Pharmacology 2 Block 1 Psychotherapeutic Drugs

Haloperidol (Haldol)

MOA: FGA; D2 antagonist (D2 antagonism in mesolimbic pathway represses positive symptoms; D2 antagonism in nigrostriatal pathway responsible for parkinsonian and EPS symptoms)

Use: Schizophrenia, severely agitated patients

SE: EPS symptoms managed by Benztropine, diphenhydramine, and amantadine

Clozapine (Clozaril)

MOA: SGA; D2 antagonist and 5HT-2 antagonist (5HT-2 antagonist blocks negative feedback on dopamine, relieving negative symptoms)

Use: Schizophrenia/psychosis

SE: "HAM" side effects; risk of agranulocytosis; need to frequently monitor WBC

Olanzapine (Zyprexa)

MOA: SGA; D2 antagonist and 5HT-2 antagonist

Use: Schizophrenia/psychosis

SE: "HAM" side effects; fewer autonomic side effects than Clozapine; high risk of weight gain

Quetiapine (Seroquel)

MOA: SGA; D2 antagonist and 5HT-2 antagonist

Use: Low doses – hypnotic; Medium doses – anti-depressant; High doses – anti-psychotic

SE: "HAM" side effects

Risperidone (Risperdal)

MOA: SGA; D2 antagonist and 5HT-2 antagonist

Use: Schizophrenia/psychosis

SE: Can increase Prolactin; most likely atypical to cause EPS; can also be used as injection (Invega)

Aripiprazole (Abilify)

MOA: Dopamine partial agonist

Use: Depression

SE: Can cause akathisia; overall not a great antipsychotic

Amitriptyline (psychotherapeutic)

MOA: TCA; blocks reuptake of norepinephrine and serotonin

Use: Depression

SE: Causes sedation (sometimes used to augment sleep)

Fluoxetine (Prozac)

MOA: Blocks reuptake of serotonin

Use: Depression, OCD, anorexia, bulimia

SE: Fewer autonomic effects than TCA's

Sertraline (Zoloft)

MOA: Blocks reuptake of serotonin

Use: Depression

SE: Preferred in elderly patients (elimination not impacted by aging)

Venlafaxine

MOA: SNRI - Blocks reuptake of norepinephrine and serotonin

Use: Depression

SE: Side effects similar to SSRI's

Bupropion (Wellbutrin) - psychotherapeutic

MOA: Many mechanisms; inhibitor of reuptake of dopamine and norepinephrine (NDRI); antagonist at nicotinic cholinergic receptors

Use: Depression

SE: Can be "activating" and lead to weight loss; also used for smoking cessation

Mirtazapine (Remeron)

MOA: Blocks presynaptic alpha-2 auto receptors; antagonist at 5HT-2A, 5HT-3, and peripheral alpha-1 adrenergic receptors; antihistamine

Use: Depression/Insomnia

SE: Orthostatic hypotension; antihistamine side effects

Lithium

MOA: Complex; overall reduces neuronal response to serotonin and norepinephrine

Use: Treatment of bipolar disorder (best treatment to control acute mania)

SE: Low therapeutic index, need to monitor lithium levels

Vortioxetine (Brintellix)

MOA: Complex; reuptake blockage of serotonin transporter; partial agonism at 5-HT1A receptor; 5-HT7 antagonism

Use: Treatment of major depressive disorder

SE: Increased risk of serotonin syndrome when used with other serotonergic agents

Lurasidone

MOA: D2 antagonist; 5-HT2A antagonist; 5-HT7 antagonism; Alpha-2c antagonism

Use: Treatment of schizophrenia and bipolar disorders

SE: Minimal "HAM" side effects; antagonism of alpha-2C adrenergic receptors increases noradrenergic and dopaminergic transmission in prefrontal corte