD SAD Paroxetine Paxil -Shortest half-life = highest risk of d/c symptoms -Most sedating SSRI and greatest weight gain and greatest sexual AEs -Greatest anticholinergic activity Panic d/o SNRIs: inhibits reuptake of both serotonin and norepinephrine Venlafaxine (ER avail) Effexor -HTN -Sedating GAD -Equally effective as SSRIs for treating major depression -May be more effective in the setting of diabetic neuropathy, fibromyalgia, msk pain, stress incontinence, sedation, fatigue, and patients with comorbid anxiety -AEs: GI, HTN, CNS, permanent sexual?, diaphoresis, dizziness, fatigue, insomnia, blurred vision, suicidal ideation, dysuria, worsened depression -Fewer drug interactions Duloxetine Cymbalta -Less AEs than venlafaxine -Works well for fibromyalgia -Good for sleep and pain
-May increase sexual function -Has stimulant effects = good for comorbid ADHD or for helping quit smoking but dont use if comorbid anxiety or eating disorder -AEs: lower seizure threshold, insomnia, nervousness, agitation, anxiety, tremor, arrhythmias, HTN, tachycardia, S-J, weight loss, GI, arthralgia or myalgia, confusion, dizziness, HA, psychosis, suicidal ideation Mirtazapine
Remeron -Less nausea and sexual AEs -Overdose is generally safe -AEs: the most sedating antidepressant (= good for insomnia!), weight gain, orthostatic hypotension, dizziness, dry mouth Nefazodone Serzone Trazodone
Oleptro -AEs: arrhythmia, hyper or hypotension, diaphoresis, GI, hemolytic anemia, leukocytosis, dizziness, HA, insomnia, lethargy, memory impairment, seizure, somnolence, priapism, weight gain
Class & MOA Generic Agent Brand Info Class & MOA Tricyclic Antidepressants: inhibits reuptake of both serotonin and norepinephrine Amitriptyline Elavil
-Good for sleep, pain, and depression
-AEs: anticholinergic, CV, CNS, weight gain, sexual dysfunction, decreased seizure threshold -CV effects: orthostatic hypotension, conduction disturbance, cardiotoxicity consider EKG prior to initiation -Overdose can be lethal Clomipramine Anafranil Desipramine Norpramin -Least sedating Doxepin Silenor Imipramine Tofranil Nortriptyline Pamelor MAOIs: block destruction of monoamines centrally and peripherally Phenelzine Nardil -Irreversible -MAO-A acts on norepinephrine and serotonin -MAO-B acts on phenylethylamine and DA -AEs: anticholinergic, lower seizure threshold, weight gain, rash, orthostasis, sexual dysfunction, insomnia or somnolence, HA, HTN crisis in presence of monoamines -Must be on tyramine-free diet = no wine, beer, cheese, aged food, or smoked meats -Overdose is lethal -2 week washout period of other antidepressants needed before starting in order to prevent serotonin syndrome Tranylcypromine Parnate -Irreversible Selegiline Emsam (transdermal) -Reversible Mood Stabilizers Carbamazepine Tegretol -MOA: antiepileptic; inhibits voltage-gated Na channels -AEs: diplopia, dizziness, drowsiness, nausea, Stevens-Johnson (dont use in Asians), hypoCa, hypoNa, SIADH, hematologic, hepatitis monitor CBC, LFTs, mental status, bone density, levels -Contraindicated with bone marrow depression -Decreases effectiveness of OCPs and warfarin -Pregnancy D Valproate Depakene Depakote -MOA: antiepileptic; increases GABA -AEs: GI upset, sedation, unsteadiness, tremor, thrombocytopenia, palpitations, immune hypersensitivity, ototoxicity monitor CBC and LFTs and levels -Contraindicated with liver disease -Many drug interactions -Pregnancy D Lamotrigine Lamictal -MOA: blocks voltage-gated Na channels and inhibits glutamate release -AEs: nausea, diplopia, dizziness, unsteadiness, HA, rash, Stevens-Johnson, hematologic, liver failure -Overdose can be fatal -Interaction with valproate -Pregnancy C Lithium Eskalith Lithobid -Inhibits adenylate cyclase -AEs: diabetes insipidus, cognitive complaints, tremor, weight gain, sedation, diarrhea, nausea, hypothyroidism -Many drug interactions -Requires baseline BMP, TSH, EKG, Ca as well as monitoring of BMP and TSH q 6-12 mo -Monitoring for signs of toxicity: nausea, tremor, polyuria, thirst, weight gain, diarrhea, cognitive impairment -Need to monitor levels -Pregnancy D for neural tube defects
Class & MOA Generic Agent Brand Info Benzodiazepines: GABA-R agonists CNS inhibition Chlordiazepoxide Librium -Long-acting -Used often during EtOH withdrawal Clorazepate Tranxene -Long-acting Diazepam Valium -Long-acting Flurazepam Dalmane -Long-acting Alprazolam Xanax -Intermediate acting -Approved for panic disorder Clonazepam Klonopin -Intermediate acting -Approved for panic disorder Lorazepam Ativan -Intermediate acting Temazepam Restoril -Intermediate acting Oxazepam Serax -Short acting Triazolam Halcion -Short acting Other Anxiolytics Buspirone BuSpar -5-HT partial agonist -Gradual onset in 2 weeks -Does not potentiate effects of alcohol = useful in alcohols -Low addiction potential = good for pts who were addicted to benzos or other drugs -AEs: sexual, dizziness, nausea, HA -Drug interactions Typical Antipsychotics: nonselective DA-R antagonists Haloperidol (inj avail) Haldol -Good for acute agitation as onset is 30 min Fluphenazine Prolixin Perphenazine Trilafon Thioridazine Mellaril -AE: retinitis pigmentosa -Less risk of EPSEs Chlorpromazine Thorazine -Less risk of EPSEs Atypical Antipsychotics: block postsynaptic DA-R, block serotonin-R, variable effect on histaminic and cholinergic-R
Aripiprazole Abilify Asenapine (SL tablet avail) Saphris -Costs $$$ Olanzapine (inj avail) Zyprexa Zyprexa Relprevv (inj) -High risk of weight gain and metabolic syndrome -Injectable can cause post-injection delirium must give at healthcare facility and monitor for 3 hours Quetiapine Seroquel -Need q 6 month eye exams due to risk of cataracts Risperidone Risperdal Consta (inj) -Least amount of AEs -Highest risk of hyperprolactinemia Ziprasidone Geodon -AE: dose-related QT prolongation -Less wt gain Clozapine
Clozaril -The only atypical antipsychotic proven effective in treatment of schizophrenia -Use limited by AEs: high risk of weight gain and metabolic syndrome, seizures, agranulocytosis, myocarditis, lens opacities need to monitor WBC and ANC frequently Iloperidone Fanapt -Costs $$$ -Not proven better than other atypical antipsychotics Lurasidone Latuda -Best choice for reversing metabolic effects Paliperidone (inj avail) Invega Invega
Sustenna (inj)
Management of Psychiatric Drug Adverse Effects Dystonias -Benztropine -Biperiden -Diphenhydramine -Trihexyphenidyl