Psychiatric drugs

Antipsychotic drugs
First generation
Phenothiazines
Aliphatic side chain:
-Chlorpromazine
-Triflupromazine

Piperidine side chain:

-Thioridazine

Piperazine side chain:

-Trifluoperazine
-Fluphenazine
 First generation-continue
Butyrophenones
-Haloperidol
-Trifluperidol
-Penfluridol

Thioxanthenes
-Flupenthixol

Other heterocyclics
-Pimozide, Loxapine
 Adverse Effects
• Sedation
• Postural hypotension
• Anticholinergic effects ‑
• blurred vision,
• dry mouth,
• constipation,
• urinary retention;
• Endocrine effects ‑ galactorhea;
• Hypersensitivity reactions ‑ jaundice,
• photosensitivity,
• rashes,
• agranulocytosis
• Idiosyncratic reactions ‑ malignant neuroleptic syndrome
• Weight gain
 Neurological Side Effects TREATMENT  

Acute dystonia Diphenhydramine,  

promethazine
Akathisia benzodiazepines or
propranolol may help  

Pseudo- trihexyphenidyl,
Parkinsonism procyclidine,  

benztropines
.  

Neuroleptic dantrolene or
malignant bromocriptine may
syndrome help:  

Perioral tremor Antiparkinsonian

("rabbit" agents often help  

syndrome)
Tardive Diazepam
dyskinesia  
Neuroleptic malignant syndrome
• combination of motor rigidity, hyperthermia, and
increased blood pressure and heart rate
• can be fatal in 5-20% of cases if untreated
 New Generations “atypical”

• clozapine
• risperidone
• olanzapine
• sertindole
• Quetiapine
• Aripiprazole
• Ziprasidone
 Clozapine
• Selectively blocks dopamine D2 receptors

Extra-pyramidal side effects are minimal

May help treat tardive dyskinesia
S/E- orthostatic hypotension, sedation, weight
gain, increased heart rate
Increased risk for seizures (2-3%)
Agranulocytosis in 1%
 Risperidone

• Blocks selective D2, norepinephrine, and 5-HT2

• effective for positive and negative symptoms
• Extra-pyramidal side effects low (but are shown at
high doses)
• No agranulocytosis risks
• Increased risk of stroke in elderly
 Olanzipine

• Improved negative symptom reduction

• Does not cause prolactin elevation
• reduced agranulocytosis risks
 Mood Stablizers

• Treatment of bipolar disorder

• Lithium and depakote are the 2 primary mood stabilizing drugs
• May take 7-14 days to reach effective dose
 Mood Stabilizers
• Antiepileptic
(anticonvulsant) drugs
– Carbamazepine (Tegretol)
– Divalproex (Depakote)
– Lamotrigine (Lamictal)

– Membrane stabilizing effect

may account for the drugs
ability to reduce mood
swings
 Lithium

• Adverse effects:
cerebral convulsions,
motor tremor
cardiac dysrhythmias,
Lowest therapeutic index
Signs of lithium toxicity;

Diaphoresis,
slurred speech,
moderate nausea
 Antidepressant drugs

• Treatment of major depressive disorders

 Major classes
• Tricyclic antidepressants; TCA (Elavil,
Tofranil, pamelor)
• MAO (monoamine oxidase) enzyme
inhibitors
• Selective Serotonin Reuptake Inhibitors
(Prozac, Zoloft, Paxil, Celexa, Lexapro)
Newer antidepressants
Serotonin-norepinephrine reuptake inhibitor
(SNRIs)
Venlafaxine (Effexor)
Duloxetine (Cymbalta)
Mirtazapine (Remeron)
Trazodone (Desyrel)
Dopamine-norepinephrine reuptake inhibitor
Bupropion (Wellbutrin/Zyban)
 Tricyclic Antidepressants

• First Antidepressants (Tofranil, Elavil)

• Sedation
• Antidepressant Effect Seen In Four To Six
Weeks
• Also Used For Panic Disorder, Obsessive
Compulsive Disorder and Psychotic Depression
 Selective Serotonin Reuptake Inhibitors

• Excellent Antidepressant Effect

• First Line Medications For Depressed
Individuals
• More Expensive
• Prozac, Zoloft, Lexapro, Paxil
 Side Effects

– Anxiety, agitation
– Headaches
– Gastrointestinal (N/V/D)
– Sexual dysfunction
– Serotonergic Syndrome
 Monoamine Oxidase Inhibitors
• Tried When Tricyclics And SSRI’s Fail
• Treat Panic Disorder, Anxiety Disorders
And Bulimia
• Effective In 3-4 Weeks
 Serious Food Interactions with
MAOI’s
• Foods Containing Tyramines :
Sharp Cheddar Chees
Salami
Sauerkraut
Beer and Wine (with yeast)
Ripe Avocados
 Antianxiety/anxiolytic

• Benzodiazepines
– Useful for short treatment,
– Dependence, tolerance can develop
 Side Effects
• Decreased Heart Rate
• Hypotension
• Dizziness/Syncope
• Anticholinergic Symptoms
• Central Nervous System Symptoms
• Sexual Dysfunction
• Weight Gain
 Pharmacogenetics

Differences in drug responses among

ethnic groups
Lithium
Greater toxicity in African Americans than in whites
Haloperidol
Same dose, but plasma concentrations 50% higher in Asian
group than in caucasion
Clozapine
Life-threatening side effect, agranulocytosis, more prevalent
in Ashkenazi Jews than in other ethnic groups
Thank you