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PHA 150.02 Drugs for Psychiatric and Mood Disorders

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by

Luis Ramos

on 15 February 2013

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Transcript of PHA 150.02 Drugs for Psychiatric and Mood Disorders

MOA
Increases reuptake of serotonin and/or NE
ADRs
N/V dizziness, tremors, fatigue, muscle weakness, dazed sedation, increased thirst and urination.
Can cause hypothyroidism, heart arrhythmias, leukocytosis
Cautions and Considerations
Narrow therapeutic Index – regular checkups with labs required lithium MOA:
Stimulate the benzodiazepine receptor in the GABA channels which increase GABA effects
ADRs
Drowsiness, constipation, muscle weakness and impaired reflexes
Cautions and considerations
Potential for abuse.
Not to mix with alcohol
Can also be used to treat insomnia Benzodiazepines GABA Channel MOA:
Inhibits the primary enzymes that metabolizes NTs in the synaptic cleft.
ADRs:
Heart palpitations, postural hypotension. Dizziness, HA, tremors, insomnia, restlessness, anxiety, anticholinergic effects
Cautions and Considerations
Many drug interactions, interactions with tyramine (pickled foods)
Products
None for this class. DO NOT CONFUSE THIS WITH SELECTIVE MAOIs IN PARKINSON’S DISEASE MAOIs MOA:
Block the reuptake of NE and 5HT
ADRs:
Drowsiness, anticholinergic effects, priapism
Cautions and considerations
Cardiotoxicity and heart arrhythmias. Postural hypotension is also a concern so use caution with elderly and those at risk of heart disease
MAOIs and TCAs are contraindicated with each other a washout period is needed between the use of these two agents TCAs Luis Ramos, PharmD
Community, A Walgreens Company Drugs for Psychiatric and Mood Disorders Atypical
Haloperidol (Haldol)
Perphenazine (Trilafon)
chlorpromazine (Thorazine)
Typical
Aripriprazole (Abilify)
Clozapin (Clozaril)
Olanzapine (Zyprexa)
Quetiapine (Seroquel)
Risperidone (Risperdal)
Ziprasidone (Geodon) Products Cautions and considerations
Careful with arrhythmias with typical class
Do not drink alcohol on either product
Atypicals can lower seizure threshold
QT prolongation Antipsychotics MOA:
not fully understood
Typical: affinity to postsynaptic DA effect and some alpha-adrenergic blockade
Atypical: affinity to 5HT receptor and some dopaminergic receptor blockade as well
ADRs:
Drowsiness, confusion, sedations, anticholinergic, EPS – more noted on typical class
Severe ADR with clozapine – neutropenia, neuroleptic malignant syndrome. Typical and Atypical antipsychotics Bipolar disorders is related to the dysfunction of NTs such as GABA, 5HT and NE. characterized with depression with manic episodes.
Treatment is often paired up with anticonvulsants and antidepressants to help with overall mood control.
Product
Lithium (lithobid) Bipolar Disorders MOA: affect the gamma –GABA receptor subparticle to increase GABA effect. Ramelteon affects MT1 and MT2 receptors in hypothalamus
ADRs:
Drowsiness (duh!!!), dry mouth, hallucinations,
Midnight amnesia like events
Cautions and considerations
Controlled substances (except ramelteon) hypnotics Inability to fall asleep or stay asleep. Often symptom of depression, anxiety, and other mental disorders
Good proper sleep hygiene improves ability to treat insomnia and ability to sleep

Drugs for insomnia
Eszopiclone (Lunesta)
Zaleplon (Sonata)
Zolpidem (Ambien)
Ramelteon (Rozerem) affect Melatonin receptors Insomnia MOA:
Blocks 5HT receptors in the brain
ADRs:
Drowsiness, dizziness, HA, nausea
Serotonin syndrome,, extrapyramidal symptoms
Cautions and Considerations
Depression and increased suicidal tendencies
MAOIs interactions
Products
Buspirone (Buspar) buspirone Alprazolam (Xanax)
Clonazepam (Klonopin)
Diazepam (Valium)
Lorazepam (Ativan)
Temazepam (Restoril)
Triazolam (Halcion) benzodiazepines Associated with the abnormal function of the NTs that regulate brain activity, mood and the fear response.
GABA seems to be the NT mostly associated with anxiety control with minor effects also from NE and 5HT
Classes of anxiety
Generalized anxiety disorder
Panic disorder
Obsessive-compulsive disorder
Post traumatic Stress Disorder Anxiety MOA:
Not understood, it seems to work on reuptake of 5HT
ADRs:
Drowsiness, hypotension, HA
Cautions and considerations
Used as a sleep agent more than antidepressant. Caution with hangover effect in the morning (dose dependent)
Product
Trazodone (Oleptro) Trazodone MOA:
block reuptake of dopamine with minor blocking of NE. metabolite active in blocking NE reuptake
ADRs
Insomnia, HA, weight loss, agitation,
Cautions and considerations
Lowers seizure threshold
Can be used for smoking cessation and weight loss. Contraindicated in anorexia and bulimia
Products
Bupropion (Wellbutrin, Wellbutrin SR, Wellbutrin XL, Zyban) Bupropion TCAs
Amitriptyline (Elavil)
Doxepin (Adapin)
Nortriptyline (Pamelor)
Tetracyclic Agent
mirtazapine TCAs SSRIs
Citalopram (Celexa)
Escitalopram (Lexapro)
Fluoxetine (Prozac)
Paroxetine (Paxil)
Sertraline (Zoloft)
SNRIs
Venlafaxine (Effexor, Effexor XR)
Duloxetine (Cymbalta) – also used to treat neuropathic pain SSRIs and SNRIs MOA:
SSRIs block serotonin reuptake at the presynaptic neuron. SNRIs block both NE and 5HT
ADRs:
temporary: N/V dry mouth, drowsiness, insomnia, HA, diarrhea. Symptoms dissipate after 2-4 weeks for most.
While on therapy: decreased libido, sexual dysfunction, weight gain on most, fluoxetine can cause weight loss as well though.
Cautions and considerations:
Increase risk for suicide in the first weeks of therapy
Serotonin syndrome due to excess serotonin in the system, includes increased HR, fever, HBP, HA and which can be lethal
Not recommended as single start of bipolar disorder SSRIs and SNRIs Selective Serotonin Reuptake Inhibitors (SSRIs)
Serotonin-Norepinephrine Reuptake inhibitors (SNRIs)
Tricycline antidepressants (TCAs)
Monoamine Oxidase Inhibitors (MAOIs)
Bupropion
Trazodone Antidepressants Leading health concern. Caused by both endogenous and exogenous sources.

Endogenous depression is more likely require drug therapy to control.

NTs involved in mood include norepinephrine (NE), serotonin (5-HT) and dopamine (DA) Depression Signal Transmission Signal conduction Neurotransmitters are chemicals that are responsible for transmitting signals from nerve cell to nerve cell within the brain.
They are released by the presynaptic neuron into the synaptic cleft
After released it will connect with receptors in the postsynaptic neuron creating a signal conduction
Also NTs can be taken back up into the presynaptic neuron (reuptake)
Monoamino oxidase and other enzymes breaks down NTs while in the cleft Neurotransmission Pathophysiology not fully understood. It is related to NT imbalances and associated with dopamine and serotonin.
Symptoms are characterized Schizophrenia and psychosis
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