Psychotropic Drugs

Substance Abuse Related

Disulfiram, Naltrexone, Methadone, Suboxone, Campral, Catapress, Topamax

Extrapyramidal Side Effect Treatment Agents

Artane, Benadryl, Cogentin, Symmetrel

Phenothiazines (Typical Antipsychotics)

Block dopamine receptors within the CNA as well as outside the CNS; also thought to depress various portions of the reticular activating system; treats postive signs of schizophrenia only • haloperidol (Haldol) * decanoate → long acting * high potency • chlorpromazine hydrochloride (Thorazine) * low potency: PO, IM, IV suppository • fluphenazine hydrochloride (Prolixin) * include depot • perphenazine (Trilafon) • trifluoperazine (Stelazine): PO, IM • thioridazine (Mellaril) *low potency, PO

Tricyclic Antidepressants

Blocks the reabsorption of norepinephrine and serotonin • amitriptyline (Elavil) • clomipramine (Anafranil) • desipramine (Norpramin) • imipramine (Tofranil) • nortriptyline (Pamelor) → tolerated well in elderly • doxepin (Sinequan) • protriptyline (Vivactil)

SSRIs - Drugs in Class

Decrease the reuptake of serotonin at selective nerve terminals in the central nervous system and increases the serotonin activity at the nerve synapse. Produces CNS excitation rather than sedation; has no effect on dopamine or norepinephrine. • escitalopram (Lexapro) • citalopram (Celexa) • fluoxetine (Prozac) • paroxetine (Paxil) • sertraline (Zoloft) • fluvoxamine (Luvox)

MAOI (Monoamine oxidase inhibitors)

Inhibit the enzyme monoamine oxidase, which breaks down norepinephrine and serotonin, increasing the concentration of these neurotransmitters. • isocarboxazid (Marplan) • phenelzine sulfate (Nardil) • tranylcypromine (Parnate) *most likely to cause hypertensive crisis; onset of action is more rapid. • selegeline Patch (EmSam)

Anti-Manic and Mood Stabilizing Drugs

Lithium, Depakote, Lamictal, Tegretol, Trileptal

Alzheimer's Disease Treatments

Razadyne, Aricept, Exelon, Namenda, Ginko Biloba

Hypnotic Drugs & Herbal Sleep Aids

Restoril, Sonata, Ambien, Lunesta, Rozerem, Valerian, Melatonin, Desyrel

Central Nervous System Stimulants/ADHD Treatment

Ritalin, Adderall, Concerta, Strattera, Vyvanse, Focalin

Benzodiazepine Anxiolytics

Work on GABA • lorazepam (Ativan) • clonazepam (Klonopin) • diazepam (Valium) • alprazolam (Xanax) • chlordiazepoxide (Librium) • clorazepate (Tranxene)

NDRI (Norepinephrine-dopamine reuptake inhibitor)

bupropion (Wellbutrin)

Tetracyclic antidepressants (TeCAs)

mirtazapine (Remeron) • strong sedating effect → taken at night • extreme weight gain

SNRIs (Serotonin-norepinephrine reuptake inhibitors )

venlafaxine (Effexor) desvenlafaxine (Pristiq) duloxetine (Cymbalta)

Extrapyramidal Symptoms (EPS)

• Acute dystonia—painful spasm of muscles of tongue, face, neck, or back; oculogyric crisis (upward deviation of the eyes); opisthotonus • Parkinsonism—muscle tremors, rigidity, spasms, shuffling gait, stooped posture, cogwheel rigidity • Akathisia—motor restlessness, pacing • Tardive dyskinesia: occurs late in therapy; symptoms are often irreversible—earliest symptom is slow, wormlike movements of the tongue; later symptoms include fine twisting, writhing movements of the tongue and face, grimacing; lip smacking; involuntary movements of the limbs, toes, fingers, and trunk

