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PSYCHOTHERAPEUTIC DRUGS - Coggle Diagram

- - - - Depress activity in the
        brainstem and limbic system
        short term treatment of anxiety
        
        indication
        
        Anxiety
        Sedation
        Muscle relaxation
        Seizure control
        Adjuvant therapy for depression
        Alcohol withdrawal
        
        drugs
        
        alprazolam (Xanax®)
        
        Indicated for generalized anxiety disorder (GAD), short-term relief of anxiety symptoms, panic disorder and anxiety associated with depression
        Adverse effects: confusion, ataxia, headache
        Interactions: alcohol ,antacids, oral contraceptives, and others
        PO onset 30-60min
        
        lorazepam (Ativan®)
        
        Intermediate-acting benzodiazepine
        Can be given intravenously or intramuscularly; useful in the treatment of an acutely agitated patient
        Continuous infusion for agitated patients who are undergoing mechanical ventilation
        Used to treat or prevent alcohol withdrawal
        PO onset 30-60min
        
        diazepam (Valium®)
        
        Indications: relief of anxiety, management of alcohol withdrawal, reversal of status epilepticus, preoperative sedation, and as an adjunct for the relief of skeletal muscle spasms
        Avoid in patients with hepatic dysfunction.
        Adverse effects: headache, confusion, slurred speech, and others
        Interactions: alcohol, oral contraceptives, and others
        PO onset 30-60min
        
        adverse effects
        
        Decreased CNS activity, sedation, amnesia
        Hypotension
        Drowsiness, loss of coordination, dizziness, headaches
        Nausea, vomiting, dry mouth, constipation
        
        overdose
        
        Dangerous when taken with other sedatives or alcohol
        Treatment is generally symptomatic and supportive.
        Flumazenil may be used to reverse benzodiazepines’ effects.
        
        contraindications
        
        known drug allergy
        
        mydriasis
        
        teratogenic
        
        narrow-angle glaucoma
        
        interaction
        
        alcohol
        other CNS depressants, when coadminister
        can result in additive CNS depression
    - - Administered on a scheduled basis
        Non-Sedating, non-habit forming
      - Adverse effects:
        Paradoxical anxiety
        Blurred vision
        Dizziness
        Headache
        Nausea
      - agonist activity at both serotonin
        and dopamine receptors
      - contraindication: drug allergy
        Not cocurrently administer with MAOIs
        for risk of hypertension. washout 14 days
      - PO onset 2-3wk
- - - - Indications: long-term treatment of psychosis
        Contraindications: hypersensitivity, Parkinson’s disease, large amounts of CNS depressants taken
        Oral, intramuscular (LAI)
        Useful in treating patients with schizophrenia who were nonadherent to their drug regimen
  - - - Selectively blocks the dopaminergic receptors in the mesolimbic region of the brain
        Associated with minor or no EPS
        Adverse effects: blood dyscrasias
    - - Indication: schizophrenia (including negative symptoms)
        Adverse effect: minimal EPS at therapeutic dosages of 1 to 6 mg/day.
        Oral and long-acting injectable forms
- - - - Lithium
        
        lithium carbonate
        
        lithium citrate
        
        treatment of mania
        
        range between 0.6 mmol/L and 1.2 mmol/L. 1.5 to 2.0 mmol/L begin to produce toxicity. Keeping the sodium level in the normal range (135 to 145 mmol/L) helps maintain therapeutic lithium levels.
        
        PO onset 7-14 days
        
        adverse effects
        
        Most serious adverse effect is cardiac dysrhythmia.
        Other effects: drowsiness, slurred speech, epilepsy-type seizures, choreoathetoid movements (involuntary wavelike movements of the extremities), ataxia (generalized disturbance of muscular coordination), and hypotension
        Long-term treatment may cause hypothyroidism.
      - combination drugs
        
        Benzodiazepines
        Antipsychotic drugs
        Antiepileptic drugs
        Dopamine receptor agonists
    - - used when lithium not tolerated
    - - 1st generation
        
        Tricyclics(TCA)
        
        Have largely been replaced by SSRIs as first-line antidepressant drugs
        Considered second line drugs
        SSRIs or other newer generation antidepressants fail
        As adjunct therapy with newer-generation antidepressants
        amitriptyline (Elavil®)
        
        amitriptyline (Elavil)
        
