You are on page 1of 4

TYPICAL ANTIPSYCHOTICS (CHF) INDICATION ACTION SIDE EFFECTS BEST AUGMENTING AGENTS

CHLORPROMAZINE (Thorazine) – LOW POTENCY o Psychosis Blocks dopamine 2 receptors, reducing positive o Motor S/E o Benztropine, amantadine for motor S/E
1. Is one of the earliest classical conventional APs o Intractable Hiccups symptoms of psychosis and improving other o Anticholinergic S/E (ABCD’S) o Benzodiazepines may be helpful for Akathisia
1. Is a low potency phenothiazine o Tetanus behaviors o Anorexic
2. Broad spectrum of efficacy o Combativeness o Blurry vision
Short-term and second-line option - risk of tardive dyskinesia o Hyperactivity children o Constipation/ Confusion
and the availability of alternative treatments o Bipolar d/o o Dry Mouth
o Acute Intermittent Porphyria o Sedation/ Stasis of urine
o Restlessness & apprehension before surgery o Prolactin (elevation)
o N/V o Antihistaminic S/E
o Schizoprenia o Neuroleptic-induced deficit syndrome
HALOPERIDOL (HALDOL) - HIGH POTENCY o Psychotic disorder o Blocks dopamine 2 receptors - reducing o Neuroleptic-induced deficit syndrome o Mood stabilizing anticonvulsant may be helpful
1. One of the most preferred APs, prior to the introduction of o Schizophrenic Patients positive symptoms of psychosis and o Akathisia in schizophrenia and bipolar mania
atypical APs o Tourette’s disorder possibly combative, explosive, and o Extrapyramidal symptoms o Lithium in bipolar mania may be helpful
2. Low doses may not induce negative symptoms, but high o Hyperexcitability of children hyperactive behaviors o Galactorrhea and Amenorrhea o Benzodiazepine for agitation
doses may o Bipolar disorder o Blocks dopamine 2 receptors in the
Long-acting intramuscular formulation lasts up to 4 weeks nigrostriatal pathway - improving tics and
(some only last up to 2 weeks) other symptoms in Tourette’s syndrome
FLUPHENAZINE (Prolixin) - HIGH POTENCY o Psychotic disorder o Blocks dopamine 2 receptors, reducing
1. Is a high potency phenothiazine o Bipolar disorder positive symptoms of psychosis
2. Less risk of sedation and orthostatic hypotension but greater
risk of extrapyramidal symptoms than with low potency
phenothiazines
3. Not shown to be effective for behavioral problems in mental
retardation
ATYPICAL ANTIPSYCHOTICS (OSCAR)
OLANZAPINE (Zyprexa, Olasek, Ziprexa, Symbax) o Schizophrenia o Blocks dopamine 2 receptors, reducing o Probably increase risk for diabetes o Valproic acid (valproate, divalproex)
1. Well accepted for use in schizophrenia and bipolar disorder, o Acute Mania positive symptoms of psychosis and mellitus and dyslipidemia o Other mood stabilizing anticonvulsants
including difficult cases o Bipolar Maintenance stabilizing affective symptoms o Dizziness, sedation o Lithium
2. One of only two atypical antipsychotics with a short-acting o Acute agitation associated with bipolar I mania o Blocks serotonin 2A receptors, causing o Joint pain, back pain, chest pain
intramuscular dosage formulation enhancement of dopamine release in certain o Tachycardia
3. Long-acting intramuscular formulation lasts up to 4 weeks, brain regions and thus reducing motor side Notice that these 3 drugs also serve as augmenting
whereas some other long-acting intramuscular effects and possibly improving cognitive and agents for the all the other ATYPICAL APs; I put the
antipsychotics may only last up to 2 weeks affective symptoms additional drugs for the other APs in bold.
