Psych Drugs


Anti-depressant

Depression PLUS Rx Options
Smoker Wellbutrin, Nortriptyline
Too Tired Wellbutrin, Prozac, Celexa, Lexapro.
Sexual Dysf. Wellbutrin.
Weight Concern Wellbutrin  (can help w/ weight loss)
Anxiety Paxil, Zoloft.
Insomnia Paxil, Zoloft, Trazodone, Mirtazapine.
Chronic Pain Amitriptyline, Cymbalta, Effexor.
Pregnant Zoloft (sertaline), Prozac (Fluoxetine) and Celexa (citalopram)
AVOID PAXIL
Anorexia Mirtazapine
PTSD Paxil, Amitriptyline
Depression in Hospice pt Ritalin (amphetamine)
No Insurance Celexa, Paxil, Zoloft, Prozac.

ITE 2013, Q#106.
Which class of medication is first-line therapy for uncomplicated depression during pregnancy?
A) Monoamine oxidase inhibitors (MAOIs)
B) SSRIs
C) SNRIs
D) Stimulants
E) Tricyclic antidepressants

ITE 2013 Q#120
An 87-year-old female is brought to the emergency department after losing consciousness at the dinner table. Her history indicates recent unintentional weight loss. Further evaluation ultimately reveals a large mass at the head of the pancreas and extensive metastasis to numerous organs, including the brain. Her life expectancy is estimated to be 2–3 weeks. The patient chooses to receive hospice care but becomes very depressed.

Which one of the following would be best for improving her depression?

A) Electroconvulsive therapy
B) Methylphenidate (Ritalin)
C) Mirtazapine (Remeron)
D) Fluoxetine (Prozac)
E) Nortriptyline (Pamelor)



 

Non-Benzodiazepine Sedatives/Insomnia

Name Plasma Half-Life
Buspirone 2-3 h
Carisoprodol 100 min
Chloral hydrate 4 min for chloral hydrate and 6–10 h for trichloroethanol
Diphenhydramine 3.4-9 h
Doxepin 15 h
Eszopiclone
(Lunesta)
6 h
Gamma hydroxyl butyric acid 0.3-1 h
Hydroxyzine
(vistaril)
20-25 h
Melatonin 40–50 min
Meprobamate 6-7 h
Ramelteon 1-3 h
Remeron
(Mirtazapine)
 20-40 h
Trazodone 3-6 h
Zaleplon 0.9-1.2 h
Zolpidem
(ambien)
1.4-4.5 h
Zopiclone and eszopiclone 3.5-6.5 h

Selected Aspects of Nonbenzodiazepine Overdose:
Agent Features Commonly Seen with Overdose Unique Toxicologic Effects
Buspirone Sedation, GI distress, vomiting, hypotension, priapism & dizziness. Generalized seizures (rare)
Serotonin syndrome (possible)
Carisoprodol Sedation, coma, cardiovascular collapse, pulmonary edema, Myoclonic jerks
Meprobamate Sedation, coma, cardiopulmonary depression Gastric bezoar with prolonged coma
Chloral hydrate Coma Cardiac instability, ventricular arrhythmias, sensitivity to catecholamines, GI distress, hemorrhagic gastritis
β-Hydroxybutyrate Amnesia, sedation, seizure, coma, cardiac and respiratory depression Steep dose-response curve
Sudden awakening
Melatonin Sedation, headache, dizziness, fatigue,  disorientation None observed
Ramelteon Sedation None observed
Zolpidem Sedation,  vivid dreams, sleep-walking & driving, coma possible Limited experience, vomiting
Zaleplon Sedation, incoordination Limited experience, headache (possible)
Zopiclone and eszopiclone Sedation Limited experience, none observed

 

PTSD


- Paxil 20mg 1 po qd (max: 60mg/day)

- Prazosin 1 mg po qhs

- Periactin 4mg qhs (increases appetite)

Anti-Psychotics

Agitated Patient
Drug Dose
Haloperidol 0.5 - 5 mg IV/IM
Ativan (Lorazepam) 1-2 mg IV/IM
Versed (Midazolam) 1-2 mg IV/IM
Benadryl (Diphenhydramine) 25 - 50 mg IV/IM
Geodon (Ziprasidone) 10 mg IM q2h prn
Zyprexa (Olanzapine) 5 - 10 mg IM
  • All antipsychotics can prolong ventricular repolarization, leading to a prolonged QT interval, which can in turn lead to torsades de pointes and sudden cardiac death.
  • The greatest propensity to prolong QTc are Thioridazine, Pimozide, Droperidol, and Ziprasidone.
  • The incidence of sudden cardiac death among patients taking antipsychotics is about twice that of the general population


Anti-psych and weight gain
↑↑ Weight Weight   Weight Neutral
- Olanzapine (ZYPREXA)
- Clozapine (CLOZARIL)
- Risperidone

- Quetiapine (SEROQUEL)
- Abilify (Aripiprazole)

- Geodon (ZIPRASIDONE)
Metabolic Syndrome:
     Fasting Glucose
      TGL, HDL
     Hypertension

Relative receptor-binding affinities of atypical antipsychotics
Receptor Ziprasidone
(Geadon)
Risperidone
(Risperdal)
Olanzapine
(Zyprexa)
Quetiapine
(Seroquel)
Clozapine
(Clozaril)
Aripiprazole
(Abilify)
D1 ++ + ++ + ++ +
D2 +++ +++ +++ ++ + ++++
D3 ++ ? + + ? ?
D4 ? + + - + ?
5-HT2A +++++ +++++ ++++ + ++++ ++++
5-HT2C +++++ ++++ ++++ - ++ ++
5-HT2A ++++ + - + + ++++
5-HT1D ++++ + + - - -
a 1 ++ +++ ++ +++ +++ -
a 2 - +++ + + +++ -
ACh - - + - ++ -
M1-muscarinic - - ++++ ++ ++++ -
H1-histaminergic ++ + ++++ ++++ ++++ ++
5-HT/NE reuptake ++ - - -5HT
+NE
-5HT
+NE
++5HT


Side effect profile:
NAME EPS effect SEDAT. ACH ORTHO-
STASIS
COMMENTS/
POTENTIAL SE
Abilify VL VL VL VL Headace, N/V, Akathesia & anxiety (activating agent)
Chlorpromazine M H M MH Photosensitivity, rare cytopenias, seizures
Clozapine N H H H Agranulocytosis, seizures, wt. gain, hypersalivation, diabetes, hyperlipidemia
Fluphenazine H L L L GI upset, headache, edema, leulopenia & akathesia
Haloperidol H L L L Akathesia, anxiety, lethargy & hyperprolactinemia
Olanzapine VL M LM LM Akathisia, headache, rhinitis, wt. gain, hyperglycemia, constipation, & dry mouth.
Perphenazine M L L L Anorexia, rare cytopenia, hepatotoxicity
Quetiapine VL MH M M Agitation, headache, dry mouth, wt. gain, diabetes, & hyperlipidemia
Risperidone LM LM VL LM Nausea, anxiety, tremor, wt. gain & hyperglycemia, akathesia & hyperprolactinemia
Thioridazine L H H MH Dec. libido, retrograde ejaculation, wt. gain & rarely retinitis pigmentosa
Thiothixene H L L LM Agitation, photosensitivity, & hepatotoxicity
Ziprasidone VL LM VL L Nausea, headache, & weakness.
* N = None, H = High, L = Low, VL = Very Low, M = Moderate, LM = Low-Moderate, MH = Moderate-High.