Psychopharmacology Chemical Mediators Metaepinephrine- Excitatory Chemical Mediator Effects: Increase- Hypertension, pheochromocytoma (adult), neuroblastoma (pedia) Decrease-

depression, lethargy, somnolence Epinephrine- Excitatory chemical mediator Effects: Increase- hypertension, anxiety, insomnia Decrease- Shock, hypotension, weakness Norepinephrine- Excitatory chemical mediator Effects: Increase- Hypertension, pheochromocytoma (adult), neuroblastoma (pedia), Hyperreflexia Decrease- Shock

Acetylcholine- Inhibitory and excitatory chemical mediator Effects: increase- Anxiety, hallucination, illusion, delusion Decrease- Parkinsons disease, Alzheimers disease, myasthenia gravis GABA (Gamma-aminobutyric acid)- Inhibitory chemical mediator Effects: increase- major depression, constipation, suicide Decrease- anxiety, bipolar, suicide Glutamate- Excitatory chemical mediator Effects- increase- hypertension Decrease- shock Serotonin- inhibitory and excitatory chemical mediator Effects: increase- schizoaffective, insomnia, personality disorder Decrease- schizophrenia, anergia, suicide Dopamine- inhibitory and excitatory chemical mediator Effects: increase- schizophrenia, mania, bipolar Decrease- Parkinsons disease, schizopherenia, ADHD

ANTIDEPRESSANT MAOI (Monoamine oxidase inhibitor) Action: inhibits the synthesis of GABA Side Effects: Hypertension- check for BP Antidote: Ca-channel blocker (NIfedipine & Verapamil) Mannitol Phentolamine Drugs: Tranylcypromine (Parnate) Isocarboxazid ( Marplan) Phenelzine (Nardil) MAOI + TCA = Toxicity MAOI + SSRI = Serotonin syndrome (SS) MAOI + tyramine = hypertensive crisis

Tyramine rich foods Avocado Beer Cheese except cottage cheese Dried fruits S/Sx of hypertensive crisis (2-3 days after the last administration of the drug) Occipital pounding headache Blurring of vision Hypertension After meal Management: Semi-fowlers Drugs Monitor BP

SSRI (Selective serotonin reuptake inhibitor) Action: inhibits the reuptake of serotonin

Heterocyclic Monocyclic, bicyclic, tricyclic Sedating (night: Imipramine, Elavil, Tofranil), Non-sedating (AM: Norpramine) Management: After meal- GI upset No driving-drowsiness PR- tachycardia Taper dose Avoid sunlight CBC-WBC- aggranulocytosis (leukopenia)- sore throat Antidote: Mannitol (TCA)

Drugs:
Flouxetine (Prozac) Paroxetine ( Paxil) Sertraline ( Zoloft) Fluvoxamine (Luvox) SSRI + TCA = toxicity SSRI + MAOI= SS SS- seizure/ delirium, heart failure, brain abscess Antidote: Fluzicin, Mannitol Management: PR and RR No driving- drowsiness Taper dose After meal

ANTIPSYCHOTIC Typical/Classic -zine Haloperidol Thorazine Atypical -pine -done Olanzapine Clozapine Risperidone Classical S/Sx: EPS- 1wk tardive dyskinesia Orthostatic hypotension Agranulocytosis Photosensitivity Keritoconjunctivitis

Throrazine- bone marrow suppression Aplastic anemia- bone marrow transplant Orthostatic hypotension
Haldol- Neuroleptic malignant syndromeTemperature EPS- Phenergan Atypical S/Sx: Agranulocytosis No EPS/ less EPS Bone marrow depression PUD (gastric ulcer)-pain- after meal Orthostatic hypotension- BP

ANTIEXTRAPYRAMIDAL SYMPTOMS Classifications: Muscle relaxant: Valproates Valproic acid-Depakene- weight gain Divalpronex-Depakote- hepatotoxicSGPT, SGOT Depakone- Nephrotoxic-Creatinine & BUN; Ototoxic- Webers test Hydralazine (apresoline)- muscle atony Dopaminergic: Dopamine (levodopa) Amantadine (Symmetrel) Carbidopa levodopa Antihistamine: Benadryl
Anticholinergic: Atropine Sulfatedrowsiness Trihexypheiedil ( Artane) Biperiden Hydrochloride ( Akineton)bone marrow suppression Robinul- xerostommia(dry mouth) Antimuscarinic: Bromocriptine Mesylate ( Parlodel)- GI disturbance Benztropine Mesylate ( Cogentin) ANTIEPS in the Philippines (commonly used) Parlodel Artane Depakene Atropine sulfate Diazepam/Dopamine Akineton Benadryl

ANTI MANIC-MOOD STABILIZER

Lithium (Eskalith, Lithotab, Lithane)

Considerations: Monitor Na- normal: 135-145mEq/L 3-5 g/day of Na (1/2 knorr cubes, 34tbsp of salt) Lithuim=Na Serum lithium- normal: 0.6-1.2 mEq/L Maintenence: 0.5-1.5 mEq/L 1.2-1.5 dizziness, vomiting, diaphoresis 1.5-2.0 vomiting, anorexia, nausea, diarrhea, abdominal cramping 2-3 arrythmia, metabolic acidosis, multiple organ failure syndrome 3-4 coma, death 12 hour after the last dose 1st month once per week >1 month once per week Increase OFI- 3-4 L/day Diarrhea/constipation To flushed lithium Photosensitivity Nephrotoxic Hepatotoxic Antidote: Mannitol Ca+ carbonate Ca+ gluconate

ANTICONVULSANT General muscle relaxant Phenobarbital- respiratory depression Mngt: Bronchodilator, ET + O2, Epinephrine Primidone- bone marrow suppression Mngt: reverse Isolation Phenytoin- pink urine, rashes/urticaria, hepatotoxic, catatonic Valproates Carbamazepine (teqetrol)- Bone marrow suppression, PUD, agranulocytosis Gabapentin (nuerontin)-nephrotoxic Steve Johnson Syndrome- side effect of anticonvulsant -Burn like rashes