QUETIAPINE (Seroquel) o Schizophrenia o Valproic acid (valproate, divalproex)
1. May be the preferred antipsychotic for psychosis in o Acute Mania o Other mood stabilizing anticonvulsants
Parkinson’s disease and Lewy Body dementia o Bipolar maintenance o Lithium
2. More sedation than some other antipsychotics o Bipolar depression o Benzodiazepine
3. Essentially no motor side effects or prolactin elevation o Behavioral disturbances in dementias
o Behavioral disturbances in Parkinson’s and Lewy
Body dementia
CLOZAPINE (Clozaril, Leponex) o Treatment-resistant schizophrenia o Probably increases risk for diabetes o Valproic acid (valproate, divalproex)
1. Not a first-line treatment choice in most countries o Reduction in risk of recurrent suicidal behavior mellitus and dyslipidemia o Lamotrigine
2. Most efficacious but most dangerous in patients with schizophrenia or o Increased salivation (can be severe) o Other mood stabilizing anticonvulsant
3. Reduces suicide in schizophrenia schizoaffective disorder o Sweating o Conventional antipsychotics
4. Little or no prolactin elevation, motor side effects, or tardive o Treatment-resistant bipolar disorder o Dizziness, sedation, headache, o Benzodiazepine
dyskinesia o Violent aggressive patients with psychosis tachycardia o Lithium
5. Documented efficacy in treatment-refractory schizphrenia
ARIPIPRAZOLE (Abilify) o Schizophrenia o Partial agonism at dopamine 2 receptors o Dizziness, insomnia, akathisia
1. Well accepted in clinical practice when wanting to avoid o Maintaining stability in schizophrenia o Theoretically reduces dopamine output when o Nausea, vomiting
weight gain and sedation because less weight gain and o Other psychotic disorders dopamine concentrations are high, thus o Othostatic hypotension
sedation than most other antipsychotics o Acute mania improving positive symptoms and o Constipation
2. Can be activating, which can be reduced by lowering the o Bipolar maintenance mediating antipsychotic actions
dose or starting at a lower dose o Bipolar depression o Theoretically increases dopamine output
3. May not have a diabetes or dyslipidemia risk, but o Behavioral disturbances in dementia when dopamine concentrations are low,
monitoring is still indicated thus improving cognitive, negative, and
mood symptoms
RISPERIDONE (Risperidol) o Schizophrenia o Blocks dopamine 2 receptors, reducing o May increase risk for diabetes and
1. Well accepted for treatment of agitation and aggression in o Delaying relapse in schizophrenia positive symptoms of psychosis and dyslipidemia
elderly demented patients o Other psychotic disorders stabilizing affective symptoms o Dose-dependent extrapyramidal
2. Well accepted for treatment of behavioral symptoms in o Acute mania o Blocks serotonin 2A receptors, causing symptoms
ochildren and adilescents, but may have more sedation o Bipolar maintenance enhancement of dopamine release in o Dose-related hyperprolactinemia
and weight gain in pediatric populations than in adult o Bipolar depression certain brain regions and thus reducing o Nausea, constipation, abdominal pain,
populations o Behavioral disturbances in dementia motor side effects and possibly improving weight gain
3. Only atypical antipsychotic with a long-acting depot cognitive and affective symptoms
formulation o Specifically, alpha 2 antagonist properties
may contribute to antidepressant actions
ANTIDEPRESSANTS
FLUOXETINE (Prozac) o Major depressive disorder o Boosts neurotransmitter serotonin o Sexual dysfunction (men: delayed o Trazodone especially for insomnia
1. May be first line choice for atypical depression o Obsessive-compulsive disorder o Blocks serotonin reuptake pump (serotonin ejaculation, erectile dysfunction; men o Bupropion, mirtazapine, reboxetine, or
2. Can cause cognitive and affective flattening o Premenstrual dysphoric disorder transporter) and women: decreased sexual desire, atomoxetine
