Pharmacology Psychiatry Cristina Resczenski

Anxiety/Depression
Generic Brand Mechanism Anxiety/Depression Other Use Other (+/-) Side Effects
Alprazolam Xanax RISK abuse/dependence
Benzodiazepines

Bind GABA-A rec( site) Sedation, hangover effect

Chlordiazepoxide Librium Withdrawal synd long term
inhibitory GABA Anterograde amnesia
Clorazepate Tranxene Anxiety Rebound anx, insomnia,
Anxiolytic Balance coordination problems
Clonazepam Klonopin GAD Overdose: tx w/ flumazenil
Anticonvulsant Resp depression
Diazepam Valium Panic: Klonopin Sig. Metabolites:
Muscle relaxant Abuse/dependence
Lorazepam Ativan Chlordiazepoxide
Sedate-hypnotic CNS tox w/ Etoh + opiods
Oxazepam Serax Chlorazepate, Diazepam
Delayed onset (1-2 week)
Azapir

reuptake dopamine, Anxiety Nausea, dizzy, jitteriness

Buspirone Buspar May augment anti-deppr
5HT, NE GAD No sedation, no abuse
Interact w/ grapefruit, CYP
Sertaline Zoloft GAD Gradual response (8-12 w)
GI: nausea
Fluoxetine Prozac SAD No abuse potential
Pre-menstr. HA, tremor, insomnia, bruxism
SSRIs

Paroxetine Paxil 5HT reuptake Panic Low risk overdose

dysphoric do Weight gain
Citalopram Celexa (selective) PTSD Serotonin syndrome*
Fluoxetine: Bulimia Sexual dysfunction, libido
Escitalopram Lexapro OCD w/ MAOIs or other SSRIs
Suicidality (initially)
Fluvoxamine Luvox Depression Withdrawal w/ abrupt stop
Venlafaxine
Effexor 5HT, NE reuptake GAD: Venlafaxine,
Duloxetine Nausea, somnolence, dizzy
SNRIs

Cymbalta Duloxetine
Desvenlafaxine DPN (Duloxetine) 3rd generation Venlafaxine: diastolic BP
Pristiq SAD: Venlafaxine
Mirtazapine Mirt: Block 2 receptor Mirt: Weight gain
Depression
Nafazadone Nefaz: antag sub 5HT
Amitriptyline Elavil Sedation, ortho hTN
Overdose
TCAs (1)

Impipramine Tofranil slow <3 conduction

Cardio, coma, convulsions
Clomipramine Anafranil weight gain
5HT, NE reuptake Anxiety Substantial sedation
Desipramine Norpramin Enuresis (Amit) sexual disturbances
Amine transporters Depression w/ antihistamine (1G)
Nortryptyline Chronic pain (nom) anti-Ach (dry mouth, blurred
High lipid solubility (X BBB)
Amoxapine vision, constipation)
High 1st pass metabolism
2

Maprotiline symp: tremor, insomnia

Trazadone Antag subtype 5HT rec Sleep Aid
2Atyp

Trazadone: priapism, Sedation

NE output, bind D Depression Smoking Cessation Bup: CI: bulimia (seizures)
Buproprion Bup: tremor, worsen psychosis
uptake receptors
Serotonin syndrome* w/ SSRIs Ortho hTN, HA
Interact w/ tyramine foods or Mild anti-Ach, dry mouth
MAO-Is

Phenelzine Nardil MAO: enzyme that Anxiety

LAST resort ephedrine Delayed ejaculation
Tranylcypromine metabolizes 5HT/NE Depression
Cheese, beer, kraut Drowsiness, weight gain
HTN crisis (NE->vasocon) sedation w/ antihist.
Propranalol (non) Bind receptors
Public Speaking Take 1-2 hrs before event

Atenolol (1) HR, contractility

*Serotonin Syndrome: hyperthermia, muscle rigidity, monoclonus, AMS
 Pharmacology Psychiatry Cristina Resczenski

Psychosis
Schizophrenia: Dopamine (mesocortical, mesolimbic pathways); Serotonin, NE, GABA, Glutamate receptors
Generic Brand Mechanism Uses Other (+/-) Side Effects
Phenothiazine

EPS
Chlorpromazine Thorazine Parkinsonism
Thioxanthenes Melleril Tx w/ anti-Ach drugs
Typical Antipsychotics

Fluphenazine Navane Amantadine

Block D2c receptors in
NMS syndrome
mesolimbic and mesocortical Schizophrenia:
Prolactin
Attenuate (+) Sx Can inject if need
Amenorrhea, galactorrhea
Butyrophenones

In pituitary: up prolactin Little effect on (-) Sx

False preg test
Haliperidol Haldol In substantia nigra: EPS
Anti-Ach
Droperidol Dry mouth, constipation, dysuria
Benperidol Anti-
Ortho hTN, sedation, ejaculate fail

Risperidone Risperdal Block D2c receptors

Antipsychotics

Now 1st line (expensive tho) Milder EPS

Olanzapine Zyprexa (less prominent than typical)
Atypical

Schizophrenia: Oral DM, weight gain

Quetiapine Seroquel Block D4 receptors
More effective @ (-)Sx than Prolonged QT
Ziprasidone Geodon 5-HT antagonism
typical
Aripiprazole Abilify Cloz: Bind D1-5; bind 5HT2 Cloz: for tx resistant, high suicide, Cloz: agranulocytosis, sedation,
Clozapine Clozaril rec; block 1, Ach, H1 rec significant Aggression, last resort dizziness
Bipolar
Tremor
Mood Stabilizer

Manic phase
5HT action Thyroid fxn
+ antidep in depress phase Diuretics, NSAIDs clearance
NE/DA turnover Nephrgenic diabetes insip
Lithium Schizophrenia clearance in preg
Block DA rec supersensitivity Chronic interstitial nephritis
+ antipsychotic CI: sick-sinus syndrome
Ach synthesis Edema
Recurrent endogenous
Weight gain
depression
Larazepam
B52 Aggressively psychotic
Mix
ED

Haloperidol Injectable Sedation (intended side effect)

(Cat Man) Severe Agitation
Benadryl
Extra Pyramidal Symptoms (EPS): (Mostly Cat-man info)
Effect Akesthesia Acute Dystonia Dyskinesia Tardive dyskinesia
Involuntary contractions Irreversible sensitization
Description Restlessness Parkinsonism
Torticollis, hand wringing, oculogyric crisis Involuntary facial/arm/trunk tics
Treatment Reduce dose Anti-Ach Anti-Ach (if dose may psychosis) STOP DRUG
(+) Sx: Delusions, hallucinations, disorganized speech, catatonic behavior
(-) Sx: Flat Affect, alogia, avolition, anhedonia
Neuroleptic Malignant Syndrome (NMS): catatonia, stupor, fever; Tx w/ dantroline