Anti-HAM side-effects:

#
SIDE-EFFECTS
TCAs and
low-potency anti- psychotics can cause anti-H2,
anti-1,
Serotonin nti-M
syndrome: 5-HT fever, confusion, flushing, swe ts, tremor, hypertonicit
Serotonin
y, rh bdo-syndrome
myolysiscombos:
ren lSSRI+MAOI,
f ilure, deSSRI+OTC
th
cough medicine, SSRI+linezolid, M
AOI+meperidine,
Serotonin
syndrome
MAOI+MDMA/MDEA
Tx: cyprohept dine or BDZ, void t king within 5 weeks of e c
h other
Hypertensive
crisis: MAOI+tyr mines or symp tho- mimetics c n c use NE/epi (severe
Extr
HTN)pyr mid l side-effects: high-potency typic l ntipsychotics c n c use P rki
nsonism,
EPS Tx: cute
k thisi
dystoni
, nddystoni
benztropine
within
or ddiphenhydr
ys
mine, k thisi -
lockers or BDZ
, Parkinsonism
Tardive
dyskinesia:
levodopa
high-potency
or amantadine
typical anti- psychotics can cause choreoatheto
sisTx:
TD
of irreversi
mouth and
le,
tongue
so monitor
after years
sx with
of use
AIMS (a
normal involuntary movement scal
e)
Withdrawal dyskinesia: tendency for TD to temporarily increase following d/c ant
Hyperprolactinemia: high-potency antipsychotics and risperidone canjavaprolactin
ipsychotic
(galactorrhea, amenorrhea, li
ido, infertility), due to dopamine in tu
eroinfundi

ular pathwaymalignant syndrome: all antipsychotics can cause FALTER Fever, Auton
Neuroleptic
omic insta
ility, Leukocytosis, Tremor, Elevated CPK, lead pipe Rigidity; mortalit
Meta
y rate
NMS
olic
isdantrolene
syndrome:
20%
or
atypical
antipsychotics can BP, insulin,
ody fat, risk of CAD/s

Tx:

romocriptine
CYP450:
troke/dia
liver
switchthat
to typical
meta
olize
antipsychotic
drugs; CYP450
if ptinducers
is at risk
drug levels, CYP450

etes;enzymes
CYP450
inhi
Teratogenic
inhi
inducers:
itors:
drugs:
levels
smoking,
fluvoxamine,
TCAs (fetal
car
amazepine,
lim
fluoxetine,
iturates,
VPA (neural
St.
duloxetine,
tu
Johns
wort
sertraline
lithium

itors

drug

defects),

ar
paroxetine,

e defects),
#
Antidepressants:
(E
steins anomaly),
ANTIDEPRESSANTS
SSRIs,
BDZs
TCAs,
(cleft
MAOIs,

palate
and +atypicals;
FAS facies)
all have similar efficacy
u
t differ in side-effect profile, require 3-4 week trial to take effect, none cau
Withdrawal
se elation phenomenon:
or have a
usedizziness,
potentialheadache, N/V, insomnia, malaise after stoppin
g most first-line
SSRIs:
anti- depressant
for MDDuse;
duemay
to low
require
incidence
tapering
of side-effects and safe in OD; i
ncludes
SSRI
side-effects:
fluoxetine,sexual
sertraline,
dysfunction,
paroxetine,
GI distress,
fluvoxamine,
serotonin
(es)citalopram
syndrome,
lack
o
x forsuicidality
SSRI
sexual dysfunction: switch to
upropion Fluoxetine (Prozac): longest T12 (fe
withdrawal (Paxil):
west
Sertraline
Paroxetine
sx)
(Zoloft):
shortest
highest T12
GI distress
(highest withdrawal sx), most anticholinergic si
Fluvoxamine
de-effects
Citalopram
fewest
Escitalopram
sexual
(Celexa):
(Luvox):
(Lexapro):
side-effects
Tx L-enantiomer
fewest
OCD drug interactions,
of citalopram, even fewer side-effects
ut
more
Venlafaxine
Desvenlafaxine
Buproprion
venlafaxine,
Duloxetine
$$$
(Well
(Cym
(Effexor):
more
utrin):
$$$ SNRI,
noSNRI,
sexual
BP
good
active
for
side-effects,
painful
meta
olite
dia
contraindicated
etic
of neuropathy,with
moreseizures
$$$
a

