Alcohol withdrawal - Rx
Benzodiazepines
Anorexia / bulimia - Rx
SSRIs
Anxiety - Rx
Benzodiazepines, Buspirone, SSRIs
ADHD - Rx
Methylphenidate, Amphetamines
Atypical depression - Rx
MAO inhibitors, SSRIs
Bipolar disorder - Rx
Lithium, Valproic acid, Carbamazepine, Atypical antipsychotics
Depression - Rx
SSRIs, NSRIs, TCAs
Depression with insomnia - Rx
Mirtazapine
Obsessive-compulsive disorder - Rx
SSRIs, Clomipramine (most 5-HT reuptake inhibition of TCAs)
Panic disorder - Rx
SSRIs, TCAs, Benzodiazepines
PTSD - Rx
SSRIs
Schizophrenia - Rx
Antipsychotics
Tourette's syndrome - Rx
Antipsychotics (haloperidol)
Social phobias - Rx
SSRIs
Methylphenidate - mechanism & use
Ritalin. Increases presynaptic NE vesicular release (like amphetamines). Used for ADHD but mechanism not known.
Typical antipsychotics - mechanism & use
Haloperidol + "azines" (fluphenazine, chlorpromazine, etc). Block dopamine D2 receptors, increasing cAMP. Used for schizophrenia (pos sx mostly), psychosis, acute mania, Tourette's
Chlorpromazine - specific toxicity
Corneal deposits. Typical antipsychotic
Thioridazine - specific toxicity
ReTinal deposits. Typical antipsychotic.
Haloperidol, trifluoperazine, fluphenazine - potency, related side effects
High potency typical neuroleptics; NEURO side effects
Thioridazine, chlorpromazine - potency, related side effects
Low potency typical neuroleptics; NON-NEURO side effects.
Typical antipsychotics: general side effects
1. Very lipid soluble = stored in fat = slow to be removed from body 2. EPS (4h acute distonia, 4d akinesia, 4wk akathisia, 4mo tardive dyskinesia) 3. Endocrine side effects (dopamine antagonism => hyperPRL => galactorrhea) 4. Side effects from blocking m
Atypical antipsychotics - mechanism & use
Olanzapine, cloazpine, quetiapine, risperidone, aripiprazole, ziprasidone. Block 5-HT2, alpha, H1, and dopamine receptors. Used for schizophrenia (pos + neg sx); olanzapine used for OCD, anxiety disorder, depression, mania, Tourette's syndrome too.
Atypical antipsychotics - general side effects
Fewer EPS / anticholinergic side effects than typicals. A/W significant weight gain, metabolic syndrome (esp. olanzapine & clozapine). Clozapine = AGRANULOCYTOSIS (weekly WBC count!)
Clozapine - specific toxicity
AGRANULOCYTOSIS (weekly WBC count!) Atypical antipsychotic.
Lithium - mechanism & use
Mechanism not established; IP3 cascade? Used as mood stabilizer for bipolar disorder; blocks relapse & acute manic events; also used for SIADH (ADH antagonist).
Lithium - toxicity
LMNOP: Lithium side effects = Movement (tremor), Nephrogenic DI, hypOthyroidism, Pregnancy problems (teratogen - Ebstein's anomaly, low tricuspid valve). Also sedation, edema, heart block; narrow therapeutic window = GET LEVELS.
Busiprone - mechanism & use
Stimulates 5-HT-1A receptors; used for GAD (no sedation, addiction, or tolerance; doesn't interact with alcohol vs benzos / barbs)
Imipramine, amitryptiyline, desipramine, nortriptyline, clomipramine, doxepin, amoxapine - mechanism & use
Tricyclic antidepressants; block NE / serotonin reuptake. For major depression, "fibromyalgia", bedwetting (imipramine), OCD (clomipramine).
Imipramine, amitryptiyline, desipramine, nortriptyline, clomipramine, doxepin, amoxapine - toxicity
TCAs. Side effects: sedation, alpha-blocking effects, ANTICHOLINERGIC (atropine-like) side effects (tachy, urinary retention). tertiary TCAs (amitryp) have more anticholinergic effects than secondary TCAs (notryp). Desipramine - least sedating, lower seiz
Fluoxetine, paroxetine, sertraline, citalopram - mechanism & use
SSRIs. For depression, OCD, bulimia, social phobias. Takes 2-3 weeks to see any effect, more for full effect.
Fluoxetine, paroxetine, sertraline, citalopram - toxicity
Fewer side effects than TCAs. GI distress, sexual dysfxn. "SEROTONIN SYNDROME" with any drug that increases serotonin (e.g. MAOi's): hyperthermia, mm rigidity, CV collapse, flushing, diarrhea, seizures. Treat with CYPROHEPTADINE (5-HT2 receptor antagonist
Fluoxetine - special characteristics
SSRI with longest half-life = least withdrawal; longest wash-out before MAOI
Paroxetine - special characteristics
SSRI with shortest half-life = most withdrawal; sedating (give qhs)
Venlafaxine, duloxetine - mechanism & use
SNRIs; inhibit serotonin, NE reuptake. For depression.
Venlafaxine - for GAD too
Duloxetine - for diabetic peripheral neuropathy too (greater effect on NE)
Venlafaxine, duloxetine - toxicity
Increased BP; stimulant effects; sedation / nausea. SNRIs.
Phenelzine, tranylcypromine, isocarboxazid, selegiline - mechanism & use
MAO-Is. Nonselective MAO inhibitors (except selegeline = MAO-B specific), so incr. levels of amine neurotransmitters (DA / NE / serotonin). For atypical depression, anxiety, hypochondriasis.
Phenelzine, tranylcypromine, isocarboxazid, selegiline - toxicty
MAO-Is. HYPERTENSIVE CRISIS with TYRAMINE ingestion (wine / cheese) and BETA-AGONISTS; CNS stimulation. Contraindicated with SSRIs / meperidine to prevent serotonin syndrome (wash-out)
Bupropion - mechanism, use, toxicity
Increases NE / dopamine, mech. unknown. For depression, also for smoking cessation. Toxicity: stimulant (tachy, insomnia), headache, SEIZURE in BULIMIC patients (lowers sz thresh; have electrolyte imbalances). NO SEXUAL side effects
Mirtazapine - mechanism, use, toxicity
Alpha-2 antagonist, increasing NE / serotonin release; also 5-HT2/3 receptor antagonist. Depression, esp pts who can't sleep / won't eat (sedating, increases appetite = wt gain, dry mouth)
Maprotiline - mechanism, use, toxicity
Blocks NE reuptake; for depression. Toxicity = sedation, orthostatic hypotension
Trazodone - mechanism, use, toxicity
Primarily inhibits serotonin reuptake; technically atypical antidepressant but used for insomnia (doses too high for antidepressant effects). SEDATION, nausea, PRIAPISM (trazoBONE), postural hypotension.