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)
1. Well accepted for treatment of agitation and aggression in
elderly demented patients
2. Well accepted for treatment of behavioral symptoms in
ochildren and adilescents, but may have more sedation
and weight gain in pediatric populations than in adult
populations
3. Only atypical antipsychotic with a long-acting depot
formulation
ANTIDEPRESSANTS
FLUOXETINE (Prozac)
1. May be first line choice for atypical depression
2. Can cause cognitive and affective flattening
3. Long half-life; even longer lasting active metabolite
4. Mood disorders can be associated with eating disorders and
be treated successfully with fluoxetine
5. Class: SSRI
IMIPRAMINE (Tofranil)
1. Was once one of the most widely prescribed agents for
depression
2. Probably the most preferred TCA for treating enuresis in
children
3. Class: TCA
VENLAFAXINE (Effexor), DESVENLAFAXINE (Pristiq)
Desvenlafaxine is an active metabolite of Venlafaxine
DULOXETINE
1. Class: SSNRI
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)
1. First anticonvulsant widely used for the treatment of
bipolar disorder
2. May be effective in patients who fail to respond to lithium
or other mood stabilizers
3. Especially preferred as a second or third-line treatment for
mania
4. Class: Anticonvulsant
VALPROATE (Depakene, Depacon, Depakote)
1. First line treatment option that may be best for patients
o Schizophrenia
o Delaying relapse in schizophrenia
o Other psychotic disorders
o Acute mania
o Bipolar maintenance
o Bipolar depression
o Behavioral disturbances in dementia
o Major depressive disorder
o Obsessive-compulsive disorder
o Premenstrual dysphoric disorder
o Bulimia nervosa
o Panic disorder
o Bipolar depression
o Depression
o Anxiety
o Insomnia
o Treatment-resistant depression
o Neuropathic pain/chronic pain
o Among the most efficacious drug for treatment
of severe depression with melancholic
features
o MDD
o Diabetic peripheral neuropathy
o Partial seizures with complex symptomatology
o Generalized tonic-clonic seizures (grand mal)
o Mixed seizure patterns
o Pain associated with true trigeminal neuralgia
o Glossopharyngeal neuralgia
o Bipolar disorder
o Mania
o Complex partial seizures that occur either in
o Blocks dopamine 2 receptors, reducing
positive symptoms of psychosis and
stabilizing affective symptoms
o Blocks serotonin 2A receptors, causing
enhancement of dopamine release in
certain brain regions and thus reducing
motor side effects and possibly improving
cognitive and affective symptoms
o Specifically, alpha 2 antagonist properties
may contribute to antidepressant actions
o Boosts neurotransmitter serotonin
o Blocks serotonin reuptake pump (serotonin
transporter)
o Desensitizes serotonin receptors, especially
serotonin 1A receptors
o Presumably increases serotonergic
neurotransmission
o Boosts neurotransmitters serotonin and
norepinephrine/noradrenaline
o Blocks serotonin reuptake pump (serotonin
transporter)
o Blocks norepinephrine reuptake pump
(norepinephrine transporter)
o May be effective in treating enuresis because
of its anticholinergic properties
o Nonselective inhibitor of reuptake Of these
Biogenic amines: serotonin, NE and
dopamine
o Acts as a use-dependent blocker of voltage-
sensitive sodium channels
o Interacts with the open channel
conformation of voltage-sensitive sodium
channels
o Interacts at a specific site of the alpha pore-
forming subunit of voltage-sensitive
sodium channels
o Inhibits release of glutamate
o Blocks voltage-sensitive sodium channels by
an unknown mechanism
o May increase risk for diabetes and
dyslipidemia
o Dose-dependent extrapyramidal
symptoms
o Dose-related hyperprolactinemia
o Nausea, constipation, abdominal pain,
weight gain
o Sexual dysfunction (men: delayed o Trazodone especially for insomnia
ejaculation, erectile dysfunction; men o Bupropion, mirtazapine, reboxetine, or
and women: decreased sexual desire, atomoxetine
anorgasmia) o Mood stabilizers or atypical antipsychotics
o Gastrointestinal (decreased appetite,
nausea, diarrhea, constipation, dry
mouth)
o Mostly central nervous system (insomnia
but also sedation, agitation, tremors,
headache, dizziness)
o Bruising and rare bleeding
o Blurred vision, constipation, urinary o Lithium, buspirone, thyroid hormone (for
retention, increased appetite, dry depression)
mouth, nausea, diarrhea, heartburn o Gabapentin, tiagabine, other anticonvulsants
