Updated: 12/31/2021

Psychiatric Medications

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  • Psychiatric Drug Introduction
    • Psychiatric medications can be broken down into the following categories:
      • antidepressants
      • antipsychotics
      • bipolar medications
      • anxiolytics
  • Psychiatric Drug Table
    • Antidepressants
        • Tricyclics
        • Name
        • Mechanism
        •  Key Indication
        •  Key Toxicity
        • Amitryptyline
        • Blocks reuptake of norepinephrine and serotonin
        • Depression
        •  Pain syndromes
        • Convulsions
        •  Coma
        •  Cardiotoxicity
        •  Anti-cholinergic side effects
        • Nortriptyline
        • Action on 5-HT, muscarinic, dopaminergic, histaminic receptors (among many others)
        • Depression
        •  Pain syndromes
        • Convulsions
        • Coma
        • Cardiotoxicity
        • Anti-cholinergic side effects
        • Imipramine
        • Blocks 5-HT, NE, dopamine, Ach reuptake (among many others)
        • Bed-wetting
        • Convulsions
        • Coma
        • Cardiotoxicity
        • Anti-cholinergic side effects
        • Non-Tricyclic SNRIs
        • Name
        • Mechanism
        •  Key Indication
        •  Key Toxicity
        • Venlafaxine
        • Duloxetine
        • Serotonin-norepinephrine reuptake inhibitor
        • Depression
        •  Anxiety
        •  Co-morbid headaches
        •  Diabetic peripheral neuropathy
        • Stimulant effects
        •  Sedation
        •  Increased blood pressure
        • SSRIs
        • Name
        • Mechanism
        •  Key Indication
        •  Key Toxicity
        • Citalopram
        • Fluoxetine
        • Paroxetine
        • Sertraline
        • Serotonin reuptake inhibitor
        • Depression
        •  Anxiety
        •  Social Anxiety (paroxetine)
        • Serotonin syndrome (in combination with MAOi's, SNRI's, TCA's)
        •  Sexual dysfunction
        •  GI distress
        •  SIADH (manage with cyproheptadine)
        • NDRIs
        • Name
        • Mechanism
        •  Key Indication
        •  Key Toxicity
        • Bupropion
        • Weak norepinephrine-dopamine reuptake inhibitor (NDRI)
        • Depression
        •  Smoking cessation
        • Lowers seizure threshold
        •  Tachycardia
        •  Headache
        •  NO sexual side effects
        • MAOIs
        • Name
        • Mechanism
        •  Key Indication
        •  Key Toxicity
        • Isocarboxazid
        • Phenelzine
        • Tranylcypromine
        • Inhibits monoamine oxidase (MAO) increasing catecholamine and dopamine levels
        • Atypical depression
        •  Social anxiety
        • Hypertensive crisis (with tyramine consumption)
        •  Serotonin syndrome (with SSRIs, SNRIs, TCAs as well as many other drugs)
    • Antipsychotics
        • Low Potency
        • Name
        • Mechanism
        •  Key Indication
        •  Key Toxicity
        • Chlorpromazine
        • Thioridazine
        • D2, α1, cholinergic, histaminic blockade
        • Psychosis
        •  Schizophrenia
        •  Mania
        • Extrapyramidal side effects
        •  Hyperprolactinemia
        •  Anti-muscarinic side effects
        •  Neuroleptic malignant syndrome
        •  Tardive dyskinesia
        •  Corneal (chlorpromazine) and retinal (thioridazine) deposits
        • High Potency
        • Name
        • Mechanism
        •  Key Indication
        •  Key Toxicity
        • Droperidol
        • Perphenazine
        • D2 blockade
        • Psychosis
        • Extrapyramidal side effects
        •  Hyperprolactinemia
        •  Anti-muscarinic side effects
        •  Neuroleptic malignant syndrome
        •  Tardive dyskinesia
        • Atypical SDAs
        • Name
        • Mechanism
        •  Key Indication
        •  Key Toxicity
        • Clozapine
        • Olanzapine
        • Risperidone
