Term
All tricyclics and tetracyclics
Side effects
Comments |
|
Definition
Anticholinergic (dry mouth, blurry vision, urinary retention, constipation, sedation, orthostatic hypotension (alpha adrenergic block), tachycardia, prolongation of QT, weight gain (anti-histamine effect)
Concern about risk of falling in elderly patients |
|
|
Term
Amitriptyline
Side effects
Comments |
|
Definition
Anticholinergic (dry mouth, blurry vision, urinary retention, constipation, sedation, orthostatic hypotension (alpha adrenergic block), tachycardia, prolongation of QT, weight gain (anti-histamine effect)
Concern about risk of falling in elderly patients
Highly anticholinergic and VERY sedating |
|
|
Term
Doxepin
Side effects
Comments |
|
Definition
Anticholinergic (dry mouth, blurry vision, urinary retention, constipation, sedation, orthostatic hypotension (alpha adrenergic block), tachycardia, prolongation of QT, weight gain (anti-histamine effect)
Concern about risk of falling in elderly patients
Highly anticholinergic and VERY sedating |
|
|
Term
Imipramine
Side effects
Comments |
|
Definition
Anticholinergic (dry mouth, blurry vision, urinary retention, constipation, sedation, orthostatic hypotension (alpha adrenergic block), tachycardia, prolongation of QT, weight gain (anti-histamine effect)
Concern about risk of falling in elderly patients
Highly anticholinergic |
|
|
Term
Clomipramine
Side effects
Comments
Indication specifically? |
|
Definition
Anticholinergic (dry mouth, blurry vision, urinary retention, constipation, sedation, orthostatic hypotension (alpha adrenergic block), tachycardia, prolongation of QT, weight gain (anti-histamine effect)
Concern about risk of falling in elderly patients
Highly anticholinergic and VERY sedating
OCD responds specifically to this or in depression with marked obsessive features |
|
|
Term
Trimipramine
Side effects
Comments |
|
Definition
Anticholinergic (dry mouth, blurry vision, urinary retention, constipation, sedation, orthostatic hypotension (alpha adrenergic block), tachycardia, prolongation of QT, weight gain (anti-histamine effect)
Concern about risk of falling in elderly patients
Highly anticholinergic and VERY sedating |
|
|
Term
Desipramine
Side effects
Comments |
|
Definition
Anticholinergic (dry mouth, blurry vision, urinary retention, constipation, sedation, orthostatic hypotension (alpha adrenergic block), tachycardia, prolongation of QT, weight gain (anti-histamine effect)
Concern about risk of falling in elderly patients
Least anticholinergic and NOT sedating |
|
|
Term
Nortriptyline
Side Effects
Comments |
|
Definition
Anticholinergic (dry mouth, blurry vision, urinary retention, constipation, sedation, orthostatic hypotension (alpha adrenergic block), tachycardia, prolongation of QT, weight gain (anti-histamine effect)
Concern about risk of falling in elderly patients
Less anticholinergic than others |
|
|
Term
Protriptyline
Side Effects
Comments |
|
Definition
Anticholinergic (dry mouth, blurry vision, urinary retention, constipation, sedation, orthostatic hypotension (alpha adrenergic block), tachycardia, prolongation of QT, weight gain (anti-histamine effect)
Concern about risk of falling in elderly patients
Less anticholinergic than others and NOT sedating |
|
|
Term
Amoxapine
Side Effects
Comments
Special side effect? |
|
Definition
Anticholinergic (dry mouth, blurry vision, urinary retention, constipation, sedation, orthostatic hypotension (alpha adrenergic block), tachycardia, prolongation of QT, weight gain (anti-histamine effect)
Concern about risk of falling in elderly patients
Less anticholinergic
May cause EPS and NMS |
|
|
Term
All SSRIs
Side Effects
Comments |
|
Definition
Agitation, akathisia, anxiety, panic, insomnia, diarrhea, GI distress, headache, sexual dysfunction, delayed ejaculation or impotence in male and anorgasmia in females, may increase risk of suicidal thoughts and behaviors in children/adolescents/young people
To avoid fatal serotonin syndrome, no SSRI or SSNRI should be combined with an MAOI and a SSRI should be discontinued at least 5 weeks before starting an MAOI |
|
|
Term
Fluoxetine (prozac)
Class
Side effects
Indication besides depression? |
|
Definition
SSRI; Agitation, akathisia, anxiety, panic, insomnia, diarrhea, GI distress, headache, sexual dysfunction, delayed ejaculation or impotence in male and anorgasmia in females, may increase risk of suicidal thoughts and behaviors in children/adolescents/young people
To avoid fatal serotonin syndrome, no SSRI or SSNRI should be combined with an MAOI and a SSRI should be discontinued at least 5 weeks before starting an MAOI
Treatment of OCD |
|
|
Term
Sertraline (zoloft)
Class
Side effects
Indications besides depression?
Special trait? |
|
Definition
SSRI; Agitation, akathisia, anxiety, panic, insomnia, diarrhea, GI distress, headache, sexual dysfunction, delayed ejaculation or impotence in male and anorgasmia in females, may increase risk of suicidal thoughts and behaviors in children/adolescents/young people
To avoid fatal serotonin syndrome, no SSRI or SSNRI should be combined with an MAOI and a SSRI should be discontinued at least 5 weeks before starting an MAOI
Used in treatment of OCD
Causes diarrhea more often than other SSRIs |
|
|
Term
Paroxetine
Class
Side effects
Indications besides depression?
Special trait? |
|
Definition
SSRI; Agitation, akathisia, anxiety, panic, insomnia, diarrhea, GI distress, headache, sexual dysfunction, delayed ejaculation or impotence in male and anorgasmia in females, may increase risk of suicidal thoughts and behaviors in children/adolescents/young people
To avoid fatal serotonin syndrome, no SSRI or SSNRI should be combined with an MAOI and a SSRI should be discontinued at least 5 weeks before starting an MAOI
Mildly anticholinergic
Used in treatment of OCD |
|
|
Term
Fluovxamine
Class
Side effects
Indications besides depression? |
|
Definition
SSRI; Agitation, akathisia, anxiety, panic, insomnia, diarrhea, GI distress, headache, sexual dysfunction, delayed ejaculation or impotence in male and anorgasmia in females, may increase risk of suicidal thoughts and behaviors in children/adolescents/young people
To avoid fatal serotonin syndrome, no SSRI or SSNRI should be combined with an MAOI and a SSRI should be discontinued at least 5 weeks before starting an MAOI
Nausea and vomiting more common
Used in treatment of OCD |
|
|
Term
Citalopram
Class
Side effects
Special trait? |
|
Definition
SSRI; Agitation, akathisia, anxiety, panic, insomnia, diarrhea, GI distress, headache, sexual dysfunction, delayed ejaculation or impotence in male and anorgasmia in females, may increase risk of suicidal thoughts and behaviors in children/adolescents/young people
To avoid fatal serotonin syndrome, no SSRI or SSNRI should be combined with an MAOI and a SSRI should be discontinued at least 5 weeks before starting an MAOI
possibly fewer sexual side effects... |
|
|
Term
Escitalopram (lexapro)
Class
Side effects |
|
Definition
SSRI; Agitation, akathisia, anxiety, panic, insomnia, diarrhea, GI distress, headache, sexual dysfunction, delayed ejaculation or impotence in male and anorgasmia in females, may increase risk of suicidal thoughts and behaviors in children/adolescents/young people
To avoid fatal serotonin syndrome, no SSRI or SSNRI should be combined with an MAOI and a SSRI should be discontinued at least 5 weeks before starting an MAOI |
|
|
Term
Venlaxfaxine
Class
Side effects (special?)
