Antidepressants

Antipsychotics

Phenothiazides

Prototype is chlorpromazine (thorazine)

• Primarily for antimetic use (anti vomiting, nausea)

• Lowers agitation in psychotic pts

• For Tx of Psychotic disorders

• Causes lowering of dopamine synaptic activity in brain

• Given orally

• Block D2 transmission

• Extrapyramidal symptoms (strange movements= tardive dyskenesia)

• Dry mouth, liver toxicity, endocrine effects, aggivation of alchohole induced depression

• Loss of conditioned reflexes

Clozapine

• An atypical antipsychotic

• only antipsychotic that effects primarily D4

• effects limbic and striatal leurons

• no extrapyramidal symptoms

• Agranulocytosis

• Causes seizures; orthostatic Hypotension

• Potentiates action of anticholinergics

Resperidone

• D2 & 5-HT2 Antagonist

• Advantages over phenothiazides (& clozapine)

  • Lower extrapyramidal effect

  • Lower sedation

  • Less cholinergic blockade

• No addiction

• Metabolized by P450 system

• Antagonizes anti-Parkinson drugs

Haloperidol (a Butyro phenone)

• Antipsychotic

• Stronger than phenothiazine

• Will block vasoconstrictor effect of epi

• Extrapyramidal symptoms

Despiramine

• the most potent norepi uptake inhibitor

St Johns Wort

• shows moderated management of depression

• Inhibits MAO and 5HT reuptake

Bupropion

• Antidepressant

• A very week norepi/seratonin uptake inhibitor

• Unknown mechanism

• Aids in smoking cessation

• Warnings about risks of seizures

Lithium

(For tx of manic depression)

• Alters Na+ transport in neuronal tissue

• Renal clearance

• Indicated to prophylaxis for mania

• Causes excessive thirst and Urination

• Chance of lithium toxicity when combined with NSAIDs or thiazide diuretics

• Depression drugs are specific to MAO-A

• Can cause Hypertensive crisis

• Side effects: HTN, tremor, headache, Agitation

• Theraputic use limited by side effects

• Lethal drug interaction with meperidine(Demerol)

Sertraline (Zoloft)

MAOI

• Drug of choice for Post traumatic stress disorder

Nortryptiline

Imipramine

Amytriptyline

• Uptake 1 blockade

• Mech. Is most related to down regulation of receptors on post synaptic terminals

• 2-3 weeks for effect to occur

• Improves depression w/out euphoria, and are not addictive

• Contraindicated with glaucoma

• Side effects resemble Atropine

  • Dry mouth

  • Blurred vision

  • Constipation

  • Postural Hypotension

• Similarities with phenothiazides

  • Disruption of conditioned reflexes

  • Potentiate sleep induction of barbiturates

  • Anticholinergic

• Increase potency of MAO inhib.

Fluoxetine (Prozac)

• For Treatment of depression

• Has a minimal effect on Norepi

Paroxetine (Paxil)

• Highest risk of causing symptoms with discontinuation of therapy

Mirtazapine

• 5HT-2 and 5HT? Antagoist

• potent antihistamine and antimuscarine effects