Psychotropics Simplified: Comprehensive Pharmacology Flashcards

Vocabulary flashcards summarizing psychotropic drug classes, indications, mechanisms of action, half-lives, key side effects, drug interactions, and patient education points from the Psychotropics Simplified cheat sheets.

citalopram (Celexa)

A first-line SSRI for depression and anxiety that exists as a racemic mixture with a half-life of $35\,\text{hours}$ and dose-related QTc prolongation risk (FDA max dose limit of $40\,\text{mg daily}$, or $20\,\text{mg}$ for patients $>60\,\text{years old}$).

escitalopram (Lexapro)

An SSRI that is the S-enantiomer of citalopram with high selectivity for serotonin, a half-life of $27\text{--}32\,\text{hours}$, and a favorable tolerability profile with minimal drug interactions.

fluoxetine (Prozac)

An SSRI with the longest half-life ($4\text{--}6\,\text{days}$) enabling gradual discontinuation; it inhibits CYP2D6 and requires a $5\text{-week}$ washout period prior to initiating an MAOI.

paroxetine (Paxil)

The most sedating SSRI with anticholinergic properties and the highest incidence of weight gain among SSRIs; it acts as a strong CYP2D6 inhibitor, requires slow tapering due to severe withdrawal symptoms, and is generally avoided in pregnancy.

sertraline (Zoloft)

A first-line SSRI indicated for depression, anxiety, OCD, and PTSD that has the most evidence for safety in pregnancy, a half-life of $26\,\text{hours}$, and commonly causes GI upset and diarrhea.

desvenlafaxine (Pristiq)

An SNRI that is the active metabolite of venlafaxine with higher norepinephrine activity, an $11\text{-hour}$ half-life, and minimal drug interactions because it is not metabolized by CYP450.

duloxetine (Cymbalta)

An SNRI with balanced $5\text{-HT}$ and NE activity indicated as a first-line option for depression accompanied by chronic pain, diabetic neuropathy, or fibromyalgia; it acts as a CYP2D6 inhibitor.

venlafaxine (Effexor XR)

An SNRI with a dose-dependent mechanism ($5\text{-HT}$ reuptake inhibition at low doses, adding NE reuptake inhibition at doses $>150\,\text{mg/day}$) effective for treatment-resistant depression and anxiety disorders.

bupropion (Wellbutrin XL/SR)

An NDRI that blocks NE and DA reuptake with no serotonergic activity; it causes minimal sexual dysfunction, aids in smoking cessation, but lowers the seizure threshold and is contraindicated in eating disorders or active seizure risk.

mirtazapine (Remeron)

A NaSSA ($\alpha_2$-antagonist, $5\text{-HT}_{2/3}$ antagonist) that increases NE and $5\text{-HT}$ release; it causes significant weight gain and sedation, though sedation paradoxically decreases at higher doses ($30\text{--}45\,\text{mg}$).

trazodone (Desyrel)

A SARI ($5\text{-HT}_{2A/C}$ and $\alpha_1$-antagonist) and weak SSRI primarily utilized at low doses ($25\text{--}100\,\text{mg}$) as a non-benzodiazepine sleep aid; carries a rare but serious risk of priapism.

vortioxetine (Trintellix)

A serotonin modulator ($5\text{-HT}$ reuptake inhibitor plus multiple receptor activity) with a $66\text{-hour}$ half-life that may improve cognitive symptoms of depression and carries a lower risk of sexual dysfunction than classic SSRIs.

carbamazepine (Tegretol)

An anticonvulsant mood stabilizer that blocks voltage-gated $\text{Na}^+$ channels, auto-induces its own metabolism, decreases oral contraceptive effectiveness, and requires testing for HLA-B*1502 in patients of Asian descent.

lamotrigine (Lamictal)

A mood stabilizer that blocks voltage-gated $\text{Na}^+$ channels and modulates glutamate release; it is best for bipolar depression maintenance (ineffective for acute mania) and requires very slow titration due to Stevens-Johnson syndrome risk.

lithium (Lithobid, Eskalith)

The gold-standard mood stabilizer for bipolar disorder that reduces suicide risk; features a narrow therapeutic index ($0.6\text{--}1.2\,\text{mEq/L}$ maintenance) and interacts dangerously with NSAIDs, ACE inhibitors, and thiazide diuretics.

valproate / divalproex (Depakote)

A first-line mood stabilizer for acute mania and mixed episodes that enhances GABA and blocks $\text{Na}^+$ channels; it is highly teratogenic (neural tube defects), increases lamotrigine levels, and requires monitoring of LFTs, CBC, and platelets.

aripiprazole (Abilify)

An atypical antipsychotic acting as a $D_2$ partial agonist, $5\text{-HT}_{1A}$ partial agonist, and $5\text{-HT}_{2A}$ antagonist with a low metabolic profile and a long half-life ($75\,\text{hours}$); akathisia is a common side effect.

brexpiprazole (Rexulti)

An atypical antipsychotic $D_2$ partial agonist with lower intrinsic activity than aripiprazole, offering better overall tolerability and a lower incidence of akathisia when used as an adjunct in MDD or for schizophrenia.

cariprazine (Vraylar)

A $D_3$-preferring $D_2/D_3$ partial agonist atypical antipsychotic with a long half-life ($2\text{--}4\,\text{days}$ for parent drug; $1\text{--}3\,\text{weeks}$ for active metabolite) indicated for schizophrenia, bipolar mania/mixed, and bipolar depression.

clozapine (Clozaril)

