DRUGS FOR PSYCHO PHARMACOLOGY EXAM MOOD STABILIZERS Lithium (Eskalith) Manic episodes of manic depressive illness (treatment,

ent, maintenance, prophylaxis) Alters cation transport in nerve and muscle Prevents/decreases incidence of acute manic episodes CNS: SEIZURES, fatigue, headache, impaired memory, ataxia, sedation, confusion, dizziness, drowsiness, psychomotor retardation, restlessness, stupor. EENT: aphasia, blurred vision, dysarthria, tinnitus. CV: ARRHYTHMIAS, ECG changes, edema, hypotension. GI: abdominal pain, anorexia, bloating, diarrhea, nausea, dry mouth, metallic taste. GU: polyuria, glycosuria, nephrogenic diabetes insipidus, renal toxicity. Derm: acneiform eruption, folliculitis, alopecia, diminished sensation, pruritus. Endo: hypothyroidism, goiter, hyperglycemia, hyperthyroidism. F and E: hyponatremia. Hemat: leukocytosis. Metabolic: weight gain. MS: muscle weakness, hyperirritability, rigidity. Neuro: tremors. Assess: mental status, I/O, sodium intake will lithium reabsorption in kidney. Just know to monitor the pts. sodium levels Evaluate renal and thyroid function, WBC with differential, serum electrolytes, and glucose periodically during therapy Therapeutic levels range from 0.5 to 1.5 mEq/L ppl hate it. Fine tremor. Urinate a lot. Malaise. Narrow TI Assess patient for signs and symptoms of lithium toxicity (vomiting, diarrhea, slurred speech, decreased coordination, drowsiness, muscle weakness, or twitching Formost danger is inducing cardiac dysrhythmias

divalproex sodium (Depakote) Anticonvulsant, also Manic episodes associated with bipolar disorder (mixed episodes and rapid cycling) VERY effective against impulsive aggression Increase levels of GABA, an inhibitory neurotransmitter in the CNS Liver and CBC baselines must be drawn Therapeutic blood levels= 50 to 100 mcg/mL

CNS: SUICIDAL THOUGHTS, agitation, dizziness, headache, insomnia, sedation, confusion, depression. CV: peripheral edema. EENT: visual disturbances. GI: HEPATOTOXICITY, PANCREATITIS, abdominal pain, anorexia, diarrhea, indigestion, nausea, vomiting, constipation, increased appetite. Derm: alopecia, rashes. Endo: weight gain. Hemat: leukopenia, thrombocytopenia. Metabolic: HYPERAMMONEMIA. Neuro: HYPOTHERMIA, tremor, ataxia. Assess mood, ideation, and behavior frequently, suicidal tendencies Monitor hepatic function (LDH, AST, ALT, and bilirubin) and serum ammonia concentrations prior to and periodically during therapy. May cause hepatotoxicity; monitor closely, especially during initial 6 mo of therapy; fatalities have occurred. Therapy should be discontinued if hyperammonemia occurs Decreased incidence of manic episodes in patients with bipolar disorders

Carbamazepine (Tegretol) Anticonvulsant and mood stabilizer- acute of mixed mania Decreases synaptic transmission in the CNS by affecting sodium channels in neurons CNS: SUICIDAL THOUGHTS, ataxia, drowsiness, fatigue, psychosis, sedation, vertigo. EENT: blurred vision, nystagmus, corneal opacities. Resp: pneumonitis. CV: CHF, edema, hypertension, hypotension, syncope. GI: hepatitis, pancreatitis, weight gain. GU: hesitancy, urinary retention. Derm: photosensitivity, rashes, STEVENS-JOHNSON SYNDROME, TOXIC EPIDERMAL NECROLYSIS, urticaria. Endo: syndrome of inappropriate antidiuretic hormone (SIADH), hyponatremia. Hemat: AGRANULOCYTOSIS, APLASTIC ANEMIA, THROMBOCYTOPENIA, eosinophilia, leukopenia. Misc: chills, fever, lymphadenopathy, liver enzymes, multi-organ hypersensitivity reactions, hepatic failure (rare). A CBC must be done periodically

Monitor for changes in skin condition in early therapy. Stevens-Johnson syndrome and toxic epidermal necrolysis are significantly more common in patients with a particular human leukocyte antigen (HLA) allele, HLA-B*1502 (occurs almost exclusively in patients with Asian ancestry, including South Asian Indians)., also monitor mental status Monitor CBC, including platelet count, reticulocyte count, and serum iron, weekly during the first 2 mo and yearly thereafter for evidence of potentially fatal blood cell abnormalities. Medication should be discontinued if bone marrow depression occurs

lamotrigine (Lamictal) Anticonvulsant- Maintenance treatment of bipolar disorder (depressive episodes) Stabilizes neuronal membranes by inhibiting sodium transport Delayed time to recurrence of mood episodes CNS: SUICIDAL THOUGHTS, ataxia, dizziness, headache, behavior changes, depression, drowsiness, insomnia, tremor. EENT: blurred vision, double vision, rhinitis. GI: nausea, vomiting. GU: vaginitis. Derm: photosensitivity, rash (higher incidence in children, patients taking valproic acid, high initial doses, or rapid dose increases). MS: arthralgia. Misc: STEVENS-JOHNSON SYNDROME. Monitor suicide and RASH