(Pristiq):

alta):
nd eating (Desyrel):
Trazodone
disorders (risk
can cause
of seizures)
sedation and priapism (Tx epi injection into peni
s)
Nefazodone
Mirtazapine
TCAs:
inhi
it
(Serzone):
(Remeron):
5-HT/NE reuptake,
can
cancause
causerarely
sedation,
weight-gain
first-line
and
ox
sedation
since
for OD
hepatotoxicity
can
e lethal (Tx NaH

lack
CO3);side-effects:
TCA
three types anti-HAM
tertiary+ 3tricyclics,
Cs Cardiotoxicity
secondary (QTc),
tricyclics,
Convulsions,
tetracyclics
Coma; lots o
f2interactions
vs. 3 TCAs:(highly
tertiary
protein
are more
anticholinergic
and lethal inandODsedating, and more lethal in O

ound)
Imipramine
Amitriptyline
Clomipramine
effects
Doxepin
Nortriptyline
Desipramine
Amoxapine
D; secondary
(Sinequan):
(Asendin):
(Tofranil):
(Norpramin):
(Anafranil):
are
(Elavil):
(Pamelor,
active
very
meta
TxAventyl):
strong
meta
sedating,
enuresis
very
olite
activating,
anticholinergic
sedating,
offewest
useful
loxapine,
of tertiary
Txless
antiasOCD
aonly
sidesleep
HAM
sedating,
amines
antidepressant
side-effects
aid least
in lowanticholinergic
doses
that can cause

more

olites
Maprotiline
EPS
MAOIs:
not first-line
(Ludiomil):duerate
to side-effects
of seizures,
ut
arrhythmias,
useful forand
atypical
fatality
depression;
w/ OD
in
cludes phenelzine (Nardil), tranylcypromine (Parnate), isocar
oxazid (Marplan),
selegiline
MAOI
side-effects:
(Emsam) serotonin syndrome (MAOI+ SSRI within 5 weeks), HTN crisis (M
# typical
AOI+tyramine)
Antipsychotics:
ANTIPSYCHOTICS
(1G) and
atypical (2G) are
oth good for positive psycho
tic
Depot
sx,antipsychotics:
long-acting
decanoate
negativeforms
psychotic
ideal sx
for noncompliant psychot

ut atypicals are

etter for
ic pts; vs.
Typical
includes
atypicals:
haloperidol,
typicalsfluphenazine,
have more EPS,
risperidone,
tardive dyskinesia,
paliperidone
anti-HAM, and
lethality in OD due to QTc prolongation; atypicals have more weight gain, DKA,
Typical
and meta
side-effects:
antipsychotics:
olic syndromeEPS
(parkinsonism
DA only + akathisia + dystonia), prolactin, anti
locks
HAM,potency:
Low
tardive anti-HAM,
dyskinesia EPS
(1% annual
and TD;incidence),
includes chlorpromazine
NMS
(corneal pigmentation +
photo Psychoph rm cology
sensitivity)
Mid-potency: midr
nd thiorid
nge properties;
zine (retin
includes
l pigment
lox tion
pine (seizures),
night blindness)
thiothixene (ocul
Atypic
High
r pigment
potency:
l ntipsychotics:
tion),
EPStrifluoper
nd TD,
blocks
zine
nti-HAM;
both
( nxiety),
DAincludes
nd 5-HTnd
h Atypic
loperidol,
perphen
l side-effects:
zine
fluphen zine,
weight
pimozide
g
Cloz
met
in,bolic
DKA,
pine syndrome
(Cloz ril):
(monitor
suicide
weight
but weight
nd lipids)
g in, seizures, gr nulocytosis (requires
Risperidone
Pweekly
liperidone
WBC (Risperd
counts),
(Inveg ):l):
R-sided
met#1bolite
for
obstip
prol
oftion
risperidone
ctin nd dystonic
Queti pine
re ctions
(Seroquel): c n c us
Zipr
orthost
Aripipr
Ol
Ziprasidone
e sed
nzsidone
pine
tion
tic(Zyprex
zole
nd
(Geodon):
hypotension
doesnt
(Abilify):
):work:
weight
weight
#1pt
forwasnt
g in
k thisi
eating,
(Txfood
-
lockers
is required
or BDZ)
to activate Geodon in t
#
Mood
he
ody
sta
ilizers:
MOOD
TxSTABILIZERS
acute mania
and prevent relapses of manic episodes, include
Lithium:
s lithiumDOC
andfor
anticonvulsants
acute mania and
(valproic
PPx foracid,
maniclamotrigine,
episodes, takes
car
5-7
amazepine)
days for onse
Li+
t, only
side-effects:
mood sta
ilizer
LMNOP to
Lithium
suicidality
causes Movement (tremors Tx propanolol), Nephrog
enic DI, Narrow TI (0.6-1.2), hypOthyroidism (Tx Synthroid), Pregnancy pro
lems
(E
Li+
level factors:
anomaly)NSAIDs ( except aspirin), dehydration (), salt deprivation (), s

steins
weating overdose:
Lithium
(), renaliffailure
leveldiuretics
>4.0, hemodialysis
()
Lithium duration: maintain u

lood (),
se for episode,
single
1 year following
maintain for lifetime if 3+ relapses Lithium HTN: Tx Ca2+-channe
#
Anticonvulsants:
l
lockers
ANTICONVULSANTS
includes car
amazepine,

oxcar
azepine, valproic acid, lamotrigi

Car
ne,
amazepine
ga
apentin,(Tegretol):
prega
alin,good
tiaga
for
rapid-cycling
topiramate
ipolar disorder and trigeminal