        • Quetiapine
        • Affects serotonin, dopamine, α1, and histamine receptors
        • Psychosis
        •  Bipolar
        •  OCD
        •  Anxiety
        •  Depression
        •  Mania
        • Agranulocytosis (must monitor WBC
        • levels)
        •  Weight gain
        •  Anti-pyramidal symptoms (less than traditional)
        •  Anti-cholinergic side effects
        •  QT prolongation
        •  Hyperlipidemia (olanzapine)
        •  Hyperprolactinemia (risperidone)
    • Bipolar Medications
        • Name
        • Mechanism
        •  Key Indication
        •  Key Toxicity
        • Carbamazepine
        • Blocks Na+ channels
        • Bipolar, esp. rapid cycling
        •  Trigeminal neuralgia
        •  Anti-epileptic 
        • Teratogenic
        •  Granulocytosis
        •  Aplastic anemia
        •  SIADHP450 inducer
        •  Steven-Johnson syndrome
        •  DiplopiaAtaxia
        • Lithium
        • Unknown
        • Bipolar
        • Nephrogenic diabetes insipidus
        •  Hypothyroidism
        •  Teratogenic
        •  Ebstein anomaly (teratogenic)
        • Valproic acid
        • Blocks voltage-gated Na+ channels
        •  Inhibits GABA transaminase (increases GABA)
        •  Blocks thalamic T-type Ca2+ channels
        • Bipolar
        •  Anti-epileptic
        •  Absence seizure (2nd line to ethosuximide)
        • Hepatotoxic
        •  Teratogenic
        •  Tremor
        •  Weight gainGI complications
        •  Treat overdose with carnitine
    • Anxiolytics
        • Name
        • Mechanism
        •  Key Indication
        •  Key Toxicity
        • Benzodiazepines
        • (lorazepam, diazepam)
        • Increase frequency of GABA channel opening
        • Seizures
        •  Anxiolytic
        • Sedation
        •  Tolerance
        •  Respiratory depression
        •  Dependence
        • Barbiturates
        • (phenobarbital, pentobarbital, thiopental)
        • Increase duration of GABA channel opening
        • Sedative
        •  Anxiolytic
        •  Seizures
        •  General anesthesia (thiopental)
        • Respiratory and cardiovascular depression
        •  Dependence
        •  P450 induction
        • Zolpidem
        • GABA channel agonist
        • Insomnia
        •  Muscle relaxant
        • Ataxia
        •  Headaches
        •  Confusion
        •  Dependence
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(M2.PH.16.4688) A 28-year-old female patient with a history of schizophrenia, type 2 diabetes mellitus, and hypothyroidism comes to clinic stating she would like to be put back on a medication. She recently stopped taking her haloperidol as it made it hard for her to "sit still." She requests to be put on olanzapine as a friend from a support group said it was helpful. Why should this medication be avoided in this patient?

QID: 107491

The patient is at a high risk for torsades de pointes

6%

(1/16)

There is a high risk for retinopathy

6%

(1/16)

The patient has type 2 diabetes

75%

(12/16)

The patient may develop galactorrhea

6%

(1/16)

Tardive dyskinesia will likely result from the prolonged use of olanzapine

6%

(1/16)

M 7 B

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(M2.PH.15.4688) A 34-year-old male presents to clinic today complaining that his medication has stopped working. He states despite being able to manage the side effects, a voice has returned again telling him to hurt his Mother. You prescribe him a drug which has shown improved efficacy in treating his disorder but requires frequent followup visits. One week later he returns with the following lab results: WBC : 2500 cells/mcL, Neutrophils : 55% and, Bands : 1%. What drug was this patient prescribed?

QID: 107496

Olanzapine

8%

(4/49)

Halperidol

8%

(4/49)

Chlorpromazine

4%

(2/49)

Clozapine

71%

(35/49)

Lurasidone

2%

(1/49)

M 7 B

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