Pharm E2: just the drugs

not done!

Memantine (Namenda XR)

NMDA glutamate receptor antagonist → decreases Glutamate signaling

Donepezil (Aricept)

AChE inhibitors, increase ACh signaling

TCAs

non-specific reuptake blockers, good for resistant depression, but many side effects

• AMITRIPTYLINE (Elavil), NORTRIPTYLINE (Pamelor)

Tetracyclics (TECAS)

antidepressant by blocking presynaptic autoreceptors

SEs: CV, sedation (blocks histamine)

• MIRTAZAPINE (Remeron)

SSRIs

• FLUOXETINE (Prozac), SERTRALINE (Zoloft), CITALOPRAM (Celexa), PAROXETINE (Paxil), ESCITALOPRAM (Lexapro)

• 5-HT₂ is usually the target that we try to stimulate, but we sometimes agonize 5-HT₁ (inhibitory) to balance

• SEs (more manageable than MAOIs and TCAs): 

  • Early onset (transitory): Nausea, anxiety, agitation, insomnia

  • Late onset: weight gain, asthenia (weakness), sexual dysfunction, withdrawal syndrome

• Combo of drugs may interact and increase 5HT (5HT/serotonin syndrome)

• SSRIs compete with other drugs for metabolism by CYP enzymes (PK drug-drug interaction)

SNRIs

• Stronger than SSRIs, for anxiety disorders and chronic nerve pain

• SEs: dry mouth, insomnia, blurred vision, high BP, seizures from Duloxetine

• VENLAFAXIN (Effexor XR), DULOXETINE (Cymbalta), DESVENLAFAXINE (Pristiq)

NDRIs

• Mechanism of Action: like SSRI/SNRI but more potent in inhibiting dopamine reuptake

  • Also nicotinic antagonist → Treats tobacco dependence

• SEs: lowers seizure threshold (convulsions), insomnia, dry mouth, nausea

• BUPROPION (Wellbutrin)

5-HT2 receptor modulators

• simultaneously modulate one+ R and inhibit NT reuptake

• TRAZODONE (Desyrel)

  • 5-HT2a antagonist

  • 5-HT1a receptor agonist

  • NR and 5-HT reuptake inhibitor

• SE: dry mouth, nausea/vomiting, fatigue, sedation (tx for insomnia) - all manageable

Phenelzine (Nardil)

irreversible, nonselective MAOI

• SEs: drowsiness/fatigue, low BP, sleep disturbances, weight gain, blurred vision…

Selegiline (Emsam)

MAO-B Inhibitor (reversible), for Parkinson’s

AMITRIPTYLINE (Elavil)

Tricyclic Antidepressants (TCAs): nonselective reuptake transporter inhibitor

NORTRIPTYLINE (Pamelor)

TCA: nonselective reuptake transporter inhibitors

MIRTAZAPINE (Remeron)

Tetracyclic (TECAS), blocks presynaptic autoreceptors → antidepressant

FLUOXETINE (Prozac)

SSRI

SERTRALINE (Zoloft)

SSRI

CITALOPRAM (Celexa)

SSRI

PAROXETINE (Paxil)

SSRI

ESCITALOPRAM (Lexapro)

SSRI

VENLAFAXINE (Effexor)

SNRI

SEs: dry mouth, insomnia, blurred vision, high BP

DESVENLAFAXINE (Pristiq)

SNRI

SEs: dry mouth, insomnia, blurred vision, high BP

DULOXETINE (Cymbalta)

SNRI

SE: seizures, dry mouth, insomnia, blurred vision, high BP

BUPROPRION (Wellbutrin)

NDRI

• SEs: lowers seizure threshold (convulsions), insomnia, dry mouth, nausea

TRAZODONE (Desyrel)

5-HT2 Receptor Modulator: simultaneously modulate one+ R and inhibit NT reuptake

SE: dry mouth, N/V, fatigue, sedation (tx for insomnia) - all manageable

Chlorpromazine (Thorazine)

Classic/typical neuroleptic (first gen) antipsychotic — dopamine receptor blocker

• SE of parkinsonism (extrapyramidal effect), hyperprolactinemia, effective against positive sx

Haloperidol (Haldol)

Classic/typical neuroleptic (first gen) antipsychotic — dopamine receptor blocker

• SE of parkinsonism (extrapyramidal effect, like Tardive dyskinesia), effective against positive sx

ARIPIPRAZOLE (Abilify)

Atypical (second gen) antipsychotic: better option! less SE because weaker D2 block, effective against both positive and negative

Clozapine (Clozaril)

Atypical (second gen) antipsychotic: better option! less SE because weaker D2 block, effective against both positive and negative

• minimal extrapyramidal SE

• SE: seizures, agranulocytosis

LURASIDONE (Latuda)

Atypical (second gen) antipsychotic: better option! less SE because weaker D2 block, effective against both positive and negative

OLANZAPINE (Zyprexa)

Atypical (second gen) antipsychotic: better option! less SE because weaker D2 block, effective against both positive and negative

QUETIAPINE (Seroquel)

Atypical (second gen) antipsychotic: better option! less SE because weaker D2 block, effective against both positive and negative

RISPERIDONE (Risperdal)

Atypical (second gen) antipsychotic: better option! less SE because weaker D2 block, effective against both positive and negative

• fewer

ZIPRASIDONE (Geodon)

Atypical (second gen) antipsychotic: better option! less SE because weaker D2 block, effective against both positive and negative

LITHIUM CARBONATE (Lithonate)

Treat Bipolar disorder by decreasing frequency and severity of mood fluctuations

• Unknown mechanism of action, but …thought to help strengthen neuronal connections in brain that regulate mood, thinking, and behavior

• Decrease NE release and increase 5-HT synthesis

• Low therapeutic index

CARBAMAZEPINE (Tegretrol)

anticonvulsant to treat bipolar disorder

VALPROIC ACID (Valproate)

anticonvulsant to treat bipolar disorder