Psychiatric drug

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Psychiatric medication
Types
There are six main groups of psychiatric medications.
1. Antidepressants
2. Antipsychotics
3. Mood stabilizers
4. Anxiolytics
5. Anti convulsants
6. Anti cholinergic
1.Antipsychotics
Neuroleptics or major tranquilizers
a. Typical antipsychotics (First-generation antipsychotics) - These medications do have a high
risk of side effects, some of which are quite severe.
b. Atypical antipsychotics (second generation antipsychotics)
Indication
Antipsychotics are most frequently used for the following conditions:
 Schizophrenia
 Schizoaffective disorder
 Bipolar disorder
 Psychotic depression.
 Treatment-resistant major depression as an adjunct to standard antidepressant therapy.
Typical antipsychotics
 Extrapyramidal side effects (particularly common in patients on first-generation antipsychotics),
which includes:
 Akathisia — an often distressing sense of inner restlessness.
 Dystonia
 Parkinsonism
 Tremor
 Orthostatic hypotension
 Tardive dyskinesia (involuntary movements of the face and jaw )
 Dry mouth, blurred vision, photosensitivity, NMS(Neuroleptic malignant syndrome- is a life-
threatening, neurological disorder most often caused by an adverse reaction
to neuroleptic or antipsychotic drugs. Symptoms include high fever, sweating, unstable blood
pressure, stupor, muscular rigidity, and autonomic dysfunction)skin rash, agranulocytosis (decrease
WBC) obstractive jaundice, weight gain
Check BP before giving injection, if it’s low, don’t give. Even if its high BP also don’t give, it can cause
hypertensive crisis.
Examples
 Haldol (haloperidol) -EPS
 Chlorpromazine (Largactil)
 Zuclopenthixol (Clopixol)
Atypical antipsychotics
 Dizziness, constipation , tachycardia (rapid heart rate) , elevated ALT-AST, orthostataic
hypotension, weight gain, dry mouth
 Sedation (particularly common in patients on, Zyprexa, Seroquel, Leponex )
 Hyperprolactinaemia (rare for those on zyprexa, seroquel and abilify), which can cause:

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 Galactorrhoea — unusual secretion of breast milk.
 Gynaecomastia
 Sexual dysfunction (in both sexes)
 Osteoporosis
 Weight gain (particularly prominent in patients on zyprexa, seroquel, Leponex)
 Anticholinergic side-effects (common for zyprexa less likely on risperidal ) such as:
 Blurred vision
 Constipation
 Dry mouth (although hypersalivation may also occur)
 Reduced perspiration
Examples
 Abilify (aripiprazole) – headache, blurred vision, constipation, increase salivation, increase blood
sugar, insomnia, agitation, akathisia
 Clozaril (clozapine)
 Geodon (ziprasidone)
 Risperdal (risperidone) –QTC increase
 Seroquel (quetiapine)
 Zyprexa (olanzapine) - weight gain
 Invega ( Paliperidone) – cardiac complications
 Serdolect ( Sertindole)
 Leponex (clozapine) – agranulocytosis, weigt gain, sedation, constipation, elevated liver enzymes,
hypersalivation, ECG changes, with tegretol may cause bone marrow suppression – WBC should
check in every 2 weeks for first 3 months. After that once in every month.
2.Antidepressants
Drugs which are used to relieve or prevent depression known as antidepressants
Indication
 Depression, major depressive disorder
 Generalized anxiety disorder, OCD
 Manic-depressive disorders, Agitation
 Posttraumatic stress disorder (PTSD)
 Bulimia nervosa, & binge eating disorder,
Types
1. Selective serotonin reuptake inhibitors (SSRIs)
2. Serotonin-norepinephrine reuptake inhibitors (SNRIs)
3. Tricyclic antidepressants (TCAs)
4. Monoamine oxidase inhibitors (MAOIs)
5. Atypical anti-depressants
Side effects of antidepressants
 May cause withdrawal symptoms if abruptly discontinued.
 Antidepressants increased the risk of suicidal thinking, and suicidal behaviour in in children and
adolescents.
1. SSRIs
Insomnia, headache, anxiety, nervousness, diarrhoea, nausea, tremor, weight gain restless and agitation in
the first week of the treatment
 Fluoxetine (Prozac, salipax- gives only morning or afternoon. Not in night because it will
create sleeplessness)

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 Sertraline (Zoloft)
2. SNRIs
Headache, dizziness, nervousness, constipation, anorexia, weakness, sweating.
 Duloxetine (Cymbalta)
 Venlafaxine (Effexor)
 Drsvenlafaxine (pristiq)
3. TCAs – urinary retention
Dry mouth, constipation, blurred vision, palpitation, nausea, tremor, sweating
 Clomipramine (Anafranil)
 Imipramine (Tofranil)
 (Amitriptyline) tryptizol
4. MAOIs
Nausea, head ache, stiff neck, dry mouth
Nardil – phenelzine – hypertension crisis
5. Atypical anti-depressants
Dry mouth,nervousness, sezure at high dose
 Maprotiline Mirtazapine (Remeron)
3.Mood stabilizer
 Used to treat bipolar disorder
 Mania
Examples are
 Lithium (Camcolit) – poliiuria, polidypsia, GI disturbances, toxic sign (slurred speech, confusion,
vomiting, diarrhea, head ache, coma, death )
Monitor thyroid function test, lithium will decrease the thyroid hormones, and check lithium plasma
concentration once in every 2 weeks.
 Carbamazepine (Tegretol)
 Lamotrigine (Lamictal)
 Valproate (Depakote)
Lithium
Mood stabilized, Anti manic
 Treatment level 0.8-1.5 meq/L
 Toxic level – above 1.5 meq/L
Side effect
 Oedema, polyuria, polydipsia, nausea, vomiting, termers
Sign and symptoms of toxicity
 Nausea, vomiting, diarrhoea, agitation, blurred vision, confusion, slurred speech
Sever sign and symptom of toxicity
 Cardiac arrhythmia, focal or generalized seizure, renal complication, coma, death
Lithium teaching
 Patient must maintain therapeutic blood level
 Anything over (1.5 meq/L ) definitely indicates toxicity
 Initial treatment requires daily to weekly blood draws
 Once stabilized , they must be willing to monthly blood draws
 If sodium decreases, lithium increases – lead to toxicity
 If sodium increases, lithium decreases – lead to ineffective dosing
4.Anxiolytic

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Benzodiazepines
 Alprazolam (Xanax)
 Chlordiazepoxide (Librium) – long acting
 Clonazepam (Klonopin, Rivotril)
 Diazepam (Valium) - long acting
 Lorazepam (Ativan)
 Bromazipam (lexothanil)
Benzodiazepines exert their anxiolytic properties at moderate dosage. At higher dosage hypnotic properties
occur.
5.Anti convulsants
Dry mouth, blurred vision, GI disturbances, tachycardia, dizziness, drowsiness
 Carbamazepine (Carbatrol or Tegretol)
 Valproic Acid ( Depakene, Sodium Valproate)
 Topiramate (Topamax)
 Pregabalin (Lyrica)
 Oxcarbazepine (Trileptal)
 Levetiracetam (Keppra)
 Lamotrigine (Lamictal)
 Diazepam (Valium ), lorazepam (Ativan)
6. Anticholinergic
 Procyclidine( Kemadrine)
 Orphenadrine (norflex)
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Commonly using drugs in the wards
Antipsychotics
 Zyprexa – atypical antipsychotics – weight gain , DN, hyperlipidaemia
 Abilify - atypical antipsychotics
 Seroquel 25,200,300,XR - atypical antipsychotics – QT widening
 Respiradal 2mg - atypical antipsychotics – hypothyroidism , gynacomastia, increase prolactin level
,QT widening
 Invega 3,6 mg – atypical antipsychotics –
 Leponex 100mg - atypical antipsychotics – increase salivation , initially constipation , QT widening ,
cardiac arrhythmias
 Dogmatil 200mg - typical antipsychotics - EPS
 Serenace 5, 10 mg – typical antipsychotics -EPS
 Largactil 50,100mg – typical antipsychotics - EPS
 Serdolect 4mg – antipsychotics
Antidepressants
 Cymbalta – antidepressant , SNRIs – suicidal thoughts
 Effexor (venlafaxine )
 Cipralex 10 –antidepressant ,SSRIs – suicidal thoughts
 Faverin 50mg – antidepressant SSRI -
 Prozac 20mg – antidepressant SSRI -
 Zoloft (scrtraline )- SSRI
 Anafranil 75- tricyclic anti-depressants – urinary retention

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 Triptizol (amithriptyline) –TCAs- orthostatic hypotension
 Tofranil (imipramine) –TCAs- orthostatic hypotension
Mood stabilizer
1st 3 months weekly once. Then every 2 weeks should check serum lithium. If it’s chronic use monthly once.
Check TFT monthly once, lithium will cause hypothyroidism. + Anti convulsants are also mood stabilizers
 Camcolit 400mg – mood stabilizer – thrust, increase urination.
Anticonvulsant
Check serum level once in every 2 weeks. Decrease and increase by tapering dose.
 Depakin chrono and plain, 500mg – anticonvulsant
 Tegretol 400mg, CR- anticonvulsant
 Trileptal 300, 600 mg - antiepileptic drug
 Trivastal 50mg - antiparkinsonian
Benzodiazephams
Check vitals before giving
 Ativan 1,2mg - benzodiazepines
 Revotril -0.5,2mg – benzodiazepines
 Valium 10 mg – benzodiazepines, antiparkinsonisam
Anticholinergic
 Kemadrine 5mg - Anticholinergics
 Artane 2mg – antiparkinsonisam
 Cogentine (benztropine)
 Phenergan ( promethazine )
Heart - BP & sugar
 Concor - mild to moderate hypertension and angina pectoris
 Capoten 25 ,50 mg – antihypertensive
 Zestril 10mg – high blood pressure, heart failure, and after heart attacks
 Tenorminn 50mg - primarily in cardiovascular diseases, antihypertensive
 Inderal 10 mg - to treat tremors, angina, hypertension, heart rhythm disorders
 Lipitor 10, 20 - reduces LDL and triglycerides & increasing HDL
 Zyloric 100 mg - tor reducing urate/uric acid formation or in casse urate/uric acid deposition
 Baby aspirin 81mg - reduce the risk of recurrent heart attack and ischemic stroke
 GTN 10mg - chest pain due to the heart and heart failure
 Moduretic - hypertension, heart failure, edema.
 Aldomet 250mg – hypertension,
 Dimicron 60 mg - used to control blood glucose
 Glucophage 500,850,1gm - antihyperglycemic drugs
Gastric & Thyroid
 Dulphalace - lactulose
 Eltroxin 50,100mg - Control of hypothyroidism
 Losec 20 - treatment of gastroesophageal reflux disease, peptic ulcer disease
 Lactulose – constipation
 Zantac - histamine-2 blockers, to treat and prevent ulcers in the stomach and intestines.
 Buscopan 10 - to treat crampy abdominal pain, renal colic, and bladder spasms
 Motilium 10mg – to control nausea and vomiting
 Dulcolax 12,15 mg – for constipation

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 Imodium 2mg – for diarrhoea
Analgesic
 Reparil gel - Reduction of localised swelling and pain
 Diclofenac - reduce inflammation and as an analgesic
 Ponstan 250 mg - mild to moderate pain
 Norgesic – used to treat muscle spasm/ pain
 Muscodol - muscle spasm and muscle tremors
Vitamins
 Bx - vitamins — B1, B2, B3, B5, B6, B7, B9, B12 supplement
 Fefol - iron and folic acid supplement
 One alpha – vitamin D supplement
 Ca resotnium 15mg - to remove excessive amounts of potassium
 Ferrous sulphate 190gm – iron supplement
 Magnesium oxcide 400mg - magnesium supplement
 Folic acid 5mg
 Omega-3 1000 mg – omega 3 fatty acid suppliment
Nebulization
 Ventolin (Salbutamol) - bronchodilator
 Atrovent - anticholinergic bronchodilator
 Pulmicot – corticosteroid
General
 Piriton 4mg – antihistamines
 Xyzal 5mg – antihistamine
Injections available
 Serenace 5mg
 Phenergan 50 mg - antiemetic and anticholinergic, antihistamine
 Norflex 60 mg - anticholinergic
Long acting injections
 Haldol 50mg - long acting antipsychotic
 Clopixol accuphase 50mg –short acting antipsychotic
 Clopixol depot 200mg – long acting antipsychotic
 Respiradal consta 25, 37.5, 50 - long acting antipsychotic
 Invega sustena – long acting antipsychotic
Insulin
 Atrapid – short acting
 Mixtard – intermediate acting
 Insultard – long acting
If giving 2 types of insulin at a time, select atrapid first and then other.
Antidote
 Anexate 0.5mg (flumazenil) - reverse benzodiazepine overdose
 Narcan 0.4 mg – antidote for narcotic drugs
Emergency drugs
 Atropine 1mg – anti cholinergic and anti spasmodic
 Aminophylline 25 mg – bronchodilator
 Anexate 0.5mg - reverse benzodiazepine overdose

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 Adrenaline 1mg – cardiac stimulant and vasodilator
 Dopamine 200mg – cardiogenic shock
 Narcan 0.4 mg – antidote for narcotic drugs
 Lidocaine 10mg – anti arrhythmic –after MI
 Hydrocortisone 100mg – anti inflammatory
 Heparin 5000 - anticoagulant
 Epanutin 50mg - anti-seizure
 Digoxin 0.5mg - cardiac glycoside
 Piriton 50mg - antihistamines
 Lasix 10mg – loop diuretics
 Isoptin 2.5mg – calcium channel blocker
 Inderal 1mg - to treat tremors, angina, hypertension, heart rhythm disorders
Chandni Narayan
18.4.2021