Psychotropics Flashcards
(21 cards)
Acts as “artificial alcohol to mitigate alcohol withdrawal effects of excessive glutamate and deficient GABA activity. May begin immediately after stopping drinking. Doses at 666mg BID.
Acamprosate (Campral)
Melatonergic 1 and 2 receptor agonist and 5HT2C antagonist indicated for depression and anxiety. Increases dopamine and norepinephrine transmission in PFC. Resynchronizes circadian rhythms in depression. Onset of full action 2-4 weeks but can improve sleep in 1 week. Liver test required prior to initiated because may increase transaminase levels.
Agomelatine (Valdoxan)
Primarily indicated for GAD (IR formulation) and panic disorder (IR and XR) along with several other anxiety-related disorders/symptoms. Half-life 12-15hrs. Binds to benzodiazepine receptors at GABA-A channels and enhances inhibitory effects of GABA. Inhibits neuronal activity in amygdala-centered fear circuits. Short-term tx preferred. Long-term tx for 6 months then taper slowly. Start 0.25-0.75mg TID. May increase depression, weakness, forgetfulness and confusion.
Alprazolam (Xanax/Xanax XR)
D2 and D3 antagonist and antiemetic used for dysthymia (50mg) and schizophrenia (400-800mg/day divided BID) in Europe. Can be sedating and increase prolactin with amenorrhea. May be partial D2 agonist. 5HT7 and 5HT2B antagonist. For patients responsive to low-dose activation effects for reduced negative symptoms and depression. Begin with complete metabolic profile and cholesterol panel/fasting glucose, CMP, CBC and EKG.
Amisulpride (Solian)
TCA (serotonin and norepinephrine/noradrenaline reuptake inhibitor indicated for depression and endogenous depression (neuropathic pain/chronic pain, fibromyalgia, headache). Common side effects are sedation and weight gain due to increased appetite and craving for carbohydrates. Start 25mg and dose to 50-150mg/day. Not recommended for patients with heart problems. Most widely prescribed TCA for headache.
Amitriptyline (Elavil)
TCA that is metabolite of conventional antipsychotic, loxapine with half-life of 24 hours. Dosed at 25mg BID-TID to start and indicated for Neurotic or reactive depressive disorder, endogenous or psychotic depression, and depression accompanied by anxiety or agitation. Potential for EPS.
Amoxipine (Asendin)
Stimulant which increases norepinephrine and dopamine by blocking reuptake (increasing the signal and decreasing the noise). Indicated for ADHD in ages 6 and older and narcolepsy in ages 12 and older. IR formula dosed at 5mg/day to start with half-life of 10-12 hours but clinical effects for 3-5 hours, sometimes shorter in younger children. 8-hour dexedrine spansule dosed daily. Also used as augmentation for treatment-refractory depression including post-stroke depression and in the elderly, especially to improve cognitive symptoms (slowing) related to depression.
Amphetamine D (Dexedrine/Dexedrine Spansules/Zenzedi/ProCentra)
Stimulant indicated for ADHD (ages 3-12 - Adderall and Evekeo), ADHD (ages 6-17 - Adderall XR, Evekeo, Dyanavel XR, and Adzenys) and in adults (Adderall XR, Evekeo, Adzenys XR-ODT. Adderall and Evekeo also indicated for narcolepsy and Evekeo indicated for exogenous obesity.
Amphetamine D and L (Adderall, Adderall XR, Evekeo, Adzenys-XR-ODT, Dyanavel XR)
Atypical antipsychotic/dopamine partial agonist indicated for schizophrenia (ages 13 and older), acute mania/mixed mania (ages 10 and older), bipolar maintenance, depression (adjunct), autism-related irritability and Tourette’s (ages 6-18), and acute agitation related to schizophrenia or bipolar. Partial agonism at D2 receptors and 5HT1A receptors. Blockade at 5HT2C and 5HT7 along with partial agonist actions at 5HT1A contribute to depression efficacy. Weight gain and sedation uncommon but may be more common in children. Dosed at 15-30mg for psychotic symptoms and 2-10mg for depression
Aripiprazole (Abilify, Abilify Maintena, Aristada)
Dopamin reuptake inhibitor (DRI)/wake-promoter indicated for narcolepsy and excessive sleepiness in OSA and shift work sleep disorder. Enhances activity in hypothalamic wakefulness center by activating histamine in tuberomamillary nucleus and activating hypothalamic neurons that release orexin/hypocretin. Augmenting therapy for sleepiness in mood disorders. Longer-lasting R enantiomer of modafinil. Dosed at 150mg/day, dosed higher in sleepiness and lower in concentration/attention issues.