Phenothiazines (Typical Antipsychotics) Side Effects/Teaching

• EPS Symptoms: Tardive dyskinesia, Parkinsonism, Acute dystonia, and Akathisia • Anticholinergic effects: dry mouth, drowsiness, constipation, urinary retention, blurring of vision • QT changes and potential for dysrhythmias • Neuroleptic malignant syndrome • Endocrine side effects: → amenorrhea, increased libido in women, decreased libido in men, delayed ejaculation, increased appetite, weight gain, hypoglycemia, and edema • Dermatologic side effects: photosensitivity • Hypersensitivity reaction: jaundice, agranulocytosis

MAOI Action/Side Effects

• Side effects: Drowsiness, insomnia, dry mouth, urinary retention, hypotension Adverse reactions: tachycardia, tachypnea, agitation, tremors, seizures, heart block, hypotension • Uses: primarily psychotic depression and depressive episode of bipolar affective disorder. • Potentiate many drug actions: narcotics, barbiturates, sedatives, and atropine-like medications. • Have a long duration of action; therefore 2-3 weeks must go by before another drug is administered while a client is taking an MAOI. • MAOIs interact with foods and drugs containing tyramine or sympathomimetic drugs (coffee, tea, cola beverages, aged cheeses, beer and wine, pickled foods, avocados, and figs and many over-the-counter cold preparations, hay fever medications, and nasal decongestants) • may cause a severe hypertensive crisis characterized by marked elevation of blood pressure, increased temperature, tremors, and tachycardia. Foods and drugs to avoid: • Monitor for bladder distention by checking urinary output.

SSRI - Action/Side Effects

• Side effects: Nausea, headache, anxiety, nervousness, insomnia, weight gain, skin rash, sexual dysfunction • Adverse reactions (serotonin syndrome): tachycardia, delirium, restlessness, fever, seizures • Uses: first-line anti-depressant, obsessive-compulsive disorder, bulimia • Interacts with St. John's wort and MAOI • Better tolerated than TCAs; safer in oversode

Atypical Antipsychotics

• aripiprazole (Abilify) • clozapine (Clozaril) * associated with agranulocytosis • ziprasidone (Geodon) * associated with elevated QT • risperidone (Risperdal) • quetiapine (Seroquel) • olanzapine (Zyprexa) • paliperidone (Invega, Invega Sustenna) • asenaoine (Saphris) • lurasidone (Latuda) • olanzapine (Zyprexa)

Non-Benzodiazepine Anxiolytics

• buspirone (Buspar) → only true non-benzo • propranolol (Inderal) → β-blocker, reduced BP & HR • hydroxyzine (Vistaril) → anti-histamine/anti-emetic • Kava-Kava

agranulocytosis

• failure of the bone marrow to make enough white blood cells (WBCs) • weekly WBC counts required

Neuroleptic Malignant Syndrome (NMS)

• rare problem • fever >105° F • "lead pipe" muscle rigidity, agitation, confusion, delirium, respiratory and acute renal failure

Atypical Antipsychotics

• second generation of antipsychotic drugs • targets positive AND negative symptoms of schizophrenia • predominantly dopamine and serotonin antagonists (blockers). • The blockade at the mesolimbic dopamine pathway is thought to decrease psychosis, similar to the mechanism by which the conventional antipsychotics work. • Decreasing dopamine can reduce psychosis but cause adverse effects elsewhere such as the movement side effects of EPS, the worsening of cognitive and negative symptoms, and an increase in the hormone prolactin, leading to gynecomastia, galactorrhea, amenorrhea, and low libido • produce fewer extrapyramidal side effects (EPS) • five of the seven available atypical antipsychotics can increase the risk of metabolic syndrome, with increased weight, blood glucose, and triglycerides. Clozapine and olanzapine have the highest risk of causing metabolic syndrome. Less weight gain with Abilify and Geodon. • The simultaneous blockade of 5-HT2C and histamine-1 receptors is associated with weight gain due to increased appetite stimulation via the hypothalamic eating centers. • Strong antimuscarinic properties at the M3 receptor on the pancreatic beta cells can cause insulin resistance, leading to hyperglycemia.

Benzodiazepine Anxiolytics

• short-term use only • withdrawal can be fatal • highly addictive • CNS depressant • Antidote to overdose: flumazenil (Romazicon)