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Psych drugs from First Aid for the Psychiatry Clerkship

Widened QRS

This is a sign of TCA toxicity

High potency antipsychotics

Haloperidol, Fluphenazine

Lorazepam

Intermediate acting benzodiazepine, brand name Ativan

Traditional

This class of antipsychotics block dopamine receptors

Atypical

This class of antipsychotics block dopamine and serotonin receptors

Low potency antipsychotics

Chlorpromazine, Thioridazine

Low potency

This class of antipsychotic has a higher incidence of anticholinergic and antihistaminic side effects, but less EPS and NMS

Atypical

This class of antipsychotic has been shown to be more effective in treating the negative symptoms of schizophrenia

Parkinsonism, akathisia, dystonia

EPS from traditional antipsychotics

Fever, autonomic instability, leukocytosis, tremor, elevated CPK, lead pipe Rigidity

FALTER, the symptoms of NMS

Olanzapine

This antipsychotic can cause hyperlipidemia, glucose intolerance, weight gain, and hepatotoxicity

Quetiapine

This antipsychotic causes less weight gain, but has been shown to cause cataracts in dogs

Atypical

This class of antipsychotic has the lowest incidence of Parkinsonian side effects

TCAs

This class of drugs must be used carefully because they can be lethal in overdose

IV sodium bicarbonate

This is given to treat TCA overdose

Convulsions, coma, cardiotoxicity

The 3 Cs of complications from TCA treatment

Antidopaminergic, Anti-HAM, weight gain, elevated liver enzymes, ophthalmologic problems, rash, seizures, TD, NMS

Side effects of the traditional antipsychotics

Nortriptyline

This TCA is the least likely to cause orthostatic hypotension

Desipramine

This TCA is the least sedating and has the least anti-cholinergic side effects of the TCAs

Clomipramine

This TCA is the most serotonin specific, and is useful in treating OCD

Fluoxetine

This SSRI has the longest half-life, and does not need to be tapered

Sertraline

This SSRI has the highest risk for GI disturbance

Paroxetine

This SSRI is the most serotonin specific and most activating

Fluvoxamine

This SSRI is currently only approved for OCD

Citalopram

This SSRI was used in Europe for 12 years before being approved in the US

Escitalopram

Similar to citalopram, but fewer side effects and much more expensive

Anorexia, sexual dysfunction, insomnia, GI disturbance, headache

SSRIs cause these side effects

Venlafaxine

This SNRI is used for refractory depression, and should be avoided in patients with untreated hypertension

Bupropion

This NDRI is used for ADHD, has a lack of sexual side effects, and should not be used in patients with anxiety or epilepsy

Trazodone

This SARI is used for refractory depression and insomnia, and side effects include nausea, dizziness, orthostatic hypotension, sedation, and priapism

Mirtazapine

This NASA is used for refractory major depression and causes weight gain

Lithium

This mood stabilizer has side effects including hypothyroidism, tremor, sedation, weight gain, and others

Carbamazepine

Anticonvulsant also used as a mood stabilizer, useful for mixed episodes and rapid-cycling bipolar disorder

Carbamazepine

Side effects of this mood stabilizer include leukopenia, hyponatremia, aplastic anemia, and agranulocytosis

Valproic acid

Side effects of this mood stabilizer include hepatotoxicity, pancreatitis, thrombocytopenia, and weight gain

Buspirone

This anxiolytic can be used for GAD as an alternative to benzos or venlafaxine

Buspirone

This anxiolytic is a partial agonist at the 5HT-1A receptor

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