Mental Health Medications Flashcards
non-selective norepinephrine-serotonin Reuptake Inhibitors
for anxiety, panic attacks, chronic pain
2 to 4 weeks for full therapeutic effect
not first-line, can easily overdose
previously known as TCAs. ofranil), desipramine (Norpramin), amitriptyline (Elavil) and doxepin (Sinequan.
effects NE, 5-HT, Ach, histamine
inc NE and 5-HT
less expensive, equally efficacious, more SE
seratonin-norepinephrine reuptake inhibitors (SNRI)
treating depression, sleep, pain disorders, anxiety, general anxiety, social phobia, add, eating disorders, possibly neuropathic pain
like TCS without antihistamine, antiadrenergic or anticholinergic SE
less protein binding that SSRI, less drug-drug interactions than SSRI,
Venlafaxine (Effexor and effexor SR)
Duloxetine (cymbalta)
desvenlafaxine (Pristiq)
may be good for double depression and melancholic depression
Norepinephrine-dopamine reuptake inhibitors
bupropion (wellbutrin)
for depression, add, social phobia, good for substance abuse, eating disorder, nicotine withdrawal d/t occupying DA receptors in reward center
affects frontal cortex, limbic system, caudate and brainstem,
mild DA reuptake, no effect on 5HT
NE in frontal cortex-activates and calms
DA blockade has compensatory 5HT increase
, nucleus acumbens
increases well being and satisfaction
serotonin agonist reuptake inhibitor - triazolopyridines
sexual SE, weight gain SE
blocks othe 5HT receptor subtypes, inc anxiolytic and antidepressant
trazodone (Desryl) and nefazodone (BBW - hepatotoxicity, lots of drug-drug)
norepinephrine and serotonin specific agonist
mirtazepine (Remeron)
5HT agonist and reuptake inhibitor that blocks the reuptake of NE and somatodendritic reuptake of 5HT, nore NE in cleft
bad-block histamine–>drowsiness and weight gain
pro-very effective for anxiety/depression, w/o 5-HT SE like sexual or GI
more adverse rxn’s at lower and higher doses
norepinephrine-specific reuptake inhibitors
atomoxetine (strattera) - for ADD, nonstimulant
inc NE in frontal cortex, executive functions improve. good for depression with hypersomnolence, amotivation, poor decision making
benzodiazepen gaba-ergic
potential for cognitive impairment, tolerance and dependence
immediate relief
act on chloride ion channels of gaba receptors, enhance gaba neurotransmission
fast acting
nonbenzodiazepine gaba agonist
buspirone, for anxiety. doesn’t act directly on GABA, agonist to 5HT and DA, main action on limbic system
con-2-3 time/day dosing, mild effects, 2 to 3 week lag time
pro-minimal SE
anxiety-goals of treatment
accepting partial response
provide adequate trial of meds (8-12 weeks)
must provide optimize dosage range and give regular f/u
depression treatment goals
reduce symptoms imp QOL and daily function eliminate SI minimize adverst tx effects prevent relapse
anxiety med classes
neural pathways are 5-HT, NE and GABA
nonselective norepi-5-HT reuptake inh
SSRI, SNRI, serotonin agonists
benzo and betablockers to a lesser extent
SSRI
depression, anxiety, OCD, panic attacks
SE-n/v/diar, sexual dysfunction, HA, insomnia
2 to 4 weeks for effects
anxiety resolves better than depression, but may need higher dose
first-line
beta-adrenergic blockers
good for panic disorders with sympathetic nervous system arousal (sob, tachycardia, clammy skin, blurred vision)
medical causes of depression
hypothyroid, malignancies (brain tumor), chronic renal failure, autoimmune disorders, ciochemical lesions in midbrain and brainstem, like huntington’s and parkinson’s
meds associated with depression
clonidine, hydralazine, methyldopa, interferons, reserpine, OCP, steroids/adrenocorticotropic hormone, isotretinoin
labs for depression
CBC w/ diff, thyroid, RPR, UDS, VitD?, testosterone?
Paxil (paroxetine)
PRO-short half life, sedating properties, good for anxiety and insomnia
CON-CYP2D6 inhibitor, sedating, wt gain, anticholinergic effects, d/c syndrome
Sertraline (zoloft)
PRO weak p450, slight cyp2d6, short half live, less sedating
CON needs full stomach to absorb, inc GI SE
Fluoxetine (prozac)
take in the am
PRO long-half life, less d/c syndrome, good for med non-compliance, easy taper
CON - long half live, metabolites may build up
sig p450 interactions (bad if lots of meds)
more likely to cause mania
citalopram
PRO- low P450, fewest drug-drug int, low d/c syndrome
CON- sedating, GI SE,
prolong QT at high doses
venlafaxine (effexor)
SNRI PRO - no P450, minimal drug-drug, short half-life, fast renal clearance (good for gero) CON-may in BP 10-15 in diastole, nausea d/c syndrom is bad, 2 week taper QT prolongation sexual SE highest, >30%
cymbalta (duloxetine)
SNRI PRO - helps with phys sx less BP inc CON - CYP2d6 and CYP1a2 can't break capsule
Remeron/mirtazapine
novel antidepressant
PRO -good augment to SSRI, hypnotic at low doses s/t antihistamine effect
CON-inc cholesterol in 20-15%, ing tri in 6%
sedating at low dose, activating at 30 mg and above
weight gain below 45 mg
buproprion (wellbutrin)
PRO - good augmenting agent
reuptake inhibition of dopamine and NE
no sw gain, sexual SE, sedation or cardiac probs, low induction of mania
2nd line ADHD med
CON - may inc seizure risk
avoid in TBI, bulimia, anorexia
doesn’t treat anxiety, may worsen and cause agitation/insomnia
abuse potential, psychotic sx at high doses
SSRI least likely to cause GI upset, HA, and insomnia
citalopram, celexa or lexapro. sertraline is the worst,
SSRI least likely to cause drug interactions
citalopram, escitalopram
SSRI least likely to cause withdrawal symptoms
fluoxetine (prozac)
SSRI most likely to cause withdrawal symptoms
paroxetine (paxil), zoloft preferrable for pregnant and elderly
serotonin syndrome precipitating drugs
SSRI, 2nd gen antidepressants, linezolid, tramadol, meperidine, fentanyl, ondansetron, sumatriptan, MDMA, LSD, St John’s wort, ginseng
serotonin syndrome clinical presentation
HTN, hyperreflexia, tremor, clonus, hyperthermia, hyperactive bowel sounds, diarrhea, agitation, coma, onset within hours, mydriasis
neuroleptic malignant syndrome
d2 blocking antipsychotics
severe parkinsonism, HTN, hyperthermia, onset within minutes, tachycardia
TCA adverse effects
Tertiary -inc anticholinergic, inc serotonin reuptake antagonism, inc ortho hypo, inc sedation, inc r/f seizures, more cardiac SE and weigh gain
Secondary - inc NE reuptake antagonism
do EKG before starting
TCA, tertiary amines
amitriptyline, clomipramine, doxepin (good for sleep), imipramine
TCA, secondary amines
desipramine, nortriptyline
less SE than tertiary
antidepressant withdrawal
FINISH = flu-like symptoms, insomnia, nausea, imbalance, sensory disturbances, hyperarousal, starts 24-72 h after last dose. lasts 1-3 weeks
herbal tx for depression
St John’s Wort (lots of drug-drug), tryptophan (caution in epilepsy, renal excretion), SAM-e