ANTIDEPRESSANTS SSRIS- block reuptake and thus, the destruction of serotonin with little or no effect on other monoamine transmitters Fluoxetine (Prozac) Antidepressant action- Decreased mood alterations associated with PMDD CNS: NEUROLEPTIC MALIGNANT SYNDROME (muscle rigidity, fever, autonomic instability and cognitive changes such as delirium, and is associated with elevated creatine phosphokinase), SEIZURES, SUICIDAL THOUGHTS, anxiety, drowsiness, headache, insomnia, nervousness, abnormal dreams, dizziness, fatigue, hypomania, mania, weakness. EENT: stuffy nose, visual disturbances.

Resp: cough. CV: chest pain, palpitations. GI: diarrhea, abdominal pain, abnormal taste, anorexia, constipation, dry mouth, dyspepsia, nausea, vomiting, weight loss. GU: sexual dysfunction, urinary frequency. Derm: sweating, pruritus, erythema nodusum, flushing, rashes. Endo: dysmenorrhea. F and E: hyponatremia. MS: arthralgia, back pain, myalgia. Neuro: tremor. Misc: SEROTONIN SYNDROME, allergic reactions, fever, flu-like syndrome, hot flashes, sensitivity reaction. Discontinue use of MAO inhibitors for 14 days before fluoxetine therapy; combined therapy may result in confusion, agitation, seizures, hypertension, and hyperpyrexia (serotonin syndrome). Fluoxetine should be discontinued for at least 5 wk before MAO inhibitor therapy is initiated Concurrent use with pimozide may risk of QT interval prolongation Assess for suicide. Assess for serotonin syndrome (mental changes [agitation, hallucinations, coma], autonomic instability [tachycardia, labile blood pressure, hyperthermia], neuromuscular aberrations [hyperreflexia, incoordination], and/or GI symptoms [nausea, vomiting, diarrhea]), especially in patients taking other serotonergic drugs (SSRIs, SNRIs, triptans) Monitor CBC and differential periodically during therapy. Notify health care professional if leukopenia, anemia, thrombocytopenia, or increased bleeding time occurs

Escitalopram (Lexapro) CNS: NEUROLEPTIC MALIGNANT SYNDROME, SUICIDAL THOUGHTS, insomnia, dizziness, drowsiness, fatigue. GI: diarrhea, nausea, abdominal pain, constipation, dry mouth, indigestion. GU: anorgasmia, libido, ejaculatory delay, erectile dysfunction. Derm: sweating. Endo: syndrome on inappropriate secretion of antidiuretic hormone (SIADH). F and E: hyponatremia. Metabolic: SEROTONIN SYNDROME, appetite. May cause serious, potentially fatal reactions when used with MAO inhibitors Concurrent use with pimozide may result in prolongation of the QTc interval and is contraindicated

Assess for serotonin syndrome, neuroleptic malignant syndrome (below FEVER) F Fever E Encephalopathy V Vitals unstable E Elevated enzymes (elevated CPK) R Rigidity of muscles

paroxetine (Paxil) CNS: NEUROLEPTIC MALIGNANT SYNDROME, SUICIDAL THOUGHTS, anxiety, dizziness, drowsiness, headache, insomnia, weakness, agitation, amnesia, confusion, emotional lability, hangover, impaired concentration, malaise, mental depression, syncope. EENT: blurred vision, rhinitis. Resp: cough, pharyngitis, respiratory disorders, yawning. CV: chest pain, edema, hypertension, palpitations, postural hypotension, tachycardia, vasodilation. GI: constipation, diarrhea, dry mouth, nausea, abdominal pain, decreased appetite, dyspepsia, flatulence, increased appetite, taste disturbances, vomiting. GU: ejaculatory disturbance, decreased libido, genital disorders, urinary disorders, urinary frequency. Derm: sweating, photosensitivity, pruritus, rash. Metabolic: weight gain, weight loss. MS: back pain, myalgia, myopathy. Neuro: paresthesia, tremor. Misc: SEROTONIN SYNDROME, chills, fever. Do not take with MAOIs Assess for suicide and serotonin syndrome

SNRIs- block reuptake of serotonin and norepinephrine duloxetine (Cymbalta) CNS: NEUROLEPTIC MALIGNANT SYNDROME, SEIZURES, SUICIDAL THOUGHTS, fatigue, drowsiness, insomnia, activation of mania, dizziness, nightmares. EENT: blurred vision, intraocular pressure. CV: blood pressure. GI: HEPATOTOXICITY, appetite, constipation, dry mouth, nausea, diarrhea, liver

enzymes, gastritis, vomiting. F and E: hyponatremia. GU: dysuria, abnormal orgasm, erectile dysfunction, libido, urinary retention. Derm: sweating, pruritus, rash. Neuro: tremor. Misc: SEROTONIN SYNDROME. Do not take with MAOIs, watch suicide Venlafaxine (Effexor)

