Psych Meds

Fluoxetine

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Other names: Also known as Prozac.

Class: Selective serotonin reuptake inhibitor (SSRI).

MOA: Inhibits the reuptake of serotonin in the brain, increasing its availability.

Adverse affects and/ special considerations:

• Longest half life (no need to taper); useful when medication adherence is a concern

Like every SSRI:

• Early onset adverse effects: (eg GI upset, insomnia) often resolve with continued use. SIAD does not resolve spontaneously

• Delayed-onset adverse effects: Motor dysfunction (eg tremors, bruxism) & sexual dysfunction

• Associated with increased bleeding due to inhibition of platelet serotonin uptake (impairing aggregation) and inhibition of cYp2C9 (increasing warfarin levels)

• In utero explore can lead to transient neonatal adaptation syndrome which usually resolves over a few days to weeks. less commonly, persistent pulmonary hypertension of the newborn (PPHN).

Escitalopram

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Other names: Lexapro

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Adverse affects and/ special considerations: Very few drug-drug interactions

Citalopram

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Other names: Usually just citalopram

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• Dose dependent QTc prolongation

Paroxetine

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Other names: Paxil

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• Shortest half life, potent CYP2D6 inhibitor; Anticholinergic risks

• Many drug-drug interactions:

  • Risperidone (Leads to increased side effects like extra pyramidal sx, QT-prolongation)

  • Metoprolol

  • Tamoxifen

Venlafaxine

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Other names: Effexor

Class: SNRI

MOA: Inhibits reuptake of serotonin and norepinephrine

Adverse affects and/ special considerations:

• Risk of hypertension at higher doses

• Can help with some neuropathic pain & headache; pain benefits are less established

Duloxetine

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Other names: Cymbalta
Class: Serotonin-norepinephrine reuptake inhibitor (SNRI)
MOA: Inhibits reuptake of serotonin and norepinephrine
Adverse affects and/ special considerations:

• Well known for tx of pain (Ex. diabetic neuropathy, fibromyalgia, & chronic musculoskeletal pain (like chronic low back pain, osteoarthritis)

• Risk of hepatotoxicity with chronic EtOH use or prexexisting liver disease. Monitor liver enzymes.

Lithium

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Other names: Naur

Class: Mood stabilizers

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