Medication and Other Things I should Know

Amphetamine MOA

Increase the release of NE and DA via replacing NT in the vesicle

Binds to MAO

Amphetamine SE

Increase BP, HR

Psychosis

Fatigue
Insomnia
Suicide
Hunger
Panic attacks
Anxiety
Depression

Dizziness

Dry mouth

Methylphenidate MOA

NE and DA reuptake inhibitor

Methylphenidate SE

Weight loss

Headaches

Increase BP, Psychosis

Arrhythmia

Insomnia

Dizziness

Methylphenidate Ex

Concerta, D-isomer (Focalin), JORNAY PM

Alpha-2 Adrenergic Agonist MOA

Stimulate A-2 adrenergic receptors that facilitate DA and NE neurotransmission → decrease NE → decrease impulsivity, hyperactivity, improve attention 

A-2 Adrenergic Agonist

Sedatiion

Dizziness

Hypotension

Dry mouth

TCA MOA

Blocks reuptake of NE and 5HT

Blocks alpha adrenergic receptor, histamine 1, muscarinic receptor

TCA SE

Muscarinic: blurry vision, urinary retention, tachycardia, constipation

AAR: orthostatic hypotension, tachycardia, dizziness

Histamic: sedation, weight gain 

Sodium: seizures, arrhythmias

ED + overdose

MAOI MOA

Forms irreversible complex with MAO-A or B

• A: breaks down NT

• B: breaks down DA

MAOI SE

Orthostasis, weight gain, ED, insomnia, headaches, nausea, palpitations

DD - inhibits MOAa → accumulation of waste and drug

• NO tyramine: hypertensive crisis

• Serotonin syndrome

MAOI Ex

Selegiline (MAOb)

SSRI MOA

Stops 5HT reuptake

• Low muscarinic, alpha, histamic

SSRI SE

Drowsiness

Insomnia

Nausea

ED

Sedation

DD interactions + anticoagulants

BB: suicide

SNRI MAO

Stops 5HT and NE reuptake + pain syndrome 

• Low muscarinic, alpha, histamic

SNRI SE

Insomnia

Nausea

Constipation

Anxiety

Sedation

ED

Increase in BP 

Tachycardia

SNRI Ex

Effexor - hypertensive crisis

Bupropion MOA

DA and NE reuptake inhibitor

• Greatest DA effect of antidepressants

Does NOT act on serotonin 

Antagonizes nicotine → decrease nicotine withdrawal symptoms and cravings

Low ED and drug-drug interactions

Bupropion SE

Sweating

Tremors

Anxiety
Nervousness

Dizziness

Increase risk of seizures

Dry mouth

Mirtazapine MOA

Blocks a2 presynaptic autoreceptors → a2 presynaptic blockade → loss of inhibition → increase NE release

Antagonises 5HT2 → less ED and GI upset

Antagonises H1 → weight gain and sedation 

• Low ED and drug drug interactions

Mirtazapine SE

Weight gain

Increased appetite

Sedation

Elevated lipid

Trazodone MOA

Weak 5HT reuptake inhibitor

Antagonizes postsynaptic 5HT2 receptor

Antagonise H1 → sedation

Trazodone SE

Orthostatic hypotension

Dizziness

Dry mouth
Sedation

Vortioxetine MOA

Inhibits 5HT reuptake

5HT1a agonism

5HT3 and 5HT7 antagonism

• Low ED

Vortioxetine SE

Diarrhea

Dizziness

Dry mouth

Constipation

Nausea

If Stimulant causes Anorexia

Give after breakfast, no high fat or citric acid as will decrease absorption

If stimulant cuases dizziness

Monitor BP, adequate fluid

If stimulant causes insomnia

Establish bedtime routine, omit last dose

If stimulant causes tics

Apropriate dose, make sure tic is med related, see mental health specialist

If stimulant cases mood change

happens when med wears off, reduce dose or switch to LA, add afternoon dose

If stimulant cause rebound

Happens when dose wears off, med stop, or dose change, increase dose of LA in the morning and add small short acting dose at night