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Behavioral Health Meds
2
Psychogenic Drugs
Anti-anxiety/ anxiolytics
Anti-anxiety
Benzodiazepines (Benzos)
What goes up must come down
Mechanism of Action:
Promotes GABA by binding to receptor site
Increases chloride channel open
membrane hyperpolarization
Benzodiazepines
Rapid Onset Drugs
Rapid Onset Drugs
These are used more in hospital settings
Alprazolam (Xanax)
Lorazepam (Ativan)
Slow Onset Drugs
These are used more at home
Clonazepam (Klonopin)
Diazepam (Valium)
Side Effects
Side Effects
Impaired mental alertness
Slow reflexes
Falls in older adults
Drug dependence
Uses
Alcohol withdrawal
Acute anxiety
Insomnia
Muscle tension
Seizures
Uses
Buspirone (BuSpar)
Needs to be taken daily for usefulness
Mechanism of Action:
Partial Serotonin Agonist
Be cautious of other drugs that increase Serotonin to avoid SS
Buspirone
Uses
Acute ANXIETY
Uses
Side Effects
Dizziness
Insomnia
Side Effects
Antidepressants
Chronic Anxiety
Do not use antidepressants taht affect NE for chronic anxiety
Antidepressants
Hypnotics/ Sleep Aids
Hypnotis/ Sleep Aids
Benzos
Benzos
Ease a person into sleep
Not go to insomnia drug due to side effects
Clonazepam (Klonopin)
Z- Hypnotics
Non-benzodiazepine receptor antagonists / Z-hypnotics
Help patients go to sleep or stay asleep
Mechanism of Action:
Selective for GABA receptors
Side Effects
Side Effects
Side effects are worsened with alcohol
ataxia
sedation
falls
delirium
sleepwalking
Melatonin Receptor Antagonists
Melatonin Receptor antagonists
Do not take with fluvoxamine
Ramelteon (Rozerem)
Side Effects
Dizziness
headaches
sex and fertility issues
Side Effects
Sleep Initiation
Uses
Doxepin (Silenor)
Strong histamine 1 receptor blockade
Doxepin (Silenor)
Uses
Insomnia for those who struggle with staying asleep
Uses
Contradictions
Should be avoided in patients with urinary retention, glaucoma, or MAOIs
Contradictions
Orexin Receptor Antagonists
Orexin receptor antagonists
Block the binding of orexin to suppress wakefulness
Surorexant (Belsomra)
Lemborexant (Dayvigo)
Uses
Suppress Wakefulness
Insomnia
Uses
Contradictions
people with narcolepsy
Contradictions
Side Effects
Sleep paralysis
Hallucinations
Cataplexy symptoms
Side Effects
Antidepressants
Anti- depressants
General uses:
anxiety
depression
PTSD
OCD
Panic disorder
ADHD
Serotonin Selective Reuptake Inhibitors
SSRIs
Mechanism of Action:
Block reuptake of serotonin
Uses:
Anxiety
Depression
Side Effects
Side effects
Apathy
Anorgasim
Inhibit Orgasm
Nausea
Reduce libido
Hyponatremia in older adults
Citalopram (Celexa)
Highly Tolerable
Can affect ECg readings: prolong QTc interval
Citalopram (Celexa)
Escitalopram (Lexapro)
Derived from Citalopram
Escitalopram (Lexapro)
Fluoxetine (Prozac)
Longest Half-life
Triggers nervousness and insomnia
Good for those who might miss doses
Fluoxetine (Prozax)
Partoxetine (Paxil)
Rapidly absorbed
not good for pregnant women
anticholinergic effects
withdrawal symptoms are common
Partoxetine (Paxil)
Sertraline (Zoloft)
Most preferred
Harsher GI side effects
Safer for pregnant and breastfeeding women
Sertraline (Zoloft)
Noradrenergic and Specific Serotonergic Antidepressants
NaSSAs
Increases NE and Serotonin by blocking alpha 2 receptors
Mirtazapine (Remoron)
Side Effects
Increased appetite
Sedation
Weight gain
Side Effects
Norepinephrine and Dopamine Reuptake Inhibitors
NDRIs
Acts as a NE and DA reuptake inhibitor
Worsen anxiety based disorders
Bupropion (Wellbutrin/ Zyban)
Uses
Depression
Smoking
Off label ADHD
Side Effects
Anorexia
Insomnia
Tremor
Weight Loss
Increases risk for seizures
Side Effects
Serotonin Antagonists and Reuptake Inhibitors
SARIs
Blocks serotonin receptors
weekly inhibiting the reuptake of NE and serotonin
Nefazodone (Serzone)
Side effect of liver failure
Nefazodone (Serzone)
Trazodone (Desyrel)
Sleep
Side Effects:
Blurred vision
dizziness
headache
nausea
prioapism
sedation
Trazodone (Desyrel)
5-HT stimulator
inhibits serotonin reuptake
Vortioxetine (Trintellix/ Brintellix)
Side Effect:
GI issues
5-HT Modulator
Serotonin Norepinephrine Reuptake Inhibitor
SNRI
Increases Serotonin NE Levels
Venlafaxine (Effexor)
Desvenlafaxine (Pristiq)
Levomilnacipran (Fetzima)
Duloxetine (Cymbalta)
Used for chronic musculoskeletal pain
Side Effect:
Sweating
Increase BP and pulse
Duloxetine (Cymbalta)
Milnacipran (Savella)
Fibromyalgia
Milnacipran (Savella)
Serotonin Partial Agonist/ Reuptake Inhibitor
SPARIs
Inhibits the serotonin transporter
stimulates serotonin receptors
Vilazadone (Vibryd)
Uses