        Oldest and most widely used of all the tricyclic antidepressants
        Original indication: depression
        Commonly used to treat insomnia and neuropathic pain
        Contraindications: known drug allergy, pregnancy, and recent myocardial infarction.
        Adverse effects: dry mouth, constipation, blurred vision, urinary retention, and dysrhythmias
        
        mirtazapine (Remeron®)
        
        Promotes the presynaptic release of serotonin and norepinephrine in the brain
        Sedation
        Indications: depression (including that associated with BPD), sexual adverse effects in male patients receiving SSRI therapy (reduction), and an appetite stimulant
        Contraindications: drug allergy and MAOIs
        Adverse effects: drowsiness, abnormal dreams, dry mouth, constipation, increased appetite, and asthenia
        Drug interactions: additive CNS depressant effects with alcohol and cytochrome P-450 (CYP) inhibitors
        
        Tetracyclics
        
        MAOIs
        
        Nonselective: phenelzine sulphate and tranylcypromine sulphate
        Selective: selegiline hydrochloride
        Rarely used for depression
        Used for Parkinson’s disease
        Disadvantage: potential to cause hypertensive crisis when taken with tyramine
        
        MAOIs and Tyramine
        Ingestion of foods or drinks with tyramine leads to hypertensive crisis, which may lead to cerebral hemorrhage, stroke, coma, or death
        
        avoid foods that contain tyramine!
        Aged, mature cheeses (cheddar, blue, Swiss)
        Smoked, pickled, and aged meats, fish, and poultry (herring, sausage, corned beef, salami, pepperoni, paté)
        Yeast extracts
        Red wines (e.g., Chianti, burgundy, sherry, vermouth)
        Italian broad beans (fava beans)
        
        interaction
        
        Concurrent use of MAOIs and SSRIs may lead to serotonin syndrome
        If the decision is made to switch to an SSRI, there must be a 2- to 5-week washout period between MAOI therapy and SSRI therapy
      - 2nd generation
        
        SSRIs
        
        sertraline (Zoloft®)
        paroxetine (Paxil®)
        fluvoxamine maleate (Luvox®)
        citalopram (Celexa®)
        escitalopram oxalate (Cipralex®)
        
        Mechanism of action:
        Selectively inhibit serotonin reuptake
        Have little or no effect on norepinephrine or dopamine reuptake
        Result in increased serotonin concentrations at nerve endings
        Advantage over tricyclics and MAOIs: little or no effect on cardiovascular system (important when considering overdose)
        
        fluoxetine (Prozac®)
        
        Indications: depression, bulimia, OCD, panic disorder, and premenstrual dysphoric disorder
        Contraindications: known drug allergy and concurrent MAOI therapy
        Adverse effects: anxiety, dizziness, drowsiness, insomnia, and others
        
        Serotonin-norepinephrine
        reuptake inhibitors (SNRIs)
        
        duloxetine hydrochloride (Cymbalta®)
        Indications: depression, generalized anxiety disorder (GAD), and pain resulting from diabetic peripheral neuropathy or fibromyalgia, chronic back pain, and osteoarthritis
        Adverse effects: dizziness, drowsiness, headache, GI upset, anorexia, and hepatotoxicity.
        Drug interactions: SSRIs and triptans (increased risk of serotonin syndrome) and alcohol (increased risk of liver injury)
        Can worsen uncontrolled angle-closure glaucoma
        
        Miscellaneous
        bupropion hydrochloride
        
        Originally indicated for treatment of depression; now also indicated as an aid in smoking cessation
        Sometimes added as an adjunct antidepressant for patients experiencing sexual adverse effects secondary to SSRI therapy
        Zyban®: approved for smoking cessation treatment and was the first nicotine-free prescription medication used to treat nicotine dependence
      - Newer-Generation
        Antidepressants: Adverse Effects
        
        CNS
        
        Headache, dizziness, tremor, nervousness, insomnia, *fatigue
        
        GI
        
        Nausea, diarrhea, constipation, dry mouth
        
        other
        
        Sexual dysfunction, weight gain, weight loss,*sweating