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Brain - Depression & Schizophrenia

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sgthuan's version from 2017-07-04 04:07

Depression - SSRIs, SNRIs, Bupropion, Mirtazapine - Increased risk of SUICIDAL, CI with MAOI, linezolid, IV methylene blue

GenericBrandClassDrug Pearl
fluoxetineProzac, Sarafem (for PMDD)SSRIs10-60mg qd, longest half life ~ 1 week - do NOT need to taper off, ** cause Activation - take QAM, S/E SEXUAL dysfunction, somnolence, insomnia, dry mouth, weakness, tremor, SIADH, hyponatremia, *** increased BLEEDING risk with anticoagulants, antiplatelets, NSAIDs..., *** strong 2D6 INHIBITOR
fluoxetine + olanzapineSymbiaxSSRIs/atypicalinitial 6/25, ***take qHS for Resistant Depression, S/E SEXUAL dysfunction, somnolence, insomnia, dry mouth, weakness, tremor, SIADH, hyponatremia, *** increased BLEEDING risk with anticoagulants, antiplatelets, NSAIDs...
paroxetinePaxil, Paxil CR, Brisdelle (for hot flash)SSRIs10-60mg qd, 10mg IR is 12.5mg CR, rapid absorption into the bloodstream --> bad withdrawal, S/E SEXUAL dysfunction, somnolence, insomnia, dry mouth, weakness, tremor, SIADH, hyponatremia, *** increased BLEEDING risk with anticoagulants, antiplatelets, NSAIDs..., *** strong 2D6 INHIBITOR, not good for pregnancy, **** Brisdelle is CI in pregnancy
fluvoxamineLuvoxSSRIs - ONLY approved for ** "OCD"50-300mg qd, NOT available in solution, more DDI, S/E SEXUAL dysfunction, somnolence, insomnia, dry mouth, weakness, tremor, SIADH, hyponatremia, *** increased BLEEDING risk with anticoagulants, antiplatelets, NSAIDs..., *** strong 2D6 INHIBITOR
sertralineZoloftSSRIs50-200mg qd, *** also used for PMDD, ** top choice for cardiac patients, S/E N/V/D - take with meal!!!, SEXUAL dysfunction, somnolence, insomnia, dry mouth, weakness, tremor, SIADH, hyponatremia, *** increased BLEEDING risk with anticoagulants, antiplatelets, NSAIDs..., *** SAFE for Pregnancy and breast feeding
citalopramCelexaSSRIs20-40mg QD, QT prolongation >40mg --> yearly EKG recommended, AVOID in cardiac patients, S/E SEXUAL dysfunction, somnolence, insomnia, dry mouth, weakness, tremor, SIADH, hyponatremia, *** increased BLEEDING risk with anticoagulants, antiplatelets, NSAIDs..., ** NO DDI
escitalopramLexaproSSRIs10-20mg QD, QT prolongation >20mg --> yearly EKG recommended, AVOID in cardiac patients, S/E SEXUAL dysfunction, somnolence, insomnia, dry mouth, weakness, tremor, SIADH, hyponatremia, *** increased BLEEDING risk with anticoagulants, antiplatelets, NSAIDs..., ** NO DDI
vilazodoneViibrydSSRIs and 5-HT1A partial agonist*** start 10mg qd x 7d, then 20mg qd, take WITH FOOD, S/E *LESS SEXUAL dysfunction, somnolence, insomnia, dry mouth, weakness, tremor, SIADH, hyponatremia, *** increased BLEEDING risk with anticoagulants, antiplatelets, NSAIDs...
vortioxetineTrintellixSSRIs, 5-HT antagonist, 5-HT1A agonist10mg qd, S/E nausea, SEXUAL dysfunction, somnolence, insomnia, dry mouth, weakness, tremor, SIADH, hyponatremia, *** increased BLEEDING risk with anticoagulants, antiplatelets, NSAIDs...
venlafaxineEffexorSNRIs37.5mg BID, *** dose is decreased in RENAL impairment, S/E SEXUAL dysfunction, increased BP, pulse, *** Diaphoresis - excessive sweating, somnolence, insomnia, dry mouth, weakness, tremor, SIADH, hyponatremia, *** increased BLEEDING risk with anticoagulants, antiplatelets, NSAIDs...
duloxetineCymbaltaSNRIs*** dose is decreased in RENAL impairment, good choice for both PAIN and Depression, S/E SEXUAL dysfunction, increased BP, pulse, *** excessive sweating, somnolence, insomnia, dry mouth, weakness, tremor, SIADH, hyponatremia, *** increased BLEEDING risk with anticoagulants, antiplatelets, NSAIDs...
desvenlafaxinePristiq, KhedezlaSNRIs*** dose is decreased in RENAL impairment, S/E SEXUAL dysfunction, increased BP, pulse, *** excessive sweating, somnolence, insomnia, dry mouth, weakness, tremor, SIADH, hyponatremia, *** increased BLEEDING risk with anticoagulants, antiplatelets, NSAIDs...
levomilnacipranFetzimaSNRIs*** dose is decreased in RENAL impairment, S/E SEXUAL dysfunction, increased BP, pulse, *** excessive sweating, somnolence, insomnia, dry mouth, weakness, tremor, SIADH, hyponatremia, *** increased BLEEDING risk with anticoagulants, antiplatelets, NSAIDs...
milnacipranSavellaSNRIs - FOR PAIN ONLYfibromyalgia - 12.5mg qd then titrate up, SE N/V, constipation, insomnia
bupropionAplezin (hydrobromide), Wellbutrin SR, Wellbutrin XL, Forfivo XLDA & NE reuptake inhibitorIR - TID, SR - BID, XL qd, **** Do NOT use > 450mg/d --> SEIZURE risk, *** CI - Seizure history, Eating Disorder such as bulimia, SE dry mouth, insomnia, constipation, HTN, **Weight Loss, *** NO sexual dysfunction
mirtazapineRemeronTetracyclic Antidepressant - alpha 2 antagonist15-45mg QHS, SE sedation, increase appetite, *** Weight Gain, NO sexual dysfunction
trazodoneOleptro (ER)inhibits 5HT reuptake, H1, alpha 1SE ***sedation, sexual dysfunction, orthostasis, ** PRIAPISM
nefazodoneNONEother antidepressants*** Hepatic Failure, SE similar to trazodone but less sedating
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Tricyclics antidepressant - NE & 5HT reuptake inhibitors and also block ACh and histamine - Increased risk of SUICIDAL, CI with MAOI, linezolid, IV methylene blue

