Psych Druuuuugs

• Anti depressants • Mood Stabilisers• Anti psychotics • Anxiolytics and Hypnotics

Anti depressants

• How do they work?Increase levels of good mood chemicals (serotonin and noradrenaline)• Where do they work?In the presynaptic cleft

Specific Serotonin Reuptake Inhibitor (SSRI)Noradrenaline reuptake inhibitor (NRI)Tricyclic antidepressant (TCA)

Mono Amine Oxidase Inhibitor (MAOI)Reversible Inhibitor of Mono amine oxidase A (RIMA)

In more detail…..

• So serotonin and noradrenaline are MONOAMINE NEUROTRANSMITTERS (made at the presynaptic cleft)

Selective Serotonin Reuptake Inhibitors (SSRI’S)

FLUOXETINE

SERTRALINE

PAROXETINE

CITALOPRAM

Side effects:• Nausea• Vomiting• Anxiety• Agitation• Insomnia• Loss of appetite• Sexual dysfunction Anorgasmia & delayed ejaculation

Contra-indication:MANIA

Noradrenaline Reuptake Inhibitor (NRI)

REBOXETINE

Tri Cyclic Antidepressant (TCA)AMITRYPTYLINE

CLOMIPRAMINE

IMIPRAMINE

LOFEPRAMINE

Tri Cyclic Antidepressant side effects

• Muscarinic acetylcholine receptor:

Blurred vision

Dry mouth

Constipation and urinary retention

QT interval prolongationST segment elevationHeart blockArrthymias

Tri Cyclic Antidepressant side effects

• Histaminergic receptor

Weight gain

Sedation

Tri Cyclic Antidepressant side effects

• Alpha adrenergic receptor

Postural Hypotension

Mono Amine Oxidase Inhibitors (MAOI)

MAOI’s:

PHENELZINE

TRANYLCYPROMINE

ISOCARBOXAZID

RIMA’s:

MOCLOBEMIDE

Side effects:Similar to TCA

Mono Amine Oxidase Inhibitors (MAOI) Side effects

• Accumulation of monoamine neurotransmitter• ‘Life Threatening Hypertensive Crisis’• How can we prevent this happening?• Reduce other amines in the body (amines found in

certain foods and drugs)• TYRAMINE rich foods: strong cheese, yeast and protein

extract (marmite, Bovil, oxo) CHEESE CRISIS• TYRAMINE rich drugs: adrenaline, noradrenaline,

amphetamines, cocaine, dopamine, decongestants

• FOOD RESTRICTIONS WHEN ON MAOI’s

SEROTONIN SYNDROME

• When SSRI’s are administered simultaneously with MAOI’s or (MAOI’s with opiates)

SYMPTOMS: (occurs in a few minutes)

• AGITATED

• FEVER

• SWEATING

• INCREASE HR

• MYOCLONUS

• OVER RESPONSIVE REFLEXES

Contra indications for starting MAOI

• Phaeochromocytoma

• Cerebrovascular Disease

• Hepatic Imparement

• Mania

Recap of drugs SSRI’S FLUOXETINESERTRALINEPAROXETINECITALOPRAM

NRIREBOXETINE

TCAAMITRIPTYLINECLOMIPRAMINEIMIPRAMINELOFEPRAMINE

MAOI’sPHENELZINETRANYLCPROMINE

RIMAMOCLOBEMIDE

Recap of drugs

FLUOXETINE

SERTRALINE

PAROXETINE

CITALOPRAM

REBOXETINE

PHENELZINE

TRANYLCPROMINE

MOCLOBEMIDE

AMITRIPTYLINE

CLOMIPRAMINE

IMIPRAMINELOFEPRAMINE

Recap of drugs

FLUOXETINESERTRALINE

PAROXETINE

CITALOPRAM

REBOXETINE

PHENELZINE

TRANYLCPROMINE

MOCLOBEMIDE

AMITRIPTYLINE

CLOMIPRAMINE

IMIPRAMINE

LOFEPRAMINE

Mood stabiliser - Lithium

• How does it work?

• Before you start taking it….

• Check patient medications before prescribing..

• How long does it take to start working?

• Common side effects?

• Lithium Toxicity

• Monitoring

• Contraindications

Mood stabiliser - Lithium

•NOT ADDICTIVE

Antipsychotics

Conventional (typical) antipsychotics• Cause EPSE because blocks dopamine D2 Receptors in other parts of the brain

Atypical antipsychotics• First line treatment for schizophreniaBecause has less effect on dopamine D2 Receptors so fewer EPSE’s

Indications (psych)

• Schizophrenia

• Schizoaffective disorder

• Delusional Disorder

• Depression or mania with psychotic features

• Delirium

• Behavioural disturbance in dementia

• Severe agitation

Non psych indications

• Motor tics (tourettes)

• Nausea and vomiting

• Intractable hiccups and pruritus

Conventional/typical antipsychotics

• Chlorpromazine

• Thioridazine

• Trifluoperazine

• Haloperidol

Phenothiazines

Clinical side effects of using conventional/typical antipsychotics

Because of non-specific blocking of receptors –Has similar side effects to TCA’s

Chemoreceptor trigger zone

Atypical antipsychotics

• Clozapine

• Olanzapine

• Resperidone

NB all cause weight gain and increase risk of diabetes.

CLOZAPINE – agranulocytosis

Drug Recap

Chlorpromazine

Thioridazine

Trifluoperazine

Haloperidol

Resperidone

Olanzapine

Clozapine

Anxiolytic and Hypnotic drugs

• BENZODIAZEPINES

Indication of Benzo’s

• Anxiety

• Alcohol withdrawal

• Akathisia

• Acute mania or psychosis

• Epilepsy prophylaxis

• (any reason someone might need to CHILL out)

Side effects

• Drowsy, ataxia (using machinery/driving)

• Can depress respiration centre so caution in chronic resp patients

• Risk of developing dependence

• OVERDOSE

• USE WITH OTHER DRUGS (ESP ALCOHOL)

Benzo’s

• Temazepam SA oral

• Oxazepam SA oral

• Lorazepam SA oral, IV, IM

• Diazepam LA oral, PR, IV, IM

• Chlordiazepoxide LA oral

FINAL DRUGS RECAP

FLUOXETINESERTRALINE

PAROXETINE

CITALOPRAM

REBOXETINE

PHENELZINE

TRANYLCPROMINE

MOCLOBEMIDE

AMITRIPTYLINE

CLOMIPRAMINE

IMIPRAMINE

LOFEPRAMINE

CHLORPROMAZINE

THIORIDAZINE

TRIFLUOPERAZINE

HALOPERIDOL

RESPERIDONE

OLANZAPINE

CLOZAPINE

LITHIUM

CHLORDIAZEPOXIDE

TEMAZEPAM

OXAZEPAM LORAZEPAM

DIAZEPAM