Drug Name



Antipsychotics/Antidepressants

|Drug Name |Class |MOA |Toxicity/Side fx |Clinical Use / Notes |

|Antipsychotic Agents |

|Promazine |Phenothiazines |Class 1 dopamine antagonist (CNS); Acts |Antihistamine (sedative) effects; Anticholinergic effects;|Neuroleptic (antipsychotic); originally used for |

| | |primarily at D2 receptors |Extrapyramidal effects: acute = dystonia, akathisia, |prolonged sedative effects |

| | | |parkinsonism; chronic = tardive dyskinesia esp. in facial | |

| | | |muscles; D2 receptor supersensitivity with chronic |Tolerance may develop to sedative effects. |

| | | |blockade; amenorrhea; orthostatic hypotension due to | |

| | | |α1-adrenergic blocking | |

|Chlorpromazine |Phenothiazines |Same as promazine; Chloride addition |Similar to promazine |Neuroleptic (antipsychotic); |

|(Thorazine®) | |(R2) makes more potent than promazine. | |Anti-emetic (not for motion-sickness); |

|Thioridazine |Phenothiazines |Same as promazine; R1 sub. of piperidine|Similar to promazine, but fewer sedative / extrapyramidal |Neuroleptic (antipsychotic); |

| | |ring ↓’s sedative and extrapyramidal |effects than above. | |

| | |effects. | | |

|Fluphenazine |Phenothiazines |Same as promazine; R1 piperazine ring |Reduced sedative and anticholinergic effects, but ↑ |Neuroleptic (antipsychotic) – usually reserved |

| | |plus R2 –CF3 group makes it most potent |extrapyramidal effects, |for severe or acute psychotic illness (Injectable|

| | |antipsychotic drug |Neuroleptic malignant syndrome: widespread, sustained |form available) |

| | | |muscle contractions, fluctuating consciousness and | |

| | | |autonomic abnormalities | |

Dr. Foster – 2/19/02

|Drug Name |Class |MOA |Toxicity/Side fx |Clinical Use / Notes |

|Haloperidol |Butyrophenones |Same as promazine; |Reduced sedative and anticholinergic effects, but ↑ |Neuroleptic (antipsychotic); anti-emetic; |

|(Haldol®) | |Potent |extrapyramidal effects, |Injectable form available. |

| | | |Neuroleptic malignant syndrome | |

| | | |(as w/fluphenazine) | |

|Thiothixene |Thioxanthenes |Same as promazine; thioxanthenes |Similar to promazine |Neuroleptic (antipsychotic) |

| | |substitute a N for a C in the structure | | |

| | |– more potent than promazine | | |

|Clozapine |Dibenzodiazepines |D1 and D4 receptor antagonist and |Low risk for extrapyramidal effects; Agranulocytosis in |Atypical antipsychotic; |

| | |interacts with muscarinic, 5-HT2 and |~1% within the first several months of treatment; | |

| | |α1-adrenergic receptors; Low potency and|Significant anticholinergic properties; orthostatic |Preferentially blocks mesolimbic and mesocortical|

| | |relatively low affinity for D2 dopamine |hypotension and compensatory tachycardia due to |tracts (not nigrostriatal) |

| | |receptors. |α1-adrenergic blockade. | |

|Risperidone |Benzisoxazoles |Prominent antiserotonergic and |No extrapyramidal effects at low doses. |Atypical antipsychotic |

| | |antidopaminergic activity | | |

|Antidepressants |

|Drug Name |Class |MOA |Toxicity/Side fx |Clinical Use / Notes |

|Imipramine |Tricyclics / |Demethylation produces active |Sedative; anticholinergic; orthostatic hypotension; weight|Antidepressant |

| |dibenzazepines |metabolite: desipramine; |gain; | |

| | | |Overdose: akathisia, seizures, depressed respiration, coma|Drugs that ↑ liver metabolism ↓ effectiveness |

| | |Inhibits neuronal reuptake of NE |Drugs that ↓ binding to albumin (NSAIDS, phenytoin, |(barbiturates, cigarettes, anticonvulsants) |

