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Psychiatric drug
- 1. 1 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:
- 2. 2 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)
- 3. 3 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
- 4. 4 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) ********************************************************************************* 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
- 5. 5 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
- 6. 6 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
- 7. 7 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