3. Long half-life; even longer lasting active metabolite o Bulimia nervosa o Desensitizes serotonin receptors, especially anorgasmia) o Mood stabilizers or atypical antipsychotics
4. Mood disorders can be associated with eating disorders and o Panic disorder serotonin 1A receptors o Gastrointestinal (decreased appetite,
be treated successfully with fluoxetine o Bipolar depression o Presumably increases serotonergic nausea, diarrhea, constipation, dry
5. Class: SSRI neurotransmission mouth)
o Mostly central nervous system (insomnia
but also sedation, agitation, tremors,
headache, dizziness)
o Bruising and rare bleeding
IMIPRAMINE (Tofranil) o Depression o Boosts neurotransmitters serotonin and o Blurred vision, constipation, urinary o Lithium, buspirone, thyroid hormone (for
1. Was once one of the most widely prescribed agents for o Anxiety norepinephrine/noradrenaline retention, increased appetite, dry depression)
depression o Insomnia o Blocks serotonin reuptake pump (serotonin mouth, nausea, diarrhea, heartburn o Gabapentin, tiagabine, other anticonvulsants
2. Probably the most preferred TCA for treating enuresis in o Treatment-resistant depression transporter) o Fatigue, weakness, dizziness, sedation
children o Neuropathic pain/chronic pain o Blocks norepinephrine reuptake pump o Sexual dysfunction, sweating
3. Class: TCA (norepinephrine transporter)
o May be effective in treating enuresis because
of its anticholinergic properties
VENLAFAXINE (Effexor), DESVENLAFAXINE (Pristiq) o Among the most efficacious drug for treatment o Nonselective inhibitor of reuptake Of these o Nausea, somnolence, dry mouth,
Desvenlafaxine is an active metabolite of Venlafaxine of severe depression with melancholic Biogenic amines: serotonin, NE and dizziness, and nervousness
features dopamine
DULOXETINE o MDD o Cause mydriasis
1. Class: SSNRI o Diabetic peripheral neuropathy
2. Half life: 12 hours
3. Use with caution in patients with narrow angle glaucoma
MIRTRAZAPINE
1. An antidepressant
2. Lacks anticholinergic effects of TCA
3. Has the anxiogenic affect of SSRI
MONOAMINE OXIDASE INHIBITOR (Aurorix)
1. Highly effective antidepressant
2. Rarely used because of dietary precautions that must be
flowed to avoid tyramine hypertensive crisis
ANTICONVULSANTS and MOOD STABILIZERS
CARBAMAZEPINE (Tegretol, Carbatrol) o Partial seizures with complex symptomatology o Acts as a use-dependent blocker of voltage- o Sedation, dizziness, confusion, Carbamazepine is itself a second-line augmenting
1. First anticonvulsant widely used for the treatment of o Generalized tonic-clonic seizures (grand mal) sensitive sodium channels unsteadiness, headache agent for numerous other anticonvulsants,
bipolar disorder o Mixed seizure patterns o Interacts with the open channel o Nausea, vomiting, diarrhea lithium, and atypical antipsychotics in treating
2. May be effective in patients who fail to respond to lithium o Pain associated with true trigeminal neuralgia conformation of voltage-sensitive sodium o Benign leukopenia bipolar disorder
or other mood stabilizers o Glossopharyngeal neuralgia channels o Rash
3. Especially preferred as a second or third-line treatment for o Bipolar disorder o Interacts at a specific site of the alpha pore-
mania forming subunit of voltage-sensitive
4. Class: Anticonvulsant sodium channels
o Inhibits release of glutamate
VALPROATE (Depakene, Depacon, Depakote) o Mania o Blocks voltage-sensitive sodium channels by o Sedation, tremor, dizziness, ataxia, o Lithium
1. First line treatment option that may be best for patients o Complex partial seizures that occur either in an unknown mechanism asthenia, headache o Atypical antipsychotics
with mixed states of bipolar disorder or for patients with isolation or in association with other type of o Increases brain concentrations of gamma- o Abdominal pain, nausea, vomiting, o Lamotrigine
rapid-cycling bipolar disorder seizures aminobutyric acid (GABA) by an unknown diarrhea, dyspepsia o Antidepressants
