PSYCHIATRIC

MEDICATIONS
A Simple Discussion
ANTIPSYCHOTICS / NEUROLEPTICS
treat the symptoms of psychosis (delusions, illusions, hallucinations) seen in
schizophrenia, schizoaffective disorder, and the manic phase of bipolar disorder
block receptors of dopamine
dopamine receptors are classified into D1, D2, D3, D4, & D5 = D2, D3, and D4 are associated
with mental illness
typical antipsychotics are potent antagonists of D2, D3, & D4 = effective in treating target
symptoms but also produces EPS because of the blocking of the D2 receptors
atypical antipsychotics
= weak blockers of D2 that accounts for the lower incidence of EPS
= inhibit the reuptake of serotonin, increasing their effectiveness in treating the depressive
aspects of schizophrenia
Typical Antipsychotics
-AZINE; -XAPINE; HALDOL; MOLINDONE

Atypical Antipsychotics
-APINE; RISPERIDONE
Extrapyramidal Symptoms (EPS)
serious neurologic symptoms / major side effects of antipsychotic drugs
APAT

Therapies for the neurologic side effects of acute dystonia, pseudo

parkinsonism, and akathisia are similar and include:
– 1) Lowering the dosage of the antipsychotic
– 2) Changing to a different antipsychotic
– 3) Administering anticholinergic medication
Neuroleptic Malignant Syndrome (NMS)
a potentially fatal, idiosyncratic reaction to an antipsychotic drug
immediate discontinuation of antipsychotics + supportive medical
care
death rates at 10-20%

Agranulocytosis
a fatal side effect of atypical antipsychotics
drug must be discontinued immediately if the WBC drops by 50% or to
less that 3,000 (NV: 5k-10k mm^3)
ANTIDEPRESSANTS
mechanism of action is not completely understood, antidepressants somehow interact
with the two neurotransmitters, norepinephrine and serotonin
TRICYCLIC ANTIDEPRESSANTS
- blocks reuptake of noradrenaline & serotonin
- may lead to serotonin syndrome
- pramine, ptyline

SELECTIVE SEROTONIN REUPTAKE INHIBITORS

- blocks reuptake of serotonin
- more modern & safe, less cardiotoxic, lacks anticholinergic effects, not
sedating
- may have increased effect if co-administered TCA, benzodiazepine, etc.
- xetine, xamine, lopram, zodone, traline
- bupropion
MONOAMINE OXIDASE INHIBITORS
- increase the levels of multiple neurotransmitters in the brain
- monoamine oxidase is involved in removing the neurotransmitters
norepinephrine, serotonin, and dopamine from the brain
- low incidence of sedation and anticholinergic effects
- selegiline, isocarboxazid (Marplan), phenelzine (Nardil),
tranylcypromine (Parnate)

IMPORTANT REMINDERS:
1. Avoid ingesting foods containing tyramine = HYPERTENSIVE CRISIS
(over 180/120 mmHg)
2. Do not give with other MAOIs, TCAs, Meperidine, CNS depressants,
Hypertensive meds, General anesthetics
MOOD STABILIZERS
treat bipolar disorder by:
- (1) stabilizing the client's mood,
- (2) preventing or minimizing the highs and lows that characterize bipolar illness, &
- (3) treating acute episodes of mania
LITHIUM
- considered the first-line agent in the treatment of bipolar disorder
- normalizes the reuptake of certain neurotransmitters (serotonin,
norepinephrine, acetylcholine, dopamine)
- reduces the release of norepinephrine through competition with calcium

- take a week or more to begin working

- clinically effective at 0.5 - 1 mmol/L = more than 1.5 is toxic
- 1 mmol/l can already produce many detectable biochemical changes
ANTICONVULSANTS
- more recently used
- about 40% of bipolar patients are not helped by lithium / cannot tolerate it

VALPROATE
= good for acute mania (alone or with antipsychotic meds)
CARBAMAZEPINE
= first anticonvulsant to be an effective mood stabilizer & for epilepsy
= more side effects than valproate, less effective than lithium
= interacts with several other medicines (oxcarbazepine as alternative)
ANXIOLYTICS & HYPNOTICS
alter an individual’s responses to environmental stimuli
binds to GABA receptors and enhance GABA transmission
prevent feelings of fear (anxiolytic)
calm patients (sedative)
cause sleep (hypnotic)
produce a state of tranquility in anxious patients (minor tranquilizer)

1. BENZODIAZEPINE
= most frequently used anxiolytic drugs, prevent anxiety without causing much
associated sedation
= -aze-, -azo- (eg. flurazepam, triazolam)
2. BARBITURATE
= previously the sedative–hypnotic drugs of choice
= higher likelihood for sedation and other adverse effects
= greater risk of addiction and dependence
= -barbital

3. OTHERS
= antihistamines, antidepressants (SSRI, SNRI), etc.
 That is all!
TRY TO GUESS WHAT TYPE OF MEDICATION
Olanzapine
ATYPICAL ANTIPSYCHOTIC

Olanzapine
Imipramine
 ANTIDEPRESSANT - TCA

Imipramine
Haloperidol
 TYPICAL ANTIPSYCHOTIC

Haloperidol
Paroxetine
ANTIDEPRESSANT - SSRI

Paroxetine
Amobarbital
ANXIOLYTIC - BARBITURATE

Amobarbital
Nortiptyline
 ANTIDEPRESSANT - TCA

Nortiptyline
Valproate
MOOD STABILIZER - ANTICONVULSANT

Valproate
Perphenazine
 TYPICAL ANTIPSYCHOTIC

Perphenazine
Escitalopram
 ANTIDEPRESSANT - SSRI

Escitalopram
Alprazolam
ANXIOLYTIC - BENZODIAZEPINE

Alprazolam
Lithium
MOOD STABILIZER

Lithium
Temazepam
ANXIOLYTIC - BENZODIAZEPINE

Temazepam
Parnate
ANTIDEPRESSANT - MAOI

Parnate