CNS: NEUROLEPTIC MALIGNANT SYNDROME, SEIZURES, SUICIDAL THOUGHTS, abnormal dreams, anxiety, dizziness, headache, insomnia, nervousness, weakness, abnormal thinking, agitation, confusion, depersonalization, drowsiness, emotional lability, worsening depression. EENT: rhinitis, visual disturbances, epistaxis, tinnitus. CV: chest pain, hypertension, palpitations, tachycardia. GI: abdominal pain, altered taste, anorexia, constipation, diarrhea, dry mouth, dyspepsia, nausea, vomiting, weight loss. GU: sexual dysfunction, urinary frequency, urinary retention. Derm: ecchymoses, itching, photosensitivity, skin rash. Neuro: paresthesia, twitching. Misc: SEROTONIN SYNDROME, chills, bleeding, yawning. Do not take with MAOIs, watch suicide and serotonin syndrome Mirtazapine (Remeron)

CNS: drowsiness, abnormal dreams, abnormal thinking, agitation, anxiety, apathy, confusion, dizziness, malaise, weakness. EENT: sinusitis. Resp: dyspnea, increased cough. CV: edema, hypotension, vasodilation. GI: constipation, dry mouth, increased appetite, abdominal pain, anorexia, elevated liver enzymes, nausea, vomiting. GU: urinary frequency. Derm: pruritus, rash. F and E: increased thirst. Hemat: AGRANULOCYTOSIS. Metabolic: weight gain, hypercholesterolemia, increased triglycerides. MS: arthralgia, back pain, myalgia. Neuro: hyperkinesia, hypesthesia, twitching. Misc: flu-like syndrome. Assess CBC and hepatic function before and periodically during therapy

Do not take with MAOIs

NDRIs- norepinephrine dopamine reuptake inhibitor, also inhibits nicotinic acetylcholine receptors to reduce the addictive effects of nicotine bupropion (Wellbutrin) CNS: SEIZURES, SUICIDAL THOUGHTS/BEHAVIOR, agitation, headache, depression, hostility, insomnia, mania, psychoses. GI: dry mouth, nausea, vomiting, change in appetite, weight gain, weight loss. Derm: photosensitivity. Endo: hyperglycemia, hypoglycemia, syndrome of inappropriate ADH secretion. Neuro: tremor. Monitor for suicide

TCAs- block the reuptake of norepherine and a little serotonin (prevent norepinephrine from coming into contact with MAO, thus increasing level of norepinrephrine in the synapse), causes dizziness and hypotension (increasing risk for falls) amitriptyline (Elavil) CNS: SUICIDAL THOUGHTS, lethargy, sedation. EENT: blurred vision, dry eyes, dry mouth. CV: ARRHYTHMIAS, hypotension, ECG changes. GI: constipation, hepatitis, paralytic ileus, increased appetite, weight gain. GU: urinary retention, libido. Derm: photosensitivity. Endo: changes in blood glucose, gynecomastia. Hemat: blood dyscrasias. Assess for suicide. Patients taking high doses or with a history of cardiovascular disease should have ECG monitored before and periodically during therapy

MAOIs- prevent destruction of monoamines (nore, epi, dop, seri) by inhibiting the action of MAO phenezine (Nardil) CNS: SEIZURES, dizziness, drowsiness, fatigue, headache, hyperreflexia, insomnia, tremor, twitching, weakness, euphoria, paresthesia, restlessness. EENT: blurred vision, glaucoma, nystagmus

CV: HYPERTENSIVE CRISIS, edema, orthostatic hypotension. GI: constipation, dry mouth, abdominal pain, liver function test elevation, nausea, vomiting. GU: sexual dysfunction, urinary retention. Derm: pruritis, rashes. F and E: hypernatremia. Endo: weight gain. Avoid with any other antidepressant (within 2 weeks), Hypertensive crisis may occur with amphetamines , methyldopa , levodopa , dopamine , epinephrine , norepinephrine , reserpine , methylphenidate , or vasoconstrictors Hypertension or hypotension, coma, seizures, respiratory depression, and death may occur with meperidine (avoid using within 23 wk of MAO inhibitor therapy) Monitor blood pressure and pulse rate before and frequently during therapy. Report significant changes promptly Avoid alcohol, watch suicide Concurrent ingestion of tyramine-rich foods and many medications may result in a life-threatening hypertensive crisis. Signs and symptoms of hypertensive crisis include chest pain, tachycardia or bradycardia, severe headache, nausea, vomiting, photosensitivity, neck stiffness, sweating, and enlarged pupils. Treatment includes IV phentolamine