Medication.txt

4/8 for 2 weeks with depressed mood or anhedonia: Sleep, interest, guilt, energy, concentration, appetite, psychomotor, suicide

Increased sleep and appetite

Chronic mild to moderate anxiety and depression

• Excessive anxiety/worry for at least 6 months 3/6: restless, easily fatigued, difficulty concentrating, irritable, muscle tension, insomnia
• Dx: PTSD
• Re-experience in at least 1 way (Intrusive recollection, flashbacks, nightmares, physiological distress or physical response to cues resembling event) Avoidance in at least 3 ways (avoiding thoughts, feelings, conversations, activities, people, places associated with events, inability to recall part of trauma, decreased interest in activities, estrangement, restricted affect, sense of shortened life)
• Increased arousal in at least 2 ways (sleep disturbance, irritability/angry outbursts, hypervigilance, exaggerated startling, decreased concentration)

PTSD criteria and affective disregulation, poor impulse control, dissociation, somatization, self-destructive activities, preoccupation with perpetrator

Obsessions: Intrusive/Inappropriate/Interfering, not real-life problems, attempts made to ignore or neutralize, recognized as product of self Compulsions: Repetitive behaviors or mental acts in response to obsessions aimed at preventing or reducing distress, not realistically connected

3/7 with euphoria or 4/7 with irritability for at least 1 week: Distractability, Insomnia, Grandiose, Flight of Ideas, Activities, Speech, Thoughtlessness -Mania because of disfunction

• 3/7 with euphoria or 4/7 with irritability for at least 1 week:
• Distractability, Insomnia, Grandiose, Flight of Ideas, Activities, Speech, Thoughtlessness -Hypomania because no disfunction, also need depressive episode (4/8 SIGECAPS)

2 or more for 1 month psychosis symptoms: Delusions (if bizarre no other symptoms needed), hallucinations, disordered speech, disturbance of behavior, negative symptoms -Disfunction-Over at least a 6 month period -Not schizoaffective, mood, substance, medical

Psychosis/schizophrenia symptoms for 1-6 months

Psychosis and mania/depression/mixed where psychosis persists with stable mood for 2 weeks; mood disorder prominent longitudinally

Non-bizarre delusions for 1 month with otherwise intact functioning

Psychotic for less than 1 month - self-resolves

• Shared delusion with close contact
• Dx: Conversion disorder
• Caused by hypofunction in dominant hemisphere 1 or more symptoms indicating neurological disorder, with related psychological factors, not feigned or fully explained by medicine that causes distress or impairment (not pain or sexual dysfunction)

Starting before 30 and lasting several years -4 pain symptoms, 2 GI, 1 sexual and 1 pseudoneurological

Preoccupation with fears of having (or thinking one has) a serious disease based on misinterpretation of physical signs, causing stress/impairment and lasting at least 6 months, with inability to be reassured

Pain causing distress or impairment that cannot fully be explained that has psychological factors

Preoccupation with imagined (or exaggerated) defect leading to distress or impairment

Block MAO from breaking down catacholamines, A - NE, Epi, 5HTB � Dopamine

MAOI

MAOI

Hypertensive crisis (with sympathomimetics or tyramine)

CHF, liver disease, pheochromocytoma

Inhibition of re-uptake of NE (5HT)

TCA

TCA

Anticholinergic (dry mouth), weight gain, sedation, orthostasis, prolonged QRS Serotonergic (sexual dysfunction)

Alkalinize serum

Inhibition of re-uptake of 5HT

SSRI

SSRI (Class D)

SSRI

SSRI

Nausea, sexual dysfunction, sleep, extrapyramidal, hyponatremia, QT prolongation, Anti-platelet, CYP2D6 Inhibition

Tamoxifen (CYP2D6 Inhibition)

Inhibit re-uptake of 5HT and NE (some dopamine)

SNRI

Nausea, sexual dysfunction, sleep, extrapyramidal, hyponatremia, QT prolongation, antiplatelet effects, increase in BP and HR

Inhibit re-uptake of dopamine (NE)

Nausea, tremor, agitation, insomnia, psychosis, seizures

Buproprion derivative for smoking cessation

Tetracyclic; Inhibition of alpha-2 (increased 5HT, NE)

Sedation, dizziness, weight gain, orthostasis, constipation, dry mouth, agranulocytosis

Serotonergic

• Sedation
• Beta blockers
• B1 - HR, lipolysis, renin
• B2 - Smooth muscle relaxation, tremor reduction
• Don't impair cognitive function

Non-selective beta blocker

Asthma

B1 Inhibition

Open more GABA channels A1 � sedation A2/3 � Anxiolysis A4 - Muscle relaxation

Dependence, tolerance, withdrawal, abuse

Benzodiazepine (short)

Benzodiazepine (short)

Benzodiazepine (long)

Benzodiazepine (long)

GABA A1 - Sedation (short acting)

Benzodiazepine-like drug (sedation)

Increase lenght of GABA channel opening

Barbituate

Tolerance, linear kinetics (overdose), drug interactions

Emergency treatment for benzodiazepine overdose

Neutral ligand for GABA receptors (competitive inhibition)

5HT receptor partial agonist (anxiolytic)

Helps people fall asleep and stay asleep, less potential for abuse

Alters sodium transport, decreases inositol recirculation

Narrow therapeutic window Initial - nausea, fatigue Persistant - tremor, edema, weight gain, polydipsia/polyurea (antagonism of ADH receptors), nephrotoxicity, thyroid, confusion, ataxia, leukocytosis, skin, arrhythmias

Drugs that Increase Li: ACE inhibitors, Thiazide diuretics, NSAIDS Drugs that decrease Li - K-sparing diuretics

Increases GABA

Narrow therapeutic window Sedation, tremor, weight gain, nausea, diarrhea, alopecia, neural tube defects, increased LFTs, platelet disfunction, pancreatitis, agranulocytosis

Na channel modulation

Narrow therapeutic window Enzyme induction and toxicity, GI, CNS, leukopenia, thrombocytopenia, edema, rashes, hyponatremia (increased ADH)

Decreased glutamate and aspartate

CNS, severe rashes

D2 blockade (positive psychotic symptoms)

Typical Antipsychotic

Typical antipsychotic

Extrapyramidal symptoms, prolactin, sexual dysfunction, orthostasis, QT prolongation, Acute dystonic rxn, tardive kinesis, neuroleptic malignant syndrome

5HT (D2) blockade

Atypical antipsychotic

Hypotension, weight gain, dizziness, increased LFTs, increased glucose, increased lipids

Agranulocytosis