Other indications? |
|
Definition
SNRI; Agitation, akathisia, anxiety, panic, insomnia, diarrhea, GI distress, headache, sexual dysfunction, delayed ejaculation or impotence in male and anorgasmia in females, may increase risk of suicidal thoughts and behaviors in children/adolescents/young people
To avoid fatal serotonin syndrome, no SSRI or SSNRI should be combined with an MAOI and a SSRI should be discontinued at least 5 weeks before starting an MAOI
Anxiety, may increase BP at high doses, headache, insomnia, sweating
Used to treat GAD and social anxiety |
|
|
Term
Levomilnacipran
Class
Side effects (special?) |
|
Definition
SNRI; Agitation, akathisia, anxiety, panic, insomnia, diarrhea, GI distress, headache, sexual dysfunction, delayed ejaculation or impotence in male and anorgasmia in females, may increase risk of suicidal thoughts and behaviors in children/adolescents/young people
To avoid fatal serotonin syndrome, no SSRI or SSNRI should be combined with an MAOI and a SSRI should be discontinued at least 5 weeks before starting an MAOI
BP increases, nausea, vomiting, sweating, constipation, erectile dysfunction |
|
|
Term
Desvenlafaxine
Class
Side effects |
|
Definition
SNRI; Agitation, akathisia, anxiety, panic, insomnia, diarrhea, GI distress, headache, sexual dysfunction, delayed ejaculation or impotence in male and anorgasmia in females, may increase risk of suicidal thoughts and behaviors in children/adolescents/young people
To avoid fatal serotonin syndrome, no SSRI or SSNRI should be combined with an MAOI and a SSRI should be discontinued at least 5 weeks before starting an MAOI |
|
|
Term
Duloxetine (cymbalta)
Class
Side effects
Other indications? |
|
Definition
SSNRI; Agitation, akathisia, anxiety, panic, insomnia, diarrhea, GI distress, headache, sexual dysfunction, delayed ejaculation or impotence in male and anorgasmia in females, may increase risk of suicidal thoughts and behaviors in children/adolescents/young people
To avoid fatal serotonin syndrome, no SSRI or SSNRI should be combined with an MAOI and a SSRI should be discontinued at least 5 weeks before starting an MAOI
Also used for GAD and painful diabetic neuropathy |
|
|
Term
Phenelzine
Class
Side effects
Comments |
|
Definition
MAOI
Orthostatic hypotension, weight gain, somnolence
All cheese, fermented or aged foods, wine, and liver should be avoided. Should not be coadministered with SSRI or any drug that increases intrasynpatic levels of amine neurotransmitters. |
|
|
Term
Isocarboxazid
Class
Side effects
Comments |
|
Definition
MAOI
Orthostatic hypotension, weight gain, somnolence
All cheese, fermented or aged foods, wine, and liver should be avoided. Should not be coadministered with SSRI or any drug that increases intrasynpatic levels of amine neurotransmitters. |
|
|
Term
Selegiline
Class
Side effects
Comments (special?) |
|
Definition
MAOI
Orthostatic hypotension, weight gain, somnolence; IRRITATION AT THE SITE OF PATCH
All cheese, fermented or aged foods, wine, and liver should be avoided. Should not be coadministered with SSRI or any drug that increases intrasynpatic levels of amine neurotransmitters.
Transdermal patch is available for use in depression; also used to treat parkinson |
|
|
Term
Tranylcypromine
Class
Side effects
Comments |
|
Definition
MAOI
Orthostatic hypotension, weight gain, somnolence
All cheese, fermented or aged foods, wine, and liver should be avoided. Should not be coadministered with SSRI or any drug that increases intrasynpatic levels of amine neurotransmitters. |
|
|
Term
Lithium
Class
Mechanism of action
Side effects
Testing
Comments |
|
Definition
Mood stabilizer
Inhibits adenylate cyclase enzyme
Nausea, tremor, hypothyroidism, cardiac dysrhythmias, diarrhea, diabetes insipidus (weight gain, increased thirst and urination, acne), at toxic levels will have altered mental status/seizures/coma/death
WBC, serum electrolytes, thyroid and renal function (specific gravity, BUN, creatinine), fasting blood glucose, pregnancy test, ECG reccommended before treatment and yearly thereafter (every 6 months for TSH and creatinine); lithium levels monitored every 3 months once stabilized
Propranolol may help with tremor, benign increase in WBC can be seen |
|
|
Term
Valproic acid (depakene)
Class
Mechanism of action
Side effects
Testing |
|
Definition
Mood stabilizer
Opens chloride channels
Thrombocytopenia, pancreatitis, weight gain, hair loos, GI distress, cognitive dulling, neuro tube defects in pregnancy
CBC, liver function, pancreatic enzyme levels, HCG in childbearing women |
|
|
Term
Divalproex sodium (depakote)
Class
Mechanism of action
Side effects
Testing |
|
Definition
Mood stabilizer
Opens chloride channels
Thrombocytopenia, pancreatitis, weight gain, hair loos, GI distress, cognitive dulling, neuro tube defects in pregnancy
CBC, liver function, pancreatic enzyme levels, HCG in childbearing women |
|
|
Term
Carbamazepine (tegretol)
Class
Mechanism of action
Side effects
Testing
Special stuff? |
|
Definition
Mood stabilizer
Inhibits kindling, inhibits repetitive firing of APs by inactivating sodium channels
Nausea, vomiting, slurred speech, dizziness, drowsiness, low WBC, high liver function test, cognitive slowing, may cause craniofacial defects in newborn
Pretreatment CBC should be obtained to look for agranulocytosis; CBC every 2 week for first 2 months of treatment then once every 3 months; platelet/retic/serum iron performed yearly; liver function initially then every month for first two months and every 3 months thereafter
Also monitor levels of drug itself (doesn't specify how often)
Serum electrolytes and ECG before treatment and yearly thereafter
Potent inducer of p450 |
|
|
Term
Lamotrigine
Class
Mechanism of action
Side effects
Testing |
|
Definition
Mood stabilizer
Unknown mechanism
Leukopenia, rash, hepatic failure, nausea, vomiting, diarrhea, somnolence, dizziness
CBC with platelet every 6-12 months
May have acute antidepressant effect; dose must be increased slowly to avoid rash |
|
|
Term
Gabapentin
Class
Mechanism of action
Side effects |
|
Definition
Mood stabilizer
Unknown mechanism
Somnolence, dizziness, ataxia, fatigue, leukopenia, weight gain
No drug interactions but rash can be fatal |
|
|
Term
Topiramate
Class
Mechanism of action
Side effects
Special comment? |
|
Definition
Mood stabilizer
Unknown mechanism
Psychomotor slowing, memory issues, fatigue
Many drug-drug interactions |
|
|
Term
Clozapine
Class
Mechanism of action
Side effects
Comments |
|
Definition
Second-generation anti-psychotic
Serotonin-dopamine antagonist
Agranulocytosis, anticholinergic side effects, weight gain, sedation, NMS
CBC and differential required weekly for first 6 months and biweekly thereafter |
|
|
Term
Risperidone
Class
Mechanism of action
Side effects
Comments |
|
Definition
Second-generation anti-psychotic
Serotonin-dopamine antagonist
EPS withdrawal syndrome in high doses, postural hypotension, increased prolactin, weight gain, sedation, decreased concentration
Present in breast milk |
|
|
Term
Olanzapine
Class
Mechanism of action
Side effects
Comments |
|
Definition
Second-generation anti-psychotic
Serotonin-dopamine antagonist
Increased prolactin, orthostatic hypotension, anticholinergic side effects, weight gain, somnolence
Alanine amino-transferase levels as drug effects the liver |
|
|
Term
Quetiapine
Class
Mechanism of action
Side effects
Comments |
|
Definition
Second-generation anti-psychotic
Serotonin-dopamine antagonist
Orthostatic hypotension, somnolence, transient increase in weight
Slit lamp eye exam at baseline and every 6 months for those at risk of developing cataracts |
|
|
Term
Ziprasidone
Class
Mechanism of action
Side effects
Comments |
|
Definition
Second-generation anti-psychotic
Serotonin-dopamine antagonist
Dose-related QT prolongation, postural hypotension, sedation
Present in breast milk, baseline potassium and magnesium |
|
|
Term
Aripiprazole
Class
Mechanism of action
Side effects
Comments |
|
Definition
Second-generation anti-psychotic
Partial agonist at dopamine and serotonin 1A and antagonist and postsynaptic serotonin 2A
headache, nausea, anxiety, insomnia somnolence
Nonsedating, no increased risk of weight gain or diabetes |
|
|
Term
Lurasidone
Class
Mechanism of action
Side effects
Comments |
|
Definition
Second-generation anti-psychotic
Mechanism of action unknown
Nausea, vomiting, dyspepsia, somnolence
Increased mortality in elderly with dementia-related psychosis |
|
|
Term
Lurasidone
Class
Mechanism of action
Side effects
Comments |
|
Definition
Second-generation anti-psychotic
Dopamine antagonist
Headache, tachycardia, somnolence
Increased mortality in elderly with dementia-related psychosis
comes in 1 month injectable form |
|
|