2. Seems to be more effective in treating manic episodes than o Simple and complex absence seizures mechanism o Alopecia (unusual)
depressive episodes in bipolar disorder o Multiple seizure types which include absence
3. May be useful as an adjunct to atypical antipsychotics for seizures
rapid onset of action in schizophrenia o Migraine prophylaxis
o Maintenance treatment of bipolar disorder
LITHIUM (Eskalith, Lithobid, Lithostat, Lithium carbonate) o Manic episodes of manic depressive illness o Unknown and complex o Ataxia, dysarthria, delrium, tremor, o Valproate
1. Original mood stabilizer and is still a first-line treatment o Maintenance treatment for manic depressive o Alters sodium transport across cell memory problems o Atypical antipsychotics
option but may be underutilized since is an older agent patients with a history of mania membranes in nerve and muscle cells o Polyuria, polydipsia o Lamotrigine
and is less promoted for use in bipolar disorder than o Bipolar depression o Alters metabolism of neurotransmitters o Diarrhea, nausea o Antidepressants
newer agents o Major depressive disorder including catecholamines and serotonin o Weight gain
2. May decrease suicide and suicide attempts not only in May be best for euphoric mania; patients with o May alter intracellular signaling through
bipolar I disorder but also in bipolar II disorder and rapid-cycling and mixed state types of bipolar actions on second messenger systems
unipolar depression disorder generally do less well on lithium
BENZODIAZEPINES
ALPRAZOLAM (Xanax, Xanax XR) o Generalized anxiety disorder (IR) o Binds to benzodiazepine receptors at the o Sedation, fatigue, depression o Benzodiazepines are frequently used as
1. One of the most popular benzodiazepines for anxiety, o Panic disorder (IR and XR) GABA-A ligand-gated chloride channel o Dizziness, ataxia, slurred speech, augmenting agents for antipsychotics and
especially among primary care physicians and o Other anxiety disorders complex weakness mood stabilizers in the treatment of psychotic
psychiatrists o Anxiety associated with depression o Enhances the inhibitory effects of GABA o Forgetfulness, confusion and bipolar disorders
2. Is a very useful adjunct to SSRIs and SNRIs in the treatment o Premenstrual dysphoric disorder o Boosts chloride conductance through GABA- o Hyper-excitability, nervousness o Benzodiazepines are frequently used as
of numerous anxiety disorders o Irritable bowel syndrome regulated channels augmenting agents for SSRIs and SNRIs in the
3. Not effective for treating psychosis as a monotherapy, but o Acute mania treatment of anxiety disorders
can be used as an adjunct to antipsychotics o Acute psychosis o Not generally rational to combine with other
DIAZEPAM (Valium, Diastat) o Anxiety disorder benzodiazepines
1. Often the first choice benzodiazepine to treat status o Symptoms of anxiety
epilepticus and is administered either intravenously or o Acute agitation, tremor, impending or acute
rectally delirium tremens and hallucinosis in acute
2. Remains popular benzodiazepine for treating muscle alcohol withdrawal
o Inhibiting actions in cerebral cortex may
spasms and acute alcohol withdrawal o Skeletal muscle spasm due to reflex spasm to
provide therapeutic benefits in seizure
3. Multiple dosage formulations allow more flexibility of local pathology
disorders
administration compared to most other benzodiazepines o Athetosis
o Stiffman syndrome
Filename: Psychopharma_table (1)
Directory: C:\Users\Locsie\Documents
Template: C:\Users\Locsie\AppData\Roaming\Microsoft\Templates\Normal.dotm
Title:
Subject:
Author: Auren
Keywords:
Comments:
Creation Date: 3/31/2012 20:50:00
Change Number: 6
Last Saved On: 9/9/2012 11:10:00
Last Saved By: Auren
Total Editing Time: 80 Minutes
Last Printed On: 9/9/2012 12:14:00
As of Last Complete Printing
Number of Pages: 3
Number of Words: 2,145 (approx.)
Number of Characters: 12,232 (approx.)