Question Answer Column 3 Column 4
amitriptylineElavilTCA - tertiary amines100-300mg QHS, MAX 300mg/d, neuropathic pain 10-50mg QHS, SE - *** CARDIOTOXICITY & QT prolong, **increased anticholinergic dry mouth, blurred vision, urinary retention, constipation, **orthostasis --> more sedation and weight gain
doxepinNONE (depression), Silenor (insomnia), Zonalon (cream for pruritus)TCA - tertiary aminesd 100-300mg qd, for insomnia 10-50mg qd, SE - *** CARDIOTOXICITY & QT prolong, ***increased anticholinergic dry mouth, blurred vision, urinary retention, constipation, **orthostasis --> more sedation and weight gain
imipramineTofranilTCA - tertiary aminesSE - *** CARDIOTOXICITY & QT prolong, ***increased anticholinergic dry mouth, blurred vision, urinary retention, constipation, **orthostasis --> more sedation and weight gain
desipramineNorpraminTCA - secondary aminesSE - *** CARDIOTOXICITY & QT prolong, LESS anticholinergic dry mouth, blurred vision, urinary retention, constipation, **orthostasis
nortriptylinePamelorTCA - secondary amines25mg TID-QID, ** MAX 150mg, SE - *** CARDIOTOXICITY & QT prolong, LESS anticholinergic dry mouth, blurred vision, urinary retention, constipation, **orthostasis
isocarboxazidMarplanMAOIhypertensive crisis when taken with TCAs, SSRIs, SNRIs or tyramine food, SE anticholinergic, orthostasis, sedation, sexual dysfunction, weight gain
phenelzineNardilMAOI15mg TID, hypertensive crisis when taken with TCAs, SSRIs, SNRIs or tyramine food, SE anticholinergic, orthostasis, sedation, sexual dysfunction, weight gain
tranylcypromineParnateMAOIhypertensive crisis when taken with TCAs, SSRIs, SNRIs or tyramine food, SE anticholinergic, orthostasis, sedation, sexual dysfunction, weight gain
selegiline transdermal patchEMSAM, Eldepryl, Zelapar ODT (for Parkinson)MAOI***change patch daily, d/c 10 days prior to surgery requiring general anesthesia, hypertensive crisis when taken with TCAs, SSRIs, SNRIs or tyramine food, SE anticholinergic, orthostasis, sedation, sexual dysfunction, weight gain
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Antipsychotics - FIRST Generation - DA blockade - BBW Elderly with dementia-related psychosis related to CV and infectious events!!!, S/E ALL cause sedation and EPS