Armodafinil (Nuvigil)
Atypical antipsychotic and mood stabilizer (D2/5HT2A antagonist, 5HT2C/5HT7/A2 antagonist) indicated for schizophrenia and acute mania/mixed mania monotherapy for ages 10 and up, adjunct to lithium and vaproate in adults. Sedation likely, weight gain possible and may cause tissue discomfort in mouth. Dissolvable tablets in 5-10mg/BID dosing with little bioavailability if swallowed - no eating or drinking within 10 minutes. Long half-life of 13-39 hours.
Asenapine (Saphris)
Selective norepinephrine reuptake inhibitor (NRI) indicated for ADHD in adults .and children over 6. Increases norepinephrine and dopamine in frontal cortex but lacks dopamine enhancement in limbic areas leading to reduced incidence of abuse. Should not be given to men with urinary flow/retention problems or people with known cardiac abnormalities.
Atomoxetine (Strattera)
Anticholinergic indicated for treatment of EPS and parkinsonism that reduces excess acetylcholine activity caused by removal of dopamine inhibition when dopamine receptors are blocked. Typical anticholinergic side effects and can exacerbate tardive dyskinesia. For EPS dosed at 1-4mg once or twice daily. May not help with EPS symptoms in chronic/long-term antipsychotic use.
Benztropine (Cogentin)
Atypical antipsychotic approved in Japan and Korea for treatment of schizophrenia/psychotic disorders with not ideal dosing schedule of BID (4mg) and after meals. Lower risk of weight gain but sedation probable.
Blonanserin (Lonasen)
Dopamine (D2) partial agonist/atypical antipsychotic approved for schizophrenia and tx-resistant depression (adjunct). Newer and not covered until other antipsychotics fail and has minimal to moderate risk of weight gain and sedation. Long half-life (91 hours) and dosed at 1mg/day x4 days then 2mg/day x2 days, then 4mg/day for schizophrenia. Dose 0.5-2mg/day for depression augmentation. Potentially more cognitive improvement and less akathisia than aripiprazole.
Brexpiprazole (Rexulti)
Mu opioid receptor partial agonist indicated for maintenance treatment of opioid dependence which binds to mu opioid receptors with strong affinity and prevents pleasurable effects of opioid consumption. Can precipitate withdrawal in active users depending on when last dose taken - induction period. Constipation common and dose dependent. Start 8mg day 1 and increase up to 32mg over one week. Observe for 2 hours following first dose with induction.
Buprenorphine (Subutex, Suboxone-w/ naloxone, Probuphine-impant)
Norepinephrine dopamine reuptake inhibitor (NDRI) indicated for MDD, SAD and nicotine dependence sometimes used for ADHD and sexual dysfunction. Dosed with splitting 150mg IR tab BID to start and increasing in divided doses with second dose given no later than noon. XR formula should be given once daily in am. Can be activating in bipolar disorder, cause insomnia, should not be used with seizure disorder and used with caution with cardiac arrhythmias and HTN.
Bupropion (Wellbutrin-IR, SR and XL, Zyban, Aplenzin)
Anxiolytic/5HT1A partial agonist indicated for management of anxiety disorders and short-term tx of anxiety symptoms. Also used as adjunct in tx-resistant depression. Starting dose of 15mg/BID and increased to max of 60mg/day - divided. Disadvantage of long duration (2-4 weeks) to efficacy and generally reserved as augmenting agent in anxiety and depression.
Buspirone (BuSpar)
Medical food prescribed for tx of dietary management of metabolic processes associated with Alzheimer’s disease (mild to moderate) through induction of hyperketonemia, providing an alternate energy substrate to glucose in the brain because ketones cross the blood-brain barrier. Ketones are taken up by neurons and enter mitochondria to increase mitochondrial efficiency. Ketones also generate ATP. May cause GI se which can be improved by taking powder in drink with food or sipping slowly over 30 minutes.
Caprylidene (Axona)
Anticonvulsant indicated for acute mania/mixed mania through blockade of voltage-sensitive sodium channels and inhibits the release of glutamate. May take several weeks to months to full effect. Run CBC, CMP, LFTs and thyroid test prior to starting. CBC q 2-4 weeks x2 months, then every 3-6 months due to risk of transient leukopenia, aplastic anemia and agranulocytosis. May cause weight gain and over sedation. CR and ER formulas may reduce risk of SE and ER formulation has better demonstrated effectiveness in BP treatment. Often will require upward dose changes over time because it induces own metabolism. Best used in patients who fail lithium or other mood stabilizers.
Carbamazepine (Tegretol)
Third-generation antipsychotic/dopamine (D2/D3) partial agonist indicated for schizophrenia and acute mania/mixed mania. D3 partial agonism contributes to medication’s efficacy for treating negative symptoms, cognition, mood, emotions, and reward circuitry. Long half-life (2-4 days and 1-3 weeks for active metabolite) and some risk of weight gain and mild sedation but lower SE risk profile than other atypicals thought should be monitoring for SE for several weeks after starting due to long half-life and time to building therapeutic dose in system. Newer and more expensive.
Cariprazine (Vraylar)
