정신 약물 효능, 효과, 부작용, 독성

SSRI(selective serotonin reuptake inhibiytors)

• 작용
  • Inhibit serotonin reuptake(몸에 세로토닌 증가)
• 주의(나타날수 있는 부작용)
  • Dry mouth → most common
  • BP change
  • Sleep pattern change
  • Nervousness
  • Tremors
  • Monitor WBC count, liver and renal function.
• 부작용
  • Toxicity
    • abd pain, diarrhea, sweating, fever, tarchycardia, HTN, delirium, muscle spasm
  • Serotonin syndrome
    • hyperactivity, restlessness, tachycardia, fever, elevated BP, seizures, muscle rigidity, abd pain
• 약물
  • Citalopram(시탈로프람)
  • Escitalopram(에스시탈로프람-렉사프로,뉴프람,에프람) - 우울증, 불안장애, 강박장애
    • 우울증에서 1차 선택약물
    • 당뇨, 고혈압, 갑상선/간/신장 질환, 뇌전증, 파킨슨 병을 동반한 우울증에서 사용가능
    • 위장장애(매스꺼움, 소화불량, 변비, 설사), 성기능장애, 피로감, 식욕 및 수면 변화
  • Fluoxetine (플루옥세틴) - 우울증, 강박장애
    • 매스꺼움, 불면증, 피로감, 성기능 장애
    • ~24세 에서 자살 충동을 증가시킴
    • 간, 신장 문제 사용불가
    • MAOI 와 상화작용 주의
    • 발작유발
  • Fluvoxamine
  • Paroxetine(파록세틴 - 팍실CR, 파록스씨알) - 우울증, 불안장애
    • 위장장애(매스꺼움, 소화불량), 성기능 장애, 입마름, 졸음
  • Sertraline(설트랄린 - 졸로푸트) - 우울증, 강박장애, 불안장애
    • 심혈관질환, 부정맥이 동반된 경우 1차 선택약물
    • 위장장애(소화불량, 변비, 설사, 구토), 성기능장애, 역행성 불안(복용 초기 일시적으로 불안이 증가하는 현상)
    • 불면, 초조 ↔ 졸음, 무기력함.
  • Vilazodone

TAC(tricyclic antidepressants)

• 작용
  • Block the reuptake of norepinephrine and serotonin, affact neurotransmitters
• 주의
  • Reduce effectiveness of antihypertensive agents
  • Cardiac toxicity → EKG check
  • Life-threatening overdose
  • May reduce threshold of seizure → 경련 빈번
• 부작용
  • Anticholinergic effect
    • Dry mouth, voiding difficulty(urinary retention), costipation, blurry vision, dilated pupil
  • Tachycardia, dysrhythmias, seizure, anxiety, irritability
  • TAC toxicity
    • Tardive dyskinesia(운동이상)
    • Akinesia(운동장애)
    • Akathisia(좌불안석)
    • Pseudoparkinsonism(가성파킨슨)
• 약물
  • Amitriptyline, Amoxapine, Clomipramine, Desipramine, Doxepin, Imipramine, Nortriptyline, Protriptyline, Trimipramine

MAOI(monoamine oxidase inhibitors)

• 작용
  • Inhibitor the enzyme monoamine(serotonin, norepinephrine, dopamin) oxidase → Monoamine 증가
• 주의
  • HTN crisis
  • Change HR and rhythm
  • Restlessness
  • Wt gain
  • Anticholinergic effect
  • CNS stimulation → 절대 알콜 같이 복용 금지
• 부작용
  • Hypertensive crisis
  • Occipital headache
  • Tachycardia or bradycardia
  • Chest pain
  • Sweating
  • Dilated pupils
• 약물
  • Isocarboxazid, Phenelzine(not approved for use in Canada), Selegiline, Tranylcypromine

Lithium (0.6~1.2 ;치료 농도)

• 작용
  • Mood stabilizers - affect transport mechanism and enhance serotonin or GABA function, or both
• 부작용
  • Polyuria, thirst, dry mouth
  • Dysrhthmia
  • Anorexia, nausea, abdominal bloating, soft stools or diarrhea
  • Fine hand tremors, inability to concentrate, muscle weakness
  • Headache, hypothyroidism and goiter(갑상선 비대)
• 중재
  • Monitor the suicidal risk
  • With food to minimize gastrointestinal irritation
  • Avoid excessive amounts of coffee, tea, or cola(소변배출 증가), which have a diuretic effect.
  • ECG, renal test, thyroid test, monitor weight
• