Drug

Drug Class

MOA / Drug effects

Used for

SE / Contraindications

Clozapine

(Clozaril)

Newer “atypical” antipsychotics

Selectively blocks the dopaminergic receptors in the mesolimbic system- so, minor or no EPS

For “positive” symptoms and “negative” symptoms- apathy, social withdrawal

~Lower risk of  EPS & TD & NMS

Causes weight gain -> diabetes

~Will not worsen motor sym. in PD

~SE: agranulocytosis, so monitor WBC weekly, hold if <3,000

~photosensitivity, sedation, anticholinergic effects (constipation)

Fluoxetine

Prozac

SSRI – antidepressant

Slows or inhibits the reuptake of serotonin into presynaptic terminals (increases its levels)

Depression

Has appetite-inhibiting action, so used for bulimia

~OCD, Premenstrual Dys.

Serotonin syndrome- involuntary muscle twitches, akathisia, tremor, seizure & coma

~insomnia, weight gain, sexual dysfunction

~Do not use for 2-5 wks after MAOIs

Aminotriptyline

(Elavil)

Tricyclic antidepressant (TCA)

Block the uptake of serotonergic, muscarinin, histaminergic, adrenergic, dopaminergic receptors in CNS

~balance of serotonin & NE

Depression and various pain disorders (ex: trigeminal neuralgia)

Potent anticholinergic -> dry mouth, constipation, blurred vision, dysrhythmias

~ sedation, impotence, orthostatic hypo, very lethal overdose, affects CNS & CV system- death from seizure (no antidote)

cardiac problems- dysrhythmias

Do not use w/in 14 days of MAOIs

Phenelzine

(Nardil)

MAOI antidepressant

Inhibits the MAO enzyme system in the CNS- amines (dopamine, serotonin..) are not broken down

Depression & panic disorders

Do not eat tyramine! Causes hypertensive crisis – nothing pickled, aged or fermented

Do not take with SSRI’s or sympathomimetics (hypertensive crisis)

Bupropion

(Wellbutrin)

(Zyban)

Other antidepressant

Has modest effect on the blockade of dopamine reuptake

Helps quit smoking

Not for pts w/ seizures, history of bulimia

Don’t mix with MAOI’s

All antidepressants have rebound depression if stop abruptly.

Drug

Drug Class

MOA / Drug effects

Used for

SE / Contraindications

Lithium Carbonate

(Lithobid)

Antimanics  - mood stabilizers

Exact MOA unknown

~lithium ions alter Na+ transport into nerve cells

Treatment of choice for mania & to prevent recurrent suicidal depression

*Serum level: .8-1.2 required

*decreased Na+ and fluid intake may lead to lithium toxicity (don’t take diuretic, and need Na+)

~Brain damage if mix w/ haloperidol

~increased thirst, urination, diarrhea, choreoathetotic movements (wavelike), weight gain

*Long term: hypothyroidism

Not for: renal/liver disease, schizo, under 12, diabetics

Take albumin, uric acid & glucose levels beforehand

~Don’t mix w/ NSAIDS- toxicity

Carbamazepine

(Tegretol)

Antimanics – mood stabilizers

*An antiepileptic agent

Decreases carbamazepine metabolism

Is similar to TCA’s

Mania, epilepsy

Bone marrow suppression, dysrhythmias, HF, vision & hearing disturbances, acute urinary retention, pneumonia

Lorazepam

(Ativan)

Antianxiety med.

~ Benzodiazepine

Depresses activity in the brainstem and limbic system

~increases the action of GABA (inhibitory neuroT)

IV or SL

Anxiety disorders

Insomnia

Preop med.

Prevents chemo- related N/V & symptoms of acute alcohol withdrawal

SE: drowsiness, ataxic gait, slurred speech

Addictive

Withdrawal: anxiety, insomnia

Severe withdrawal: seizures

Don’t mix w/ alcohol or sedatives

Aluminum antacids

(Mylanta)

Antacids

Promote gastric mucosal defensive mechanisms by stimulating secretion of:

Mucus (protective barrier against HCl)

PG (prevents histamine from binding to parietal cells) bicarb (helps buffer acidic properties of HCl)

Peptic ulcer disease

Hyperacidity disorders

Gastritis

Constipation

Not for renal disease or CV disease (high sodium causes increased BP)

Affects the absorption of meds given at the same time.

Calcium antacids

(Tums)

Antacids

See Aluminum

See Aluminum

Constipation, Rebound hyperacidity,

Gas, Affects the absorption of meds given at the same time.

OK for renal failure