Question Answer Column 3 Column 4
chlorpromazineThorazine1st Gen APs - LOW potency300-1000mg qd, low risk of EPS, high risk of sedation & anticholinergic
thioridazineMellaril1st Gen APs - LOW potency300-800mg qd, low risk of EPS, high risk of sedation & anticholinergic, ***BBW QT prolongation
loxapineLoxitane, Adasuve (powder inh for acute)1st GEN APs - MILD potency30-100mg qd, ***powder inhalation - metallic taste in mouth, ** Bronchospasm --> adasuve REMS program
perphenazineTrilafon1st GEN APs - MILD potency8-64mg qd
fluphenazineNONE1st GEN APs - HIGH potency6-12mg qd, IM - q2-4weeks, ** also acute injection, high risk for EPS, low risk for sedation & anticholinergic, d/c if ANC < 1,000
haloperidolHaldol1st GEN APs - HIGH potency0.5-2mg BID or TID, IM - q1month, ** also acute injection, high risk for EPS, low risk for sedation & anticholinergic, *** IV haldol HIGH risk for CVD - orthostasis, tachycardia, QT prolong, Agranucytosis --> check CBC --> d/c if ANC < 1,000
thiothixeneNavane1st GEN APs - HIGH potency15-60mg qd
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Antipsychotics - SECOND Generation - DA & 5HT2a blockade. BBW Elderly with dementia-related psychosis related to CV and infectious events!!!

Question Answer Column 3 Column 4
aripiprazoleAbilify, Abilify Maintena, Abilify Aristada, Ability Discmelt (ODT)2nd GEN APs, DA&5HT1a partial agonist10-30mg qAM, IM available q1month, ** low risk for metabolic S/E, low risk for QT prolongation, *** Akathisia, anxiety, insomnia
asenapineSaphris (ODT)2nd GEN APslow risk of metabolic S/E, *** tongue numbness, AVOID in hepatic impairment
lurasidoneLatuda2nd GEN APslow risk of metabolic S/E, high risk for EPS, CI - strong CYP3A4 inducers & inhibitors, *** take WITH FOOD > 350 kcal
ziprasidoneGeodone2nd GEN APs** acute injection available, low risk of metabolic S/E, *** GREATEST risk for QT prolongation (CI), *** take WITH FOOD > 500 kcal
paliperidoneInvega, Invega Sustenna, Invega Trinza2nd GEN APs3-12mg qd, IM qmonth & q3months, high risk for EPS, high risk for increased PROLACTIN --> gynecomastia, sexual dysfunction, irregular menses, moderate risk for metabolic S/E
risperidoneRisperdal, Risperdal M tab (ODT), Risperdal Consta2nd GEN APs4-16mg qd, IM q2weeks, high risk for EPS, high risk for increased PROLACTIN --> gynecomastia, sexual dysfunction, irregular menses, moderate risk for metabolic S/E (> 6mg a day), *** Less sedating
olanzapineZyprexa, Zydis ODT, Relprevv2nd GEN APs10-20mg qHS --> sedating!, IM q2-4weeks --> REMS program, ** acute injection available, high risk of metabolic S/E, DRESS warning (rash), low risk of QT prolongation, *** dose adjustment for SMOKING
quetiapineSeroquel, Seroquel XR2nd GEN APsBID or QHS WITHOUT FOOD or light meal, high risk of metabolic S/E, low risk of EPS, low risk of QT prolongation
brexpiprazoleRexulti2nd GEN APs2-4mg qd, akathisia, weight gain, upset stomach
cariprazineVraylar2nd GEN APs, DA&5HT1a partial agonist1.5-6mg qd, high risk for EPS, insomnia
iloperidoneFanapt2nd GEN APs12-24mg qd, orthostasis, dizziness, tachycardia, QT prolongation, Avoid with QT risk
clozapineClozaril, Fazaclo ODT, Versacloz sus2nd GEN APsONLY used if failed 2 other APs, 5 BBWs - high risk for metabolic S/E, orthostasis, agranucytosis - severe neutropenia, very sedating, constipation, SEIZURE, *** LEAST risk of EPS, ** dose adjustment in SMOKING, start ANC > 1,500 --> check ANC weekly x 6m, q2w x 6m, then qmonth (REM program)
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