• Anxiolytic (RX relieves anxitey)
• Amnesic (Rx creates memory loss)
• Anticonvulsant
• Muscle Relaxant
• Hypnotic (Produces sleep but tolerance will develop)

Aytpical Antipysch -

• Most widely prescribed antipysch
• Dose related E.P.S.

Aytpical Antipysch

• Used for Schiz, Tourette's & borderline personality disorder
• Highest risk of weight gain & diabetes
• Drug levels decreased by cigarettes
• Dose related E.P.S.

Atypical Antipysch

• Low incidence of EPS even at high doses
• Sedation noted early in treatment

Atypical Antipysch

• Risk of QTc prolongation
• Less chance of weight gain/diabetes
• Take with food

Atypical Antipysch

• Active metabolite of Risperidone 
• Take with full meal, bioavailablity increases 50%
• Does not require intact liver funciton, metabolism or excretion

Atypical Antipysch

• Causes a little wt. gain but also little EPS and fewer cardiovascular effects
• Long elimination half life
• Dopamine Agonist & Antagonist

First Atypical Antipysch 

• High risk of agranulocytosis, must have WBC monitored
• Low EPS

• Primarily block dopamine
• All are associated with Extrapyrimidal Symptoms and increased proclactin

*Nb: EPS can be treated with diphenhydramine

Tryicyclic Antidepressants

MOA: Block reuptake of norepinephrine, thus increasing the amount of NorEpi in the synapse

Examples:

• Amitryptyline, Nortriptyline, Protyrptyline
• Desipramine, Imipramine, Trimipramine
• Amoxapine
• Doxapin

Remember TCA's: Tryptylines,Pramines, Oxapin

Adverse Effects

• Anticholinergic Side Effects
• Drowsiness
• Insomnia/Agitation
• GI distress
• Weight Gain
• Orthostatic hypertension
• Cardiac Arrhythmia

  Do not use with drugs that prolong QTc interval or when pregnant

Considered first line therapy for depression.  Can also be used for OCD, bulimia, panic disorders, and PMS

Examples

• Fluoxetine (Prozac)
• Paroxetine (Paxil)
• Sertraline (Zoloft)
• Citalopram (Celexa)
• Escitalopram (Lexapro)
• Fluvoxamine (Luvox)

Generally Mild

• Maybe assocaited with sexual dysfunction
• Serotonin Syndrome

MOA: Monoamine oxidase breaks down NorEpi, Epi, Dopamine and Serotonin; MAO-I's inhibit this.

Examples

• Tranylcypromine
• Pheneizine
• Isocarboxazid
• Moclobemdie
• Selegiline

  Drugs that lower seizure threshold

• Antipyschotics
• Antidepressants
• Flouroquinolones

        Tyramine is broken down by MAO-A and inhibiting its action may result in excessive levels and this can lead to a hypertensive crisis (Headache, stiff neck, palpitations, chest pain, increased or decreased heart rate, N/V/, stroke/death).

        Avoid foods such as aged cheese, wines like Chianti, fava beans, pods, chocolate and soy sauce.

Drug Interactions:

     Avoid sympathomimetics: Psuedoephedrine, Resperine, TCAs, Levodopa & anticholinergics

    Used for patients who do not respond to TCA or SSRI can also be used for smoking cessation (Zyban)

Blocks reuptake of NorEpi

A/E:  Can lower threshold for seizures so caution in pts w/history or rx's that also lower seizure threshold like antipyschs, antidepressants & flouroquinolones.

    Used for depression; Serotonin antagonist, blocks histamine and alpha-1 receptor.

Adverse effects: Dizziness, Headache, Sedation and associated with priapism

Major CYP3A4 substrate

SNRI used for depression

A/E

• Increase blood pressure
• May cause increased sweating

    Alpha-2 adrenergic antagonist==> increases release of Serotonin and NorEpi.

May cause drowsiness (take qhs) and can cause wt gain

Major CYP interactions and avoid MAOIs

Rx for bipolar disorder; MOA: alters cation transport across cell membrane in nerve & muscle cells.

• There is a 4-10 day latency period
• Start with a 300mg BID or TID dose than increase q 4-5 days.
• Maintenance dose: 900-1200 qd
• Target blood levels of 0.6-1.2 meq/L

Short Term A/E: Tremor, Cognitive S.E., Polyuria, Loose Stools, Weight gain

Long Term A/E: Renal impairment, Cardiac Rythym disturbance & hypothyroidism.

Interactions:

Diurectics, Ace-Inhibitors and NSAIDs

*NB:Diuretic details complicated

   Used for bipolarism, causes increased availability of the inhibitory neurotransmitter (GABA) to brain neurons.

Adverse effects:

Hair loss            Easy bruising      Tremors

Weight Gain,  N/V

Caution for: Liver failure, suicidal behavior

Interacts with TCA

Used for bipolarism

Warnings

• SJS & Toxic epidermal syndrome (1st 8 weeks)
• Neurotoxic side effects: HA,dizzy, drowzy, blurred vision

A/E:

- Rash and SJS syndrome

-Pruritis

-Leukopenia, Hyponatremia

- N/V/D & Fluid retention