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