| | | |scopolamine, phenothiazines) or ↓ liver metabolism | |

| | | |(neuroleptics, contraceptives) ↑ side effects; |Tricyclics should NEVER be abruptly stopped due |

| | | |Additive sedative effects w/EtOH, neuroleptics and |to possibly severe withdrawal symptoms |

| | | |antihistamines. | |

| | | |Severe CNS interaction with MAO inhibitors, adrenaline and| |

| | | |noradrenaline, ephedrine, isoproterenol | |

|Amitriptyline |Tricyclics / |Demethylation produces active |Same as imipramine; extreme sedative effects |Antidepressant |

| |dibenzocyclo-heptadienes |metabolite: nortriptyline; Inhibits | |See imipramine notes |

| | |neuronal reuptake of NE | | |

|Doxepin |Tricyclics / |Inhibits neuronal reuptake of NE |Same as imipramine |Antidepressant |

| |dibenzoxepines | | |See imipramine notes |

|Phenelzine and |MAO inhibitors |Irreversible inhibitor of monoamine |High risk of orthostatic hypotension; hepatotoxic; |Antidepressant |

|Tranylcypromine | |oxidase |OD: insomnia, agitation, convulsions; | |

| | | |Severe drug interactions: tricyclics, sympathomimetics, | |

| | | |foods containing pressor amines like tyramine (cheese, red| |

| | | |wine), caffeine | |

|Moclobemide |MAO inhibitors |Selective irreversible inhibitor of |See above |Antidepressant |

| | |monoamine oxidase A | | |

|Drug Name |Class |MOA |Toxicity/Side fx |Clinical Use / Notes |

|Selegiline |MAO inhibitors |Selective irreversible inhibitor of |See phenelzine |Antiparkinson’s drug |

| | |monoamine oxidase B | | |

|Fluoxetine |SSRI |Causes downregulation of presynaptic |GI upset; ↓ libido |Antidepressant and tx for OCD |

|(Prozac®) | |5-HT1D autoreceptors, facilitates |OD: “serotonin syndrome” = akathisia, muscle twitches, | |

| | |transmission |hyperreflexia, sweating as a prelude to coma | |

|Fluvoxamine, Paroxetine |SSRI’s |See above | |Antidepressants |

|(Paxil®) | | | | |

|Sertraline (Zoloft®) | | | | |

|Venlafaxine |SSRI / NERI | |Less sedative than other antidepressants |Antidepressant |

|(Effexor®) | | | | |

|Amoxapine |2nd-generation (atypical)|Similar to tricyclics but also blocks DA|Cardiac effects; antimuscarinic; some sedative fx; |Antipsychotic/ Antidepressant |

| |antidepressants |receptors |extrapyramidal symptoms, amenorrhea | |

|Trazodone |2nd-generation (atypical)|Weakly inhibits 5-HT uptake, antagonist |Sedative, but less anticholinergic; less sexual |Antidepressant |

| |antidepressants |of 5-HT2 receptors and partial agonist |dysfunction, but priapism possible | |

| | |of 5-HT1A receptors | | |

|Bupropion |2nd-generation (atypical)|Inhibits DA uptake |Seizures, insomnia, psychosis |Anticraving drug for smokers |

|(Wellbutrin®, Zyban®) |antidepressants | | | |

|Drugs for Bipolar Disorder |

|Lithium salts | |Competes at cellular sites with Na+, K+,|GI irritation, goiter, rashes |DOC for recurrent bipolar affective disorder |

| | |Ca++ and Mg++; may interfere with |Low toxicity: apathy, lethargy, weakness, nausea; Med. | |

| | |monoamine neurotransmitters |toxicity: tremor, slurred speech, unsteady gait, | |

| | | |confusion; Severe toxicity: seizure, coma, | |

| | | |cardiovascular collapse | |

|Carbamazepine | | | |Anticonvulsant used for bipolar if Lithium |

| | | | |intolerance or incomplete protection from |

| | | | |recurrence |

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