Psych drugs

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Author:
danabug86
ID:
220912
Filename:
Psych drugs
Updated:
2013-05-23 23:30:35
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psych drugs
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Description:
Psychiatric drugs
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  1. SSRIs
    • Fluvoxamine
    • Paroxetine
    • Fluoxetine
    • Sertraline
    • Citalopram
    • Escitalopram
  2. Fluvoxamine
    • Luvox
    • FDA approved for OCD
    • Strongly anticholinergic --> give at night
  3. Paroxetine
    • Paxil
    • Most serotonin specific of the SSRIs
    • Most activating (stimulating)
    • Half life of 6-12 hours --> good for drug holiday and quick withdrawal
    • SE: sexual dysfunction, anticholinergic --> dry --> along with P450 interactions --> not good for elderly, weight gain (packs on pounds), sedating
    • Good for PTSD and anxiety
  4. Fluoxetine
    • Prozac
    • Very effective for depression!
    • Activating
    • half life 13-15 days --> self tapers
    • FDA approved for bulimia and premature ejaculation
    • Lots of P450 interactions
  5. Sertraline
    • Zoloft
    • SE: platelet problems
    • Can be activating (25%) or sedating (75%)
    • Good for adolescents
    • More effect on anxiety than depression
  6. Citalopram
    • Celexa
    • Cheap
    • Few interactions --> Safe for geriatrics 
    • Need to use at least 60mg for anxiety
    • BBW: >60mg --> increased QTC
  7. Escitalopram
    • Lexapro
    • Same as Celexa
    • Expensive! --> no generic
  8. Dosing SSRIs
    • 1. Start at low dose
    • 2. Reassess at 4-6 weeks, if partial response --> 
    • 3. increase dose 
    • 4. Reassess at 4-6 weeks later, if partial response --> 
    • 5. increase dose
    • 6. Try a different drug if no response after 2 adjustments --> after 2-3 SSRIs, try atypical
  9. SNRIs
    • Duloxetine
    • Venlafaxine
    • Desvenlafaxine
  10. Duloxetine
    • Cymbalta
    • FDA approved for depression and pain (neuralgia)
    • BID dosing
    • Not dose dependent for the 1NE:4-5S effect
  11. Venlafaxine
    • Effexor
    • Dose dependent!
    • - Up to 150mg, only getting S
    • - Up to 225mg, getting 1NE:4-5S
    • - Above 300mg, also getting DA
    • Good for refractory depression and neuropathy
    • SE: HTN, withdrawal after 1-3 missed doses (zapping pain, flulike sx), similar SE for SSRI
  12. Desvenlafaxine
    • Pristiq
    • Not effective!
  13. Atypical antidepressants
    • Buproprion
    • Mirtazapine
    • Trazodone
  14. Buproprion
    • Wellbutryn
    • Good for: smoking, SAD, adult ADHD
    • Less sexual SE than SSRIs 
    • Serious SE: seizures! - careful in EtOH withdrawal or eating disorders, psychosis (high dose), similar SE to SSRIs
    • Good to use in manics - won't cycle up the mood
    • NE and DA reuptake inhibition
    • Can be monotherapy or adjunct
  15. Mirtazapine
    • Remeron
    • a2 agonist --> also used for HTN
    • SE: sedation, increased appetite, slowed metabolism, dizziness, tremor, agranulocytosis
    • 7.5-15mg: good for sleep and appetite in geri pts  --> can be used with more activating med in the AM
  16. Trazodone
    • Desyrel
    • Useful for refractory MDD, MD with anxiety and insomnia
    • Need at least 300mg for antidepressant effects
    • Non-addictive
    • Easy to build up tolerance
    • Vivid dreams --> don't use in PTSD!
    • SE: sedation, N, dizziness, orthostasis, arrhythmias, priapism

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