5/9/2016

 Most commonly prescribed are the SSRI’s such as fluoxetine, citalopram, sertraline, escitalopram

 Effectively Managing Psychiatric Medications Other types of antidepressants include SNRI’s in the Medically Ill Patient (venlafaxine, duloxetine), atypical agents (mirtazipine, bupropion) Jane Sundberg PharmD, BCPP Strong Memorial Hospital Department of Psychiatry  Used, but not frequently, are MAO-I’s and University of Rochester Medical Center April 2016 tricyclics ( nortriptyline, doxepin)

 Stimulants (methylphenidate)

 Management of depression  Serotonin Syndrome  Management of anxiety  Suicidal thoughts  Obsessive Compulsive Disorder  Anticholinergic  SIADH(syndrome of inappropriate antidiuretic  Post Traumatic Stress Disorder hormone secretion)  Panic Attacks  Sexual  Weight gain  Sweating  Gastrointestinal  Apathy  Discontinuation symptoms

1 5/9/2016

 Primarily to be used for short-term  Withdrawal syndromes: risk of seizure, management of anxiety delirium  Dependence  As a controlled substance, monitoring by the provider of patient use is essential.

 Common anxiolytics: lorazepam, diazepam, alprazolam, clonazepam

 Other medications used for management of anxiety include hydroxyzine, gabapentin, buspirone

 These medications changed the practice of  Anticholinergic psychiatry when first introduced in the mid-  Extrapyramidal: pseudoparkinsonism, 1950’s akathisia, dystonic reactions, tardive  Atypical antipsychotics (quetiapine, risperidone, dyskinesia olanzapine) are used more frequently today than the typicals (haloperidol, fluphenazine) primarily  Sedation because of a different side effect profile.  Neuroleptic Malignant syndrome  QTc prolongation  Special caution must be taken with clozapine,  Metabolic provider must be registered with the Clozapine  Hyperprolactinemia REMS program.  Postural hypotension  Off-label use

2 5/9/2016

 Antidepressants and Antipsychotics: dosage,  Used to treat primarily bipolar disorder and length of time on the medication, target some personality disorders with mood lability symptoms, Black Box warnings, tolerability, as a symptom when to change antidepressants or antipsychotics, augment with another drug,  Lithium: first line treatment for Bipolar how to cross taper, renal function, liver Disorder. Requires regular monitoring for function, what labs to monitor, drug blood levels. interactions.  Anticonvulsants: Valproic acid, Carbamazepine,Oxcarbazepine, Lamotrigine.

 Lithium: Must monitor renal and thyroid Antipsychotics: functioning. Sodium/water balance. Tremor. Asenapine Early signs of toxicity. Pregnancy test. Lurasidone  Valproic Acid: Hyperammonemia, Cariprazine Thrombocytopenia, Tremor, Signs of toxicity. Brexpiprazole Pregnancy test Antidepressants:  Lamotrigine: Rash Vilazodone  Carbamazepine: Blood dyscrasias, Pregnancy Trazodone Extended Release test, Genotype screening HLA-B in patients of Milnacipran Asian descent, Sodium. Levomilnacipran  Oxcarbazepine: Sodium Vortioxetine  Drug interactions

3 5/9/2016

 Has patient been compliant with medication?  Should medications be discontinued or dosage reduced?  Possible discontinuation issues  Restarting medications

4