The most effective atypical antipsychotic indicated strictly for treatment-resistant schizophrenia; reduces suicide risk but carries severe risks of agranulocytosis, myocarditis, seizures, and metabolic syndrome, requiring mandatory structured monitoring.

lumateperone (Caplyta)

A newer atypical antipsychotic acting as a $D_2$ presynaptic partial agonist / postsynaptic antagonist and $5\text{-HT}_{2A}$ antagonist; given as a single fixed dose of $42\,\text{mg daily}$ with food without titration.

lurasidone (Latuda)

An atypical antipsychotic for bipolar depression and schizophrenia with a low metabolic risk profile that must be administered once daily with food (at least $350\,\text{calories}$) to ensure adequate absorption.

olanzapine (Zyprexa)

A highly effective atypical antipsychotic for schizophrenia and bipolar mania associated with significant weight gain and high metabolic risk; metabolized by CYP1A2, meaning cigarette smoking decreases drug levels.

paliperidone (Invega)

The active metabolite of risperidone that is not primarily metabolized by CYP450; available in oral extended-release form and long-acting injectable (LAI) formulations (Sustenna, Trinza).

quetiapine (Seroquel)

An atypical antipsychotic with low $D_2$ affinity and potent $H_1$ antagonism; highly sedating with lower EPS risk, commonly prescribed for bipolar depression and schizophrenia.

risperidone (Risperdal)

A first-line atypical antipsychotic with high $D_2$ affinity causing dose-dependent EPS and the highest rate of prolactin elevation among second-generation antipsychotics.

ziprasidone (Geodon)

An atypical antipsychotic with low weight-gain risk requiring BID dosing with meals (at least $500\,\text{calories}$) and baseline ECG screening due to QTc prolongation concerns.

amphetamine / dextroamphetamine (Adderall)

A DEA Schedule II CNS stimulant that increases DA and NE release and blocks reuptake; highly effective for ADHD but possesses a higher abuse potential and longer duration than methylphenidate.

dexmethylphenidate (Focalin)

A DEA Schedule II stimulant consisting of the isolated active d-isomer of methylphenidate, allowing for equivalent efficacy at half the dose of racemic methylphenidate.

lisdexamfetamine (Vyvanse)

A Schedule II prodrug converted in the body to d-amphetamine, resulting in a smooth $10\text{--}13\,\text{hour}$ duration, lower abuse potential, and FDA approval for both ADHD and binge eating disorder.

methylphenidate (Ritalin, Concerta)

A first-line Schedule II CNS stimulant for ADHD across all age groups that blocks DA and NE reuptake; preferred over amphetamines if comorbid anxiety symptoms are present.

atomoxetine (Strattera)

A non-stimulant selective NE reuptake inhibitor for ADHD that requires $4\text{--}6\,\text{weeks}$ for therapeutic effect and carries an FDA boxed warning for increased suicidal ideation in children/young adults.

clonidine ER (Kapvay)

An extended-release $\alpha_{2A}$-adrenergic agonist approved for ADHD with hyperactivity/impulsivity; highly sedating and requires gradual tapering to avoid severe rebound hypertension.

guanfacine ER (Intuniv)

An extended-release $\alpha_{2A}$-adrenergic agonist for ADHD that enhances prefrontal cortex function; less sedating than clonidine ER with a $17\text{-hour}$ half-life.

viloxazine (Qelbree)

A non-stimulant selective NE reuptake inhibitor and $5\text{-HT}_{2B}$ receptor agonist for ADHD that carries an FDA warning for suicidal ideation.

alprazolam (Xanax)

A short-acting Schedule IV benzodiazepine with rapid onset ($15\text{--}30\,\text{minutes}$) and a half-life of $11\text{--}15\,\text{hours}$; associated with frequent interdose rebound anxiety and a high risk of dependence.

clonazepam (Klonopin)

A long-acting Schedule IV benzodiazepine ($30\text{--}40\,\text{hour}$ half-life) used for panic disorder maintenance, social anxiety, and antipsychotic-induced akathisia.

diazepam (Valium)

A long-acting Schedule IV benzodiazepine ($20\text{--}100\,\text{hour}$ half-life) with multiple active metabolites; used for alcohol withdrawal and muscle spasms but carries an accumulation risk in the elderly.

lorazepam (Ativan)

An intermediate-acting Schedule IV benzodiazepine ($12\text{--}18\,\text{hour}$ half-life) without active metabolites, making it the preferred benzodiazepine in elderly patients or those with hepatic impairment.

eszopiclone (Lunesta)

A Schedule IV non-benzodiazepine Z-drug hypnotic ($6\text{-hour}$ half-life) approved for sleep onset and maintenance for $>35\,\text{days}$; commonly causes an unpleasant metallic taste.

zolpidem (Ambien)

A short-acting Schedule IV Z-drug hypnotic selective for $\alpha_1$ GABA-A subunits used for short-term insomnia; carries risk for complex sleep behaviors (sleepwalking, sleep-driving) and requires lower dosing in women.

clonidine IR (Catapres)

An immediate-release centrally-acting $\alpha_{2A}$ agonist used off-label for PTSD nightmares, tics, and opioid/alcohol withdrawal; must be tapered over $2\text{--}4\,\text{days}$ to prevent rebound hypertension.

guanfacine IR (Tenex)

An immediate-release centrally-acting $\alpha_{2A}$ agonist with a $17\text{-hour}$ half-life used off-label for PTSD nightmares and tics; less sedating than immediate-release clonidine.