Psychopharmacology Notes

Antidepressant Drugs

  • Used for major depressive illness.
  • Categories:
    • TCAs (Tricyclic and related cyclic antidepressants):
    • SSRIs (Selective Serotonin Reuptake Inhibitors):
    • MAOIs (Monoamine Oxidase Inhibitors):
    • Other: Includes desvenlafaxine, venlafaxine, bupropion, trazodone, nefazodone.
  • SSRIs: Primarily affect serotonin levels.
  • Treatment Considerations:
    • Takes 4-6 weeks to see effects.
    • Do not stop medication abruptly.
    • Take with food if stomach upset occurs (e.g., Olanzapine).
    • May cause drowsiness (take at bedtime).

Antipsychotic Drugs

  • Used for: Schizophrenia, manic phase, schizoaffective disorder, bipolar disorder.
  • Generations:
    • 1st Generation: Not often used due to side effects.
    • 2nd Generation
    • 3rd Generation
  • Neurotransmitters Affected:
    • Dopamine (1st generation).
    • Norepinephrine, serotonin antagonists.
  • Side Effects:
    • Sexual dysfunction.
    • Risk for bleeding.
  • Treatment:
    • If experiencing toxicity from medication (e.g. Fluoxetine):
      • Stop medication.
      • Start IV fluids.
  • 2nd Generation Considerations:
    • Dementia-related cardiovascular problems.

Mood Stabilizer Drugs

  • Used for bipolar disorder.
  • Lithium:
    • Therapeutic range: (0.6−1.2)(0.6-1.2).
    • Levels of 1.5+1.5+ require dialysis.
    • Check kidney and liver function before starting.
    • Monitor frequently.
    • Check pregnancy test.
    • ECG might be needed
  • Side Effects:
    • Anticholinergic effects.
    • Male specific considerations
  • Treatment for Lithium Toxicity:
    • Stop medication.
    • Administer IV fluids.
  • Patient Education:
    • Drug interactions.
    • Drink plenty of water, avoid dehydration.
  • Other Medications:
    • Cyproheptadine.
    • Chlorpromazine (for hiccups).
    • Benztropine, Benadryl.
    • Haloperidol (for acute situations).
  • Clozapine:
    • Monitor for agranulocytosis, check WBC frequently.
  • Risperidone:
    • Side effect: weight gain, increased prolactin levels.
  • Quetiapine:
    • Used for insomnia (take at bedtime), may cause milk production.
  • Paliperidone, Lurasidone, Asenapine:
  • Syndromes:
    • Metabolic syndrome (monitor cholesterol, etc.).
    • Neuroleptic Malignant Syndrome: Agitation, hyperthermia, rigidity.

Anxiety Drugs

  • Types:
    • SSRIs (e.g., Citalopram, Fluvoxamine, Paroxetine, Sertraline).
  • Side Effects of SSRIs:
    • Diarrhea.
    • Insomnia.
  • Other Options:
    • Mirtazapine (may cause weight gain).
    • Trazodone
    • Trimipramine, Amoxapine
  • TCAs (Tricyclic Antidepressants):
    • Imipramine (for nocturnal enuresis).
    • Doxepin (for bedwetting).
    • Desipramine.
    • Amitriptyline (for pain management).
    • Nortriptyline.
    • Protriptyline.
    • Clomipramine.
  • Side Effects:
    • Extrapyramidal Side Effects (EPS): Acute dystonia, pseudo-parkinsonism, akathisia.

MAOIs (Monoamine Oxidase Inhibitors)

  • Examples: Phenelzine, Tranylcypromine, Isocarboxazid.
  • Risk of hypertensive crisis.
  • Interactions:
    • Avoid foods high in tyramine (e.g., tap beers, cheese, aged foods).
  • 3rd Generation: Vortioxetine

Mood Stabilizers (cont.)

  • Lithium Considerations:
    • Regular salt intake (do not diminish or increase drastically).
    • Monitor lithium levels, electrolyte levels, BUN (kidney function).
  • Anticonvulsants:
    • Lamotrigine: Risk of Stevens-Johnson Syndrome.
    • Carbamazepine: Side effects include drowsiness. Change position slowly, risk of aplastic anemia and agranulocytosis.
    • Valproic Acid: Risk of liver/hepatic failure, pancreatitis, and bleeding.

Anti-Anxiety Drugs

  • Used for: OCD, alcohol withdrawal, acute anxiety.
  • Benzodiazepines: CNS depressants.
  • Buspirone: Non-benzodiazepine, used for anxiety relief.
  • Stimulant Drugs:
    • Amphetamines: Potential for abuse, can cause addiction, not for long-term use.
    • Alprazolam: Most addictive, short half-life, long-term use can lead to dependence.
  • Side Effects:
    • Insomnia (advise taking in the morning).
    • Weight loss, monitor growth in children.
    • Pemoline: Infrequently used due to potential liver problems.
    • Methylphenidate: Do not use with alcohol.
  • Other Considerations:
    • Monitor BP and weight regularly.

Cholinesterase Inhibitors

  • Used for Alzheimer's disease (e.g., Donepezil, Rivastigmine, Galantamine).
  • Slow the progression of the disease but do not cure it.
  • Benzodiazepines (cont.):
    • Temazepam (for insomnia).
    • Lorazepam (for agitation).
  • Side Effects of Benzodiazepines: Slurred speech, drowsiness. check vital sings
  • Risk of falls: Assist with ambulation.
  • Drug Interactions:
    • Do not mix with other CNS depressants or alcohol (potentiates effects).
  • Benzodiazepine Antidote: Flumazenil
  • Naltrexone (Vivitrol): Opioid antagonist, alcohol antidote. stop drinking for +48h
  • Important considerations:
    • Antipsychotic drugs: Do not stop medication abruptly due to side effects.
    • Hold medication if there is a problem.
  • DSM-5: Language, cause, etc.
  • Duloxetine Pain neurdere
  • Trazadone Priapism (Prolonged erection) take at night
  • Atomoxetine Can use it for ADHD, Avoids Ptwith anorexia and seizures