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Psycho-Pharmacology

Psycho-Pharmacology. Isahel N. Alfonso, R.N. Antidepressant Drugs. Selective Serotonin Reuptake Inhibitor (SSRI) Fluoxetine Fluvoxamine Paroxetine Sertraline Citalopram Tricyclic Compound (TCA) Impiramine Despiramine Amitriptyline nortriptyline. Doxepine Trimipramine

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Psycho-Pharmacology

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  1. Psycho-Pharmacology Isahel N. Alfonso, R.N

  2. Antidepressant Drugs • Selective Serotonin Reuptake Inhibitor (SSRI) • Fluoxetine • Fluvoxamine • Paroxetine • Sertraline • Citalopram • Tricyclic Compound (TCA) • Impiramine • Despiramine • Amitriptyline • nortriptyline

  3. Doxepine • Trimipramine • Protriptyline • Maprotiline • Mirtrazapine • Amoxapine • Clomipramine • Monoamine Oxidase Inhibitors (MAOI) • Phenelzine • Tranylcypromine • Isocarboxazid

  4. Indication: • Treatment of major depressive disorder, anxiety disorder, depressed phase of bipolar disorder and psychotic depression. • Off-label uses: Treatment of chronic pain, migraine, peripheral and diabetic neurophaties, sleep apnea, certain dermatologic disorders, panic disorder and eating disorder. • Mechanism of Action • Interacts with norepinephrine and serotonin that are responsible for arousal, attention, mood and appetite. • SSRI’s block serotonin uptake • Cyclic antidepressants and venlafaxine primarily blocks norepinephrine and to some extent serotonin. • MAOI’s interfere with enzyme metabolism. • Antidepressants take effect in: SSRI- 2-3 weeks, Cyclic-4-6 weeks, MAOI- 2-3 weeks

  5. Side Effects • SSRI: Anxiety, agitation, akathisia, nausea, insomnia, Sexual dysfunction, diminish sexual drive, difficulty achieving orgasm, erection, weight gain, sedation, sweating, hand tremors, headache and diarrhea. • TCA: Dry mouth, Constipation, urinary hesitency/retention, Dry nasal passages, Blurred vision, Agitation, Delirium, Orthostatic hypotension, Sedation, Weight gain, Tachycardia, Sexual dysfunction • MAOI: Daytime sedation, Insomnia, Weight gain, Dry mouth, othostatic hypotension, Sexual dysfunction, hypertensive crisis.

  6. Mood Stabilizing Drugs • Lithium, Carbamazipine, Valproic, Gabapentin, Topiramate, Oxcarbazepine, Lamotigrine. • Indication: Treatment of bipolar disorders and acute episode of mania • Mechanism of Action: • Lithium normalizes reuptake of serotonin, norepinephrine, acetylcholine and dopamine. • Valproic acid and Topiramate increases GABA level.

  7. Side Effects • Lithium: Nausea, Diarrhea, Anorexia, Fine hand tremor, Polydipsia, Polyuria, Metallic taste in mouth, fatigue, Lethargy and weight gain. Therapeutic serum level: 0.6-1.2 mEq/L Mild to moderate toxic reactions: 1.5-2 mEq/L Moderate to severe toxic reactions: 2-3 mEq/L Toxic effect: Severe diarrhea, vomiting, drowsiness, muscle weakness and lack of coordination, coma and death if serum level is >3 mEq/L • Carbamazepine and Valproic Acid: Drowsiness, sedation, dry mouth, blurred vision, othostatic hypotension, weight gain, alopecia and tremor

  8. Carbamazepine and Valproic Acid: Drowsiness, sedation, dry mouth, blurred vision, orthostatic hypotension, alopecia, weight gain, tremor • Toparimate: Dizziness, sedation, weight loss, increased incidence of renal calculi

  9. Anxiolytics • Benzodiazepinez • Alprazolam • Chlordiazepam • Clonazepam • Chlorazepate • Diazepam • Flurazepam • Lorazepam • Oxazepam • Temazepam • Triazolam • Non-benzodiazepines • Buspirone

  10. Indication • Use to treat anxiety and anxiety disorders, insomnia, obsessive compulsive disorders, depression, post traumatic stress disorder and alcohol withdrawal • Mechanism of Action • Benzodiazepines mediate the actions of the amino acid GABA • Buspirone acts as a partial agonist at serotonin receptors which decreases serotonin turnover. • Side Effects • Can cause physical dependency, drowsiness, sedation, poor coordination, impaired memory and clouded sensation

  11. Stimulants • Methylphenidate • Dextroamphetamine • Amphetamine • Pemoline • Selective Norepenephrine Reuptake inhibitor • Atomoxetine

  12. Indication • For treatment of attention deficit hyperactive disorder and narcolepsy. • Mechanism of action • Acts as cortical and RAS stimulants by increasing the release of norepinephrine, dopamine and serotonin from the presynaptic neurons and block their reuptake. • Paradoxical effect of calming hyperexcitability through CNS stimulation is related to increase stimulation of an immature RAS (Receptor alpha stimulants). • Adverse Reactions: Nervousness, Insomnia, Dizziness and headache, blurred vision, Nausea, vomiting, hypertension, arrhythmia and angina • Side Effects: Anorexia, weight loss, nausea, irritability, growth and weight suppression

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