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Treatment of panic disorders
SSRIs
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Valproic acid (Divalproex)
N/V, sedation, weigth gain, transitory hair loss, transient increase in LFTs
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donepezil
- cholinesterase inhibitor
- used for mild to moderate Alzheimer's
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rivastigmine
- cholinesterase inhibitor
- mild to mod Alzheimer's
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galantamine
- cholinesterase inhibitor
- mild to mod Alzheimer's
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clozapine
- *atypical antipsychotic
- *agranulocytosis
- *hypersalivation that can cause aspiration despite anticholinergic activity
- *myocarditis
- only antipsychotic shown to decrease risk of suicide
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Chlorpromazine
- Thorazine
- low-potency typical antipsychotic
- orthostatic hypotension
- bluish skin discoloration
- photosensitivity
- can treat N/V and intractable hiccups
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Thioridazine (Mellaril)
retinitis pigmentosa
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Loxapine (Loxitaine
- higher risk of seizure
- metabolite is an antidepressant
- mid-potency typical neurleptic
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trifluoperazine (Stelazine)
- mid-potency typical neurleptic
- can reduce anxiety
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Perphenazine
midpotency neuroleptic
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Haloperidol (Haldol)
- high potency neuroleptic
- used for Tourette d/o
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Fluphenazine
*high potency typical neuroleptic
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Pimozide
- high potency typical neuroleptic
- associated with heart block, ventricular tachycardia, and other cardiac effects
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Risperidone
- atypical antipsychotic
- *prolactinemia
- *orthostatic hypotension and reflex tachycardia
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Quetiapine (Seroquel)
- atypical antipsychotic
- *sedation
- *orthostatic hypotension
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Olanzapine
- atypical antipsychotic
- weight gain
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Ziprasidone (Geodon)
- atypical antipsychotic
- less likely to cause weight gain
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Aripiprazole (Abilify)
- atypical antipsychotic
- *unique mechanism of partial D2 agonism
- *can be more activating (akathisia) and less sedating
- *less potential for weight gain
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Paliperidone (Invega)
- newer atypical antipsychotic
- *metabolite of risperidone
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sustenna
long-acting rejectable form of paliperidone
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asenapine
- (Saphris)
- *atypical antipsychotic
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Iloperidone (Fanapt)
atypical antipsychotic
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SE of atypical antipsychotics in general
- QTc prolongation
- liver fxn-monitor LFTs
- metabolic syndrome
- hyperglycemia
- some anti-HAM effects
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QTc prolongation culprits
- atypical antipsychotics
- TCAs(general widening of QRS, QT, and PR intervals avoid in patients with preexisting cardiac disese)
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flumazenil
- tx for benzo overdose
- can precipatate seizures in those with pre-existing seizure d/o
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Ritalin
- SE
- insomnia is best known
- others- GI distress, HA, decrease appetite, emergence of tics
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Treatment for Tourette d/o
Haloperidol
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Treatment for narcolepsy
- amphetamines
- if cataplexy is present SSRIs and TCAs or antidepressants in general
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P450 inducers
- Barbituates
- Carbamazepine
- Griseofulvin
- Phenytoin
- Quinidine
- Rifampin (rev up enzyme)
- St. John's Wort
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P450 inhibitors
- Protease inhibitors
- Isoniazid
- Cimetidine
- Ketaconazole
- Erythromycin
- G
rapefruit Juice - Sulfonamides
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Treatment for PTSD
many different treatments but clonidine and beta blockers particularly good for hyperarousal
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amantidine
- dopaminergic via decrease reuptake of dopamine and other stuff
- used for parkinsons
- used for neuroleptic malignant syndrome
- (could also use bromocriptine or dantrolene)
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tx for NMS
supportive care then consider dantrolene or maybe amatidine or bromocriptine (dopaminergic agents)
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Depot versions of antipsychotics
- Fluphenazine deconate (2x/month)
- Haloperidol deconate (2x/month)
- Risperidone depot (2x/month)
- Paliperidone depot (1x/month)
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