ine,
CBZ
neuralgia;
side-effects:
takes BATHS
5-7 days
Blood
for onset
dyscrasias,
and requires
P450 Autoinduction,
CBC/LFT monitoring
Teratogenic, Hepat
otoxic,
Valproic
VPA
side-effects:
Stevens-Johnson
acid (Depakote):
4 Fs syndrome
Fat
requires
(weightCBC/LFT/VPA
gain), Farts
monitoring
(GI distress), Fatal hepatotoxic
ity,
Lamotrigine
Fetal teratogen
(Lamictal):
(neural
can VPA
tu
elevels,
defects)causes Stevens-Johnson syndrome so raise
levels slowly
Topiramate
(Topamax): causes weight loss, cognitive slowing (aka Dopamax), kidne
#
Anxiolytics:
Oxcar
Prega
Tiaga
y
stones
Ga
apentin
azepine
alin
(Ga
(Neurontin):
(Lyrica):
(Trileptal):
enzodiazepines,
ANXIOLYTICS
rarely
rarely
goodrarely
used
used
for
ar
chronic
iturates,
used pain
and non-
enzodiazepine hypnotics/an

ine

atril):

Benzodiazepines: three types
ased on T12 (<6 hrs, 6-20 hrs, >20 hrs), choice of
xiolytics
Intermediate-acting
Oxazepam,
Long-acting
(Valium)
BDZ overdose:
Non-liver
depends
and
Temazepam
meta
BDZ:
on
clonazepam
olized
onset,
T12
flumazenil
BDZ:
BDZ:
>20
duration,
(Klonopin)
T12
hrs;
LOT6-20
includes
and
Lorazepam,
hrs;
meta
includes
diazepam
olism alprazolam (Xanax), lorazepam (At

give
ivan), oxazepam
Short-acting
BDZ:(Serax),
T12 <6and
hrs;temazepam
includes(Restoril)
triazolam (Halcion) and midazolam (Versed)
,NonBar
used
iturates:
enzo
mainly
hypnotics:
overdose:
in
rarely
medical
used
zolpidem
Tx and
IV
surgical
lethal
(Am
ien),
in
settings
zaleplon
overdose (Sonata), and eszopiclone (Lune


iturate

/cNaHCO3
sta); Txhydrate
Chloral
short-term
(Somnote):
insomnia,
sedative,
no tolerance/dependence
rarely used due to tolerance/depedence and
liver toxicity
Ramelteon
(Rozerem): melatonin MT-2/3 agonist used for sedation, no tolerance/de
Buspirone (BuSpar): 5-HT1A partial agonist given for anxiety, useful in alcoholi
pedence
cs (no EtOH potentiation
Diphenhydramine
(Benadryl):
likeantihistamine
BDZ)
given for sedation, anticholinergic sid
Hydroxyzine (Atarax): antihistamine given for anxiety, anticholinergic side-effec
e-effects

Psychostimulants:
ts
Propanolol: -
locker
OTHER
Tx ADHD
used
DRUGSand
to
Tx
refractory
panic attacks,
depression;
performance
includesanxiety,
D-amphetamine,
and akathisia
amp
hetamine salts,
Amphetamines
(Dexedrine,
methylphenidate,
Adderall):
atomoxetine,
schedule IImodafanil
(a
use potential), monitor BP and
Methylphenidate
watch for weight(Ritalin,
loss, insomnia
Concerta): schedule II (a
use potential), monitor BP/CB
C/LFTs and watch
Atomoxetine
(Stattera):
for weight
appetite
loss, suppression
insomnia
and insomnia,
ut hepatotoxicity and
SI ininhi
Modafanil
AChE
adolescents
itors: Tx mild
usedAlzheimer
in narcolepsy
disease;
Cognitive
includes
enhancers:
donepezil,
used
galantamine,
in dementiariv

(Provigil):

Electroconvulsive
astigmine,(Namenda):
Memantine
tacrine
OTHERtherapy:
TREATMENTS
NMDA
Tx
locker

refractory
used fordepression;
moderate-severe
8-12 sessions
Alzheimergiven
disease
3/week
thenmethod:
ECT
monthlyptECTputtounder
prevent
general
relapse;
anesthesia
safe forandpregnant
muscle relaxant,
and elderlythen electrodes
ECT
induce
side-effects:
electrodes:
efficacy:
c/i:
arecent
seizure;
75%
ilateral
amnesia
efficacy
anything
electrodes
(MC),
w/ headaches,
possi
on
num
length
ility
of
ofpostictal
hemorrhagic
sessions
soreness,
utstroke
confusion
amnesia
(raised
and confusion
ICP, a

MI,

ased

ermuscle

suppression
neurysms,
Psychoph
rm cology
d/o, BBB distruption)

leeding
Deep
DBS method:
br in stimul
impl nt
tion:
device
Tx chronic
in br inpth
in,t Psends
rkinsons
regul dise
r electric
se, tremor,
l impulses
nd dystoni
to sp
ecific
Repetitive
regions,
tr nscr
high
nirisk
l m gnetic
of surgic
stimul
l complic
tion: noninv
tions sive method to excite neuro
ns vi electro- m gnetic induction, Tx psychi tric conditions but modest effects
Light
rTMS
t best
side-effects:
ther py: Tx ser son
re seizures,
l ffective
discomfort
disorder t the delivery site