Psychiatric Drugs Flashcards
Most commonly used Drugs for Depression and Anxiety =
- SSRIs
- Benzos
- SNRIs
SSRIs =
- first line tx for depression/anxiety
- safety in overdose
- easy of titration to target dose
- main side effects: GI( D/C), appetite changes, HA, sexual, agitation/anxiety, sedation or insomnia
Main types of SSRIs
- Fluoxetine (Prozac)
- Fluvoxamine (Luvox)
- Sertraline (Zoloft)
- Paroxetine (Paxil)
- Citalopram ( Celexa)
- Escitalopram ( Lexapro)
Benzos: examples, SE, use
- Valium, Ativan, Xanax
- can worsen depression
- use if anxiety is severe
- high abuse potential
Fluoxetine (Prozac)
- oldest SSRI
- longest half life
- high potential for drug-drug interaction
- can be used in Bulimia and PMDD
- can be used in pregnancy and breastfeeding
Sertraline (Zoloft)
- low drug-drug interactions
- GI upset (diarrhea)
- can be used in pregnancy and breast feeding
Paroxetine (Paxil_
- mod-high drug-drug interactions
- more prominent anti-cholinergic side effects, wt gain, sedation
- potential for discontinuation syndrome
- **Do not give while pregnant
Fluvoxamine (Luvox)
- **first SSRI to get approval for OCD
- initial nausea sometimes problematic
- high drug-drug interactions
- avoid in pregnancy and breast feeding
Citalopram ( Celexa)
- Low drug-drug interactions
- fairly well tolerated
Escitalopram (Lexapro)
-better tolerated then celexa, twice as potent as celexa
Discontinuation Syndrome
- lasts on avg about 10 days after abrupt d/c of SSRIs
- flu-like ax’s, Nausea, dizziness, HA, insomnia, nervousness, “zaps”
- can occur with paroxetine, venlafaxine, duloxetine and sertraline
Trazodone =
- seratonergic agent
- heavily sedating
- free of cardiac conduction concerns
- can cause priapism
- common side effect = orthostasis
Buproprion (Wellbutrin)
- Increases dopamine and NE (no effect on serotonin)
- avoid in pregnancy/breastfeeding
- effective in anergic/atypical depression and good for smoking cessation
Advantages of Buproprion
-NO SEXUAL side effects, non sedating, minimal anticholinergic effects, NO WT GAIN, low drug-drug interaction, safe in overdose
Disadvantages of Buproprion
- potentially activating/agitating
- rarely tx’s panic
- seizure risk
SNRIs (Serotonin NE Reuptake Inhibs)
- dual action antidepressants : increase serotonin and NE
- Venlafaxine
- Mirtazapine
- Duloxetine
Venlafaxine (Effexor)
- similar side effect profile as an SSRI
- potential for increased BP
- safe in overdose
- no contraindications for cardiac pts
Mirtazapine (Remeron)
- predominant sedation
- wt gain
- low occurrence of sexual side effects
- inverse rltnshp btwn dose and sedative effects
Duloxetine (Cymbalta)
- used for diabetic peripheral neuropathic pain
- can increase BP
Main things to add to SSRIs
- Wellbutrin
- Remeron
- Thyroid hormone
- Lithium
- low dose anti psych
Psychotic Drugs: 2 main types
- Typical
- Atypical
Typical Antipsychs
- Phenothiazines: low potency (Chlorpromazine)
- Butyrophenones: high potency (Haloperidol)
Atypical Antipsychs
- Clozapine
- Risperidone
- Olanzapine
- Quetiapine
- Ziprasidone
- Apriprazole
Clozapine (Clozaril)
- ***gold stand for atypicals
- poorly tolerated
- wt gain, sedation, orthostasis, hypersalivation
- Seizure risk
- agranulocytosis
Risperidone (Risperidol)
- less wt gain
- less anticholinergic side effects
- disadvantages: Increase prolactin, orthostasis, sinus tach, dose related EPS
Olanzapine (Zyprexa)
- advantages: IM prep (acute administration), sedation, FDA approval for maintenance phase of bipolar d/o
- disadvantages: metabolic syndrome, wt. gain,sedation
Quetiapine (Serquel)
- tx’s Parkinson’s related psychosis
- low anticholinergic load
- least EPS
- problems: wt gain,sedation, orthostasis, underdosing, BID dosing
Ziprasidone (Geodon)
- Advantages: IM prep, low propensity for wt gain and met syndrome
- disadvantages: potential QT elongation, BID dosing, EPS, anxiety, insomnia at lower doses
Apriprazole (Abilify)
- advantages: FDA approval for maintenance phase of bipolar d/o, fairly well tolerated, lower propensity for met syndrome
- disadvantages: initial akasthesia, insomnia
