Mit week 5 meds
Mentors
NU670-PMHNPPortfolioforClinicalPractice-Update12.docxPMHNP Portfolio for Clinical Practice
Table of Contents NU670 Psychopharmacology and Health promotion Neurotransmitter Chart (Unit 2) Antipsychotics Chart (Unit 7) Antidepressants, Anxiolytics, & Mood Stabilizers Chart (Units 5, 6) Substance Use Resources (Chart links) (Units 11, 13, 14) Additional Resources List Neurotransmitters Chart ( Muench & Hamer, 2010). Function (Excitatory or Inhibitory) Locations Receptors Effects of Deficient Effects of Surplus Agonist Drug Antagonist Drug Acetylcholine Both (depends on receptor) CNS, neuromuscular junctions, autonomic ganglia Nicotinic, Muscarinic Memory impairment (Alzheimer's), muscle weakness Muscle spasms, excessive salivation Bethanechol (muscarinic), Nicotine (nicotinic) Atropine (muscarinic), Tubocurarine (nicotinic) Dopamine Excitatory Substantia nigra, ventral tegmental area D1-D5 Parkinson's (movement), depression Schizophrenia, mania Bromocriptine (D2), Pramipexole (D3) Haloperidol (D2), Risperidone (D2) Endorphins Inhibitory Pituitary, hypothalamus, spinal cord μ, δ, κ opioid Increased pain sensitivity, anxiety Euphoria, respiratory depression Morphine (μ agonist) Naloxone (μ antagonist) GABA Inhibitory Widespread in CNS GABA-A, GABA-B Anxiety, seizures, insomnia Sedation, coma Benzodiazepines (GABA-A), Baclofen (GABA-B) Flumazenil (GABA-A antagonist) Glutamate Excitatory Widespread in CNS NMDA, AMPA, kainate Cognitive impairment Neurotoxicity, seizures Ketamine (NMDA partial agonist) Memantine (NMDA antagonist) Glycine Inhibitory Spinal cord, brainstem GlyR Hyperexcitability, startle disease Sedation, respiratory depression - Strychnine (GlyR antagonist) Glutamate Excitatory Locus coeruleus, sympathetic NS α1, α2, β1-3 Depression, fatigue Anxiety, hypertension Amphetamines (indirect), Dobutamine (β1) Propranolol (β antagonist) Norepinephrine Both (depends on receptor) Raphe nuclei, GI tract 5-HT1-7 Depression, OCD Serotonin syndrome SSRIs (reuptake inhibition), LSD (5-HT2A) Ondansetron (5-HT3 antagonist) Serotonin Excitatory Substantia nigra, ventral tegmental area D1-D5 Parkinson's (movement), depression Schizophrenia, mania Bromocriptine (D2), Pramipexole (D3) Haloperidol (D2), Risperidone (D2)
Notes:
Neurotransmitters control brain and bodily functions via excitatory and inhibitory mechanisms. Acetylcholine has a role in memory and muscles; too little causes Alzheimer’s or spasms. Dopamine modulates movement and emotion; too little is associated with Parkinson’s, too much with schizophrenia. Endorphins diminish pain; when they’re low, anxiety grows, when they’re high, euphoria. GABA quiets neural activity; too little causes seizures, too much sedation. Glutamate promotes learning; too much activity is toxic to neurons. Glycine blocks spinal cord transmission, excess results in sedation, and deficiency in spasticity. Norepinephrine influences mood and alertness. Serotonin affects mood; imbalance associated with depression or serotonin syndrome. Drugs can be agonists or antagonists to change effects.
Notes:
There are two classes of antipsychotic, first-generation (conventional or typical) antipsychotics and second-generation (atypical) antipsychotics. The first-generation drugs, such as haloperidol and chlorpromazine, antagonize dopamine D2 receptors, thereby treating schizophrenia and agitation, but induce high extrapyramidal symptoms (EPS) and moderate-to-high cognitive and metabolic side effects. Drugs of the second generation, such as risperidone and olanzapine, block these two receptors, and are used to control schizophrenia, bipolar disorders, irritability in autism, etc, with less extrapyramidal motor, and more metabolic side effects (weight gain, diabetes, hyperlipidemia). Long-acting injectables (LAIs) such as Haldol Decanoate, Consta, and Relprevv increase adherence. Prices are generally low to moderate, and side-effects differ not only between drugs but also with the response of individuals.
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Antidepressants, Anxiolytics & Mood Stabilizers (Kandel et al., 2013). |
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Antidepressants |
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Side Effects (L=Low, M=Moderate, H=High) |
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Generic Name |
Trade Name |
Route(s) of Administration |
LAI option |
Starting Dose |
Half Life |
Indications (s/sx & diagnosis) |
MOA (neurotransmitter effects) |
EPS |
Hyperlipidemia |
T2DM |
Weight Gain |
Cognitive Issue |
Other SE |
Costs |
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SSRIs |
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Fluoxetine |
Prozac |
PO |
No |
20 mg/day |
4-6 days |
MDD, OCD, bulimia |
SSRI |
Low |
Low |
Low |
Low |
Low |
Activation, long half-life |
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Sertraline |
Zoloft |
PO |
No |
50 mg/day |
26 hrs |
MDD, PTSD, panic |
SSRI |
Low |
Low |
Low |
Moderate |
Low |
GI upset |
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SNRIs |
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Venlafaxine |
Effexor |
PO |
No |
37.5 mg/day |
5 hrs |
MDD, GAD |
SNRI |
Low |
Low |
Low |
Moderate |
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Duloxetine |
Cymbalta |
PO |
No |
30 mg |
12h |
MDD, neuropathic pain |
SNRI |
Low |
Low |
Low |
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TCAs |
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MAOIs |
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Atypical |
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Anxiolytics |
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Benzodiazepines |
(Sadock et al., 2017). |
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Lorazepam |
Ativan |
PO,IM |
No |
0.5-1 mg |
12h |
Anxiety, insomnia |
GABA-A agonist |
Low |
Low |
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Clonazepam |
Klonopin |
PO |
No |
0.25 mg BID |
30-40h |
Panic, seizures |
GABA-A agonist |
Low |
Low |
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Barbiturates |
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Mood Stabilizers |
(Bear et al., 2020). |
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Lithium |
Lithobid |
PO |
No |
300 mg BID |
24 hrs |
Bipolar |
Modulates glutamate/GABA |
Moderate |
Moderate |
Moderate |
Moderate |
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Valproate |
Depakote |
PO |
No |
250 mg BID |
9-16h |
Bipolar, epilepsy |
GABA ↑, Na+ channels |
Low |
High |
High |
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Notes:
The following depicts a summary of the main psychiatric drugs, with emphasis of antidepressant, "anxiolytic" and mood stabilizer drugs. SSRI's, such as Prozac and Zoloft, are first-line for depression and anxiety, with relatively low side effect profiles. SNRIs (like Venlafaxine, Duloxetine) contribute norepinephrine activity – which may carry more S/Es including weight gain.. Like-of benzos (e.g., Lorazepam, Clonazepam) are fast acting for anxiety, and also have some addictive potential. Lithium is a paradigmatic mood stabilizer, with moderate metabolic impact necessitating monitoring. Valproate is good for bipolar and for seizures but has high metabolic properties. Side effects, including weight gain, cognitive problems and the risk of diabetes, differ by drug class and medication. LAI options are limited.
Substance Use Resources
Commonly Used Drugs and Treatment Information Charts:
https://www.drugabuse.gov/sites/default/files/nida_commonlyuseddrugs_final_printready.pdf
Withdrawal Sx Chart
References
American Psychiatric Association (APA). (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
Bear, M. F., Connors, B. W., & Paradiso, M. A. (2020). Neuroscience: Exploring the brain (4th ed.). Wolters Kluwer.
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2017). Kaplan & Sadock's synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Wolters Kluwer.
Kandel, E. R., Schwartz, J. H., Jessell, T. M., Siegelbaum, S. A., & Hudspeth, A. J. (2013). Principles of neural science (5th ed.). McGraw-Hill Education.
Muench, J., & Hamer, A. M. (2010). Adverse effects of antipsychotic medications. American Family Physician, 81(5), 617–622. https://www.aafp.org/pubs/afp/issues/2010/0301/p617.html
Stahl, S. M. (2021). Prescriber's guide: Stahl's essential psychopharmacology (7th ed.). Cambridge University Press.
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Last updated: 10/2020 nw