Good for mized anxiety and depression
Uses
Side Effects
Apathy
Nausea
Hyponatremia in older adults
Side Effects
Tricyclic Antidepressants
Block reuptake of NE and serotonin by preventing it from coming in contact with the enzyme in postsynaptic cell
Triptylines
AIpramines
TCAs
Side Effects
Overdose risk
blurred vision
dry mouth
tachycardia
urinary retention
constipation
confusion in older adults
Side Effects
Uses
Depression
Migraine Headache
Neuropathic pain
Bed wetting
Uses
Monoamine Oxidase Inhibitors
MAOIs
Blocks the enzyme MAO and therefore inhibits destruction of serotonin, EP, NE, and DA
Used for severe depression
Takes 2-3 weeks to clear out of patient's system (wait to start new drugs)
Side Effects
HTN crisis (severe dietary restrictions)
Serotonin Syndrome
Side Effects
Ketamine
used for treatment resistant depression
Eskatamine (Spravato)
Ketamine
Brexanolon (Zulresso)
Used for Severe Postpartum Depression
Brexanolon (Zulresso)
Mood Stabilizers
Lithium
Mechanism of Action is unknown
Lithium
Uses
Bipolar disorder
mania
suicidal ideation
Uses
Side Effects
Acne
Alopecia
Diarrhea
Edema
Hypothyroidism
Nausea and vomiting
polyuria
Psoriasis
Sedation
Weight gain
Side Effects
Anticonvulants
Anticonvulsants
reduce firing rate of very high frequency neurone in the brain
creates stabilizing effects
Used for bipolar depression and seizures
Valproate (Depakote)
Side effects:
Avoid in people of child-bearing age
Sedation
tremor
weight gain
thrombocytopenia
pancreatitis
liver failure
hyperammonemia
Valproate (Depakote)
Carbamazepine (Tegretol)
Not safe for child-bearing age women
Side Effects:
Steven-Johnsons Syndrome
Reduce effectiveness of other medications
oral contraceptives
antiretrovirals
immunosuppressants
Carbamazepine (Tegretol)
Lamotrigine (Lamictal)
Front line drug in this class
Not used for actively manic patients
stabilizng more depressive-phase
Lamotrigine (Lamictal)
Side Effects
Rashes
Stevens-Johnson Syndrome
Side Effects
Antipsychotic / Neuroleptic
Antipsychotic / neuroleptic
FGAs - typical
FGAs/ DRAs/ Typical
Antagonists of D2 receptors for DA
Block the attachment of DA, reducing stimulation
Haloperidol (Haldol)
Uses
Agitation
Psychotic symptoms positive
Schizophrenia
Uses
Side Effects
Anticholinergic Effects
Extrapyramidal symptoms (EPS)
Galactorrhea
Gynecomastia
Neuroleptic Malignant syndrome
Sedation
Weight gain
Worse negative symptoms
Neuroleptic Malignant Syndrome
Muscle rigidity
Altered mental status
hyperthermia
tachypnea
Neuroleptic Malignant Syndrome
SGAs / atypical
D2 and 5-HT antagonist
Strong anti-muscarinic properties at the M3 receptor
SGAs/ SDAs/ atypical
Uses
Positive and Negative symptoms
depression
acute mania
aggressive behaviors
Uses
Metabolic Effects
Hyperglycemia
Hyperlipidemia
Weight gain
Metabolic effects
Side Effects
Lower rate of EPS
Lower rate of NMS
Metabolic Effects
Side Effects
Clozapine (Clozaril)
highest risk of metabolic effects
used for schizophrenia
reduces suicidal ideation
Clozapine (Clozaril)
Side Effects
anticholinergic effects
orthostatic hypotension
sedation
seizures
neutropenia
Side Effects
Risperidone (Risperdal)
Long acting
Side Effects:
hyperprolactinemia
gynecomastia
Attention- Deficit Hyperactivity Disorder
ADHD
ADHD Stimulants
Stimulants
Direct and indirect agonists at adrenergic receptor sites
block reuptake of NE and DA
Methylphenidate (Ritalin, Concerta)
Amphetamines (Adderall, Vyvanse)
Side Effects
Agitation
insomnia
growth suppression
hypertension
tachycardia
mania
depress appetite
Side Effects
ADHD Non-Stimulants
Non- stimulants
Atomoxetine (Strattera)
NE reuptake inhibitor
Atomoxetine (Strattera)
Alpha 2 adrenergic agonists
Cardiac effect
Guanfacine (Intuniv)
Clonidine (Kapvay)
Alpha 2 adrenergic agonists
Cardiac effects
Clonidine (Kapvay)
Bupropion (Wellbutrin)
NE and DA reuptake inhibitor
Side Effects:
Hypotension
Bradycardia
Side Effects
Appetite Suppression
Dizziness
Fatigue
Weight Loss
Urinary Issues
Bradycardia
Hypotension
Side Effects
Antidementia
Anti- Dementia
Cholinesterase inhibitors
Inactivate the enzyme that breaks down ACh (cholinesterase)
Cholinesterase Inhibitors
Uses
Alzeimer's Disease
Parkinson's Disease dementia
Early stage dementia
Uses
Side Effects
Bradycardia
Diarrhea
Nausea and vomiting
Urinary incontinence
Side Effects
Mild to Moderate
Galantamine (Razadyne)
Mild to moderate
Mild to Severe
Donepezil (Aricept)
Rivastigmine (Excelon)
Mild to severe
NMDA Receptor Antagonists
NMDA receptor Antagonists
affect NMDA receptor by blocking it from glutamate
Memantine (Namedna)
Side Effects
Constipation
Confusion