Psychiatric pharmacology
Depression
TCA (imipramine, amytriptyline) and MAOI
Sefx:
SSRI (Fluoxetine, Sertraline, paroxetine, citalopram)
SNRI (Duloxetine, Venlafaxine)
Others
Note: For children, use fluoxetine. Others may cause increased risk of suicide ideation
Note: Usage in pregnancy may result in SGA
Note: SNRI has greater risk of OD
Schizophrenia
Typical (haloperidol, chlorpromazine, zuclopenthixol) - Block D2 receptors
Atypical (olanzapine, quetiapine, risperidone, amisulpride, aripiprazole, asenapine, clozapine) - Block 5HT-2A (more) and D2
NOTE: Olanzapine --> Can use when breastfeeding
NOTE: Olanzapine for mood stabiliser and IMI injection (aggression)
NOTE: Clozapine used when other antipsychotics are refractory
NOTE: Clozapine can treat TD
NOTE: Risperidone has depot form
Anxiolytics
Benzos
SSRI (Fluoxetine, Sertraline)
Buspirone
Hypnotics
Note: Use much higher doses of SSRI for PTSD, OCD and severe anxiety
Bipolar (mood stablisers)
Lithium
Lamotrigine
Na Valproate
Carbamazepine
Atypical antipsychotics (quetiapine, olanzepine, aripiprazole)
Aggression
Haloperidol IM
Lorazepam IM
Source
Prof S Pridmore 2014
TCA (imipramine, amytriptyline) and MAOI
Sefx:
- Anti cholinergic (dry mouth, urinary retention, tremors, etc)
- Weight gain
- Postural hypotension
- TCA cardiotoxic in OD
SSRI (Fluoxetine, Sertraline, paroxetine, citalopram)
- Takes weeks to work
- Sefx:
- GI (diarrhoea)
- Discontinuation syndrome (headache, dizziness, n+v) --> Fluoxetine not included
- Serotonin Syndrome
- Erectile dysfunction
SNRI (Duloxetine, Venlafaxine)
- More effective than SSRI
Others
- MAOI (sefx: hypertensive crisis - when eaten with cheese, SS)
- Quetiapine (antiphychotic)
- Agomelatine (melatonin agonist)
Note: For children, use fluoxetine. Others may cause increased risk of suicide ideation
Note: Usage in pregnancy may result in SGA
Note: SNRI has greater risk of OD
Schizophrenia
Typical (haloperidol, chlorpromazine, zuclopenthixol) - Block D2 receptors
- EPS Sefx:
- Acute = oculogyric crisis (head tilt, eyes roll), laryngospasm
- Intermediate = Akathisia, Parkinsonism
- Chronic = TD (eg. lip smacking)
- Other sefx:
- NMS
- Prolactinaemia
- Anticholinergic efx (eg. dry mouth, oligouria, constipation)
- Sedation (H2 blockade)
- Weight gain
Atypical (olanzapine, quetiapine, risperidone, amisulpride, aripiprazole, asenapine, clozapine) - Block 5HT-2A (more) and D2
- Sefx:
- Weight gain
- Sedation
- QT prolongation (torsade de pointes --> VF --> death)
- Myocarditis/ cardiomyopathy (clozapine)
- Neutropaenia (clozapine)
- Prolactinaemia (risperidone)
- EPS sefx (amisulpride)
NOTE: Olanzapine --> Can use when breastfeeding
NOTE: Olanzapine for mood stabiliser and IMI injection (aggression)
NOTE: Clozapine used when other antipsychotics are refractory
NOTE: Clozapine can treat TD
NOTE: Risperidone has depot form
Anxiolytics
Benzos
- Rapid onset (cf SSRI takes weeks)
- Diazepam (long acting), oxazepam (intermediate acting)
- Sefx:
- Drowsiness
- Potentiate efx of alcohol
- Addiction
SSRI (Fluoxetine, Sertraline)
- Effect takes weeks
Buspirone
- Not as sedating as benzos
- Delayed affect (2/52)
- Less effective on ex benzo user
Hypnotics
- Temazepam (benzo)
- Zolpidem (GABA agonist)
Note: Use much higher doses of SSRI for PTSD, OCD and severe anxiety
Bipolar (mood stablisers)
Lithium
- 1st line
- Sefx
- Dehydration (leads to toxicity - confusion, ataxia, n+v, diarrhoea)
- Nausea
- Diarrhoea
- Weight gain
- Tremor
- Hypothyroidism
- kidney failure
- Not good for pregnancy but may still continue
Lamotrigine
- 1st line for bipolar depression
- Sefx: headache
Na Valproate
- Can use when breastfeeding
- Sefx
- n+v
- diarrhoea
- hair loss (reversible)
- weight gain
- Toxicity - heart block, coma, death
- Not for pregnant
Carbamazepine
- Sfex (rare)
- Blood dyscrasia
- Rashes (SJS)
- Hyponatremia
Atypical antipsychotics (quetiapine, olanzepine, aripiprazole)
Aggression
Haloperidol IM
Lorazepam IM
Source
Prof S Pridmore 2014