psychotropic medications

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powerpoint presentation psychotropic medications * overview ► ssri antidepressants ► atypical antidepressants ► tricyclic antidepressants ► maoi antidepressants ► older mood stabilizers ► newer mood stabilizers ► older antipsychotics ► newer antipsychotics ► anticholinergics ► benzodiazepines ► other anxiolytic/hypnotics ► stimulants ► meds for dementia ► meds for substance abuse ► psychiatric uses of antihypertensives * ssri antidepressants mechanism of action inhibit serotonin reuptake so increase synaptic serotonin levels many ssris affect other receptors especially at high doses clinical effect usually takes weeks so mechanism goes beyond simply increasing synaptic serotonin levels several serotonin (5-ht) receptor subtypes serotonin receptors are located throughout the body (especially gi tract) * ssri antidepressants indications & off-label uses all except luvox fda approved to tx depression (major depressive d/o and dysthymia) various class members also approved to treat: generalized anxiety d/o, ocd, panic d/o, ptsd, eating disorders, premenstrual dysphoric d/o, social anxiety d/o off-label …

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lexapro interacting effects may be dose dependent (zoloft) ssri levels tend not to be altered by other drugs but can potentially increase levels (inhibit metabolism) of certain drugs examples: paroxetine > ↑ risperidone fluoxetine > ↑ buspirone fluvoxamine > ↑ olanzapine (consult references such as www.drug-interactions.com , www.drugs.com, others) * ssri antidepressants cautions suicidal ideation and ↑ suicide risk especially with children early in tx but significant debate serotonin syndrome (ssri + maoi, possibly lithium, others) >> diarrhea, tremor, sweating, restlessness, hyperreflexia progression of symptoms if untreated ► ► ► >> disorientation, rigidity, fever >> coma, seizures >> >> death (approximately 10% mortality rate) many medications/substances have serotonin activity: dextromethorphan, fentanyl, meperidine, sumatriptan, st john’s wort, mdma (ecstasy), lsd, many others… * atypical antidepressants mechanism of action venlafaxine and duloxetine are both serotonin and norepinepherine reuptake inhibitors- “snris” mirtazapine has serotonin subtype & norepinephrine activity trazodone, nefazodone have different serotonin …

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(serzone) rarely used due to irreversible liver toxicity pulled from market by initial manufacturer in 2004 although still available as generic still popular with some patients trazodone (desyrel) sedation, weight gain, low blood pressure used most commonly (off label) for insomnia rare reports of sustained painful erection (priapism) that should be treated in er (can lead to impotence) * tricyclic antidepressants mechanism of action norepinephrine, serotonin, histamine, muscarinic (cholinergic) and α-adrenergic receptor activity although in differing ratios anticholinergic activity leads to many of the side effects of these drugs indications & off-label uses depression and similar spectrum of disorders as ssris especially helpful with chronic pain and depression secondary to medical conditions such as aids enuresis, narcolepsy, premature ejaculation, insomnia, migraine prophylaxis blood levels: may be obtained to monitor dose effectiveness * tricyclic antidepressants drug-drug interactions (ddi) multiple significant interactions in each direction with potentially serious consequences side effects (se) …

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h ne- noropinephrine activity; 5ht- serotonin activity (5-hydroxy-tryptamine); ocd:obsessive-compulsive d/o ach- anticholinergic effects; sed- sedation; mod-moderate; mgrha- migraine headache prophylaxis * mood stabilizers- introduction treat bipolar disorder (manic-depressive disorder) many used to treat various seizure d/o types, migraines, chronic pain syndromes, aggression, impulsivity, augmentation of antidepressants and antipsychotics other classes of meds also used in bipolar treatment usually in combination with mood stabilizers treatment of acute mania vs. prophylaxis vs. depression * older mood stabilizers lithium- features only mood stabilizer without significant anticonvulsant properties up to 70% response rate demonstrated effectiveness in reducing suicidality less effective in rapid cycling and mixed bipolar states full clinical effect may take up to 1-2 months serum levels guide dosing lab draw 8-12 hrs after last dose excreted through the kidneys minimal liver mediated drug-drug interactions (but see next slide for other medication issues) * older mood stabilizers lithium- side effects fine tremor, weight …

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reducing their levels) & other medications affecting it (increasing carbamazepine levels) induces its own metabolism so may need to adjust dose over several weeks * older mood stabilizers carbamazepine (tegretol)- side effects gi: nausea, constipation, diarrhea, appetite loss cns: sedation, dizziness, unsteadiness, confusion benign rashes common, catastrophic rashes rare many possible serious abnormalities in cbc may reduce sodium levels (hyponatremia) liver function abnormalities rare but possible toxic metabolite (10-11-carbamazepine epoxide) can create problems via ddi (valproate, lamotrigine and phenobarbital) independent of carbamazepine levels and can be checked separately * older mood stabilizers valproic acid (valproate, depakote)- features can be dosed rapidly to treat acute mania more effective than lithium in rapid cycling & mixed states used by some to treat aggression and impulsivity in other psychiatric disorders approved for migraine prophylaxis serum levels can be helpful in guiding dosing lab draws 8-12 hours after last dose commonly used at top …

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powerpoint presentation psychotropic medications * overview ► ssri antidepressants ► atypical antidepressants ► tricyclic antidepressants ► maoi antidepressants ► older mood stabilizers ► newer mood stabilizers ► older antipsychotics ► newer antipsychotics ► anticholinergics ► benzodiazepines ► other anxiolytic/hypnotics ► stimulants ► meds for dementia ► meds for substance abuse ► psychiatric uses of antihypertensives * ssri antidepressants mechanism of action inhibit serotonin reuptake so increase synaptic serotonin levels many ssris affect other receptors especially at high doses clinical effect usually takes weeks so mechanism goes beyond simply increasing synaptic serotonin levels several serotonin (5-ht) receptor subtypes serotonin receptors are located throughout the body (especiall...

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