o Fatigue, weakness, dizziness, sedation
o Sexual dysfunction, sweating
o Nausea, somnolence, dry mouth,
dizziness, and nervousness
o Cause mydriasis
o Sedation, dizziness, confusion, Carbamazepine is itself a second-line augmenting
unsteadiness, headache agent for numerous other anticonvulsants,
o Nausea, vomiting, diarrhea lithium, and atypical antipsychotics in treating
o Benign leukopenia bipolar disorder
o Rash
o Sedation, tremor, dizziness, ataxia, o Lithium
asthenia, headache o Atypical antipsychotics
 with mixed states of bipolar disorder or for patients with
rapid-cycling bipolar disorder
2. Seems to be more effective in treating manic episodes than
depressive episodes in bipolar disorder
3. May be useful as an adjunct to atypical antipsychotics for
rapid onset of action in schizophrenia
LITHIUM (Eskalith, Lithobid, Lithostat, Lithium carbonate)
1. Original mood stabilizer and is still a first-line treatment
option but may be underutilized since is an older agent
and is less promoted for use in bipolar disorder than
newer agents
2. May decrease suicide and suicide attempts not only in
bipolar I disorder but also in bipolar II disorder and
unipolar depression
BENZODIAZEPINES
ALPRAZOLAM (Xanax, Xanax XR)
1. One of the most popular benzodiazepines for anxiety,
especially among primary care physicians and
psychiatrists
2. Is a very useful adjunct to SSRIs and SNRIs in the treatment
of numerous anxiety disorders
3. Not effective for treating psychosis as a monotherapy, but
can be used as an adjunct to antipsychotics
DIAZEPAM (Valium, Diastat)
1. Often the first choice benzodiazepine to treat status
epilepticus and is administered either intravenously or
rectally
2. Remains popular benzodiazepine for treating muscle
spasms and acute alcohol withdrawal
3. Multiple dosage formulations allow more flexibility of
administration compared to most other benzodiazepines
isolation or in association with other type of
seizures
o Simple and complex absence seizures
o Multiple seizure types which include absence
seizures
o Migraine prophylaxis
o Maintenance treatment of bipolar disorder
o Manic episodes of manic depressive illness
o Maintenance treatment for manic depressive
patients with a history of mania
o Bipolar depression
o Major depressive disorder
May be best for euphoric mania; patients with
rapid-cycling and mixed state types of bipolar
disorder generally do less well on lithium
o Generalized anxiety disorder (IR)
o Panic disorder (IR and XR)
o Other anxiety disorders
o Anxiety associated with depression
o Premenstrual dysphoric disorder
o Irritable bowel syndrome
o Acute mania
o Acute psychosis
o Anxiety disorder
o Symptoms of anxiety
o Acute agitation, tremor, impending or acute
delirium tremens and hallucinosis in acute
alcohol withdrawal
o Skeletal muscle spasm due to reflex spasm to
local pathology
o Athetosis
o Stiffman syndrome
o Increases brain concentrations of gamma-
aminobutyric acid (GABA) by an unknown
mechanism
o Unknown and complex
o Alters sodium transport across cell
membranes in nerve and muscle cells
o Alters metabolism of neurotransmitters
including catecholamines and serotonin
o May alter intracellular signaling through
actions on second messenger systems
o Binds to benzodiazepine receptors at the
GABA-A ligand-gated chloride channel
complex
o Enhances the inhibitory effects of GABA
o Boosts chloride conductance through GABA-
regulated channels
o Inhibiting actions in cerebral cortex may
provide therapeutic benefits in seizure
disorders
o Abdominal pain, nausea, vomiting,
diarrhea, dyspepsia
o Alopecia (unusual)
o Ataxia, dysarthria, delrium, tremor,
memory problems
o Polyuria, polydipsia
o Diarrhea, nausea
o Weight gain
o Sedation, fatigue, depression
o Dizziness, ataxia, slurred speech,
weakness
o Forgetfulness, confusion
o Hyper-excitability, nervousness
o Lamotrigine
o Antidepressants
o Valproate
o Atypical antipsychotics
o Lamotrigine
o Antidepressants
o Benzodiazepines are frequently used as
augmenting agents for antipsychotics and
mood stabilizers in the treatment of psychotic
and bipolar disorders
o Benzodiazepines are frequently used as
augmenting agents for SSRIs and SNRIs in the
treatment of anxiety disorders
o Not generally rational to combine with other
benzodiazepines
Filename: Psychopharma_table (1)
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Creation Date: 3/31/2012 20:50:00
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