Pharm 2 Final Exam: Psychotherapeutic Drugs

Haloperidol (Haldol)

MOA: FGA (D2 antagonist); D2 blockade in mesolimbic pathway reduces positive symptoms; D2 blockade in nigrostriatal pathway causes EPS. Use: Schizophrenia, severe agitation. SE: EPS (managed by benztropine, diphenhydramine, or amantadine).

Clozapine (Clozaril)

MOA: SGA; D2 antagonist + 5HT-2 antagonist; 5HT-2 blockade disinhibits dopamine in mesocortical pathway, reducing negative symptoms. Use: Schizophrenia/psychosis. SE: HAM side effects (sedation, hypotension, anticholinergic); risk of agranulocytosis — monitor WBC frequently.

Olanzapine (Zyprexa)

MOA: SGA; D2 and 5HT-2 antagonist. Use: Schizophrenia/psychosis. SE: HAM side effects; fewer autonomic effects than clozapine; high risk of weight gain.

Quetiapine (Seroquel)

MOA: SGA; D2 and 5HT-2 antagonist. Dose-dependent: low = hypnotic, medium = antidepressant, high = antipsychotic. Use: Schizophrenia/psychosis, depression, insomnia. SE: HAM side effects.

Risperidone (Risperdal)

MOA: SGA; D2 and 5HT-2 antagonist. Use: Schizophrenia/psychosis. SE: Can increase prolactin; most likely atypical to cause EPS; available as IM injection (Invega).

Aripiprazole (Abilify)

MOA: Dopamine partial agonist. Use: Depression. SE: Can cause akathisia; not a great antipsychotic overall.

Amitriptyline

MOA: TCA; blocks reuptake of NE and serotonin. Use: Depression (also migraine prophylaxis). SE: Sedation (sometimes used to augment sleep).

Fluoxetine (Prozac)

MOA: Blocks reuptake of serotonin (SSRI). Use: Depression, OCD, anorexia, bulimia. SE: Fewer autonomic effects than TCAs.

Sertraline (Zoloft)

MOA: Blocks reuptake of serotonin (SSRI). Use: Depression. SE: Preferred in elderly (elimination not affected by aging).

Venlafaxine

MOA: Blocks reuptake of NE and serotonin (SNRI). Use: Depression. SE: Similar to SSRIs.

Bupropion (Wellbutrin)

MOA: Weak inhibitor of dopamine, NE, and serotonin reuptake (NDRI); antagonist at nicotinic cholinergic receptors. Use: Depression, smoking cessation. SE: "Activating," weight loss.

Mirtazapine (Remeron)

MOA: Blocks presynaptic alpha-2 autoreceptors (increases NE and serotonin release); antagonist at 5HT-2 and 5HT-3. Use: Depression/insomnia. SE: N/A.

Lithium

MOA: Complex; reduces neuronal response to serotonin and NE. Use: Bipolar disorder (best for acute mania). SE: Low therapeutic index; monitor levels