Topic 1: Ch 3 Psychotropic Medications

pharmacodynamic

the study of what a drug does to the body and how it does it, including drug action and responses

pharmacokinetics

the movement of a drug through the body

agonists

mimic the effects of an NT naturally found in the human brain by binding to and stimulating the NT’s receptor

antagonsit

blocks a NT from binding to its receptor and obstructs the NT’s action

GABA

the major inhibitory (calming) NT in the CNS

selective serotonin reuptake inhibitors (SSRIs)

block the reuptake of serotonin, making more of the NT available in the synapse; the first line medications for the treatment of MDD and anxiety disorders; common SE include nausea, restlessness, jitterness, sleep disturbances, and sexual dysfunction

Fluoxetine

SSRI that is the most activating agent and causes insomnia and nervousness, has a very long half-life which may cause elderly and those with hepatic impairment to have more severe side effects

sertraline

SSRI that appears to cause the most GI distress (diarrhea)

fluvoxamine

SSRR that is the most sedating agent that should be started at bedtime

Paroxetine

SSRI that is the most anticholinergic due to M1 receptor antagonism and may not be ideal for patients with contraindications to anticholinergic agents (narrow angle glaucoma)

mirtazapine (Remeron)

a norepinephrine and serotonin specific antidepressants (NaSSA) that enhances both NTs; common SE are sedation, appetite stimulation, and weight gain; commonly given to patients with symptoms of insomnia or decreased appetite and weight loss; has fewer GI symptoms and less sexual dysfunction than SSRIs

Buproprion (Wellbutrin)

a norepinephrine and dopamine reuptake inhibitor (NDRI) that is an antidepressant and approved for smoking cessation; common SE include insomnia, tremore, anorexia, and weight loss; causes less sexual dysfunction than other antidepressants; contraindications includes those with seizures, eating disorders, or those abruptly discontinuing the use of alcohol or sedatives secondary to seizure risk

Nefazodone (Serzone)

antidepressant that is a serotonin antagonist and reuptake inhibitor (SARI) than inhibits uptake of serotonin and norepinephrine; common SE include sedation, HA, nausea, dizziness, and blurred vision; not commonly used as it is associated with life-threatening liver failure

trazodone (Desyrel)

antidepressant that is a serotonin antagonist and reuptake inhibitor (SARI) and is approved for depression but MC used as a hypnotic due to its sedating effects, it is prescribed at low doses at bedtime for insomnia; common SE include priapism, dizziness, sedation, and hypotension

serotonin norepinephrine reuptake inhibitors (SNRIs)

increase both serotonin and norepinephrine in the synapse, and are a first-line treatment for MDD and anxiety disorders. similar to SSRI (nausea, restlessness, jitterness, sleep disturbances, sexual dysfunction) and include excessive sweating and can affect BP and HR

Vilazodone (Viibryd)

serotonin partial agonist and reuptake inhibitor that has similar side effecets to SSRIS (nausea, restlessness, jitterness, sleep disturbances, sexual dysfunction) and diarrhea, N/V, and insomnia; take with food to enhance bioavailabilit

tricyclic antidepressants (TCAs)

antidepressants that are not first line of treatment anymore due to secondary side effects and greater lethality in overduse; also used for migraines and neuropathic pain; common SE include sedation, weight gain, dizziness, orthostatic hypotension, blurred vision, dry mouth, tachycardia, urinary retention, constipation, and memory difficulties/confusion in elderly patients

monoamine oxidase inhibitors

antidepressants that are rarely used and are last-line agents, avoid taking with meds that enhance serotonin due to the risk of serotonin syndrome

esketamine (Spravato)

NMDA receptor that alleviates depression by antagonizing the effects of glutamate, only available as an intranasal spray and should be used along with an oral antidepressant; common SE include dissociation and increased BP

brexanolone (Zulresso)

the 1st medication to receive FDA approval for postpartum depression, administered over 60 hours via continuous infusion; monitor for hypoxia using continuous pulse ox; excessive sedation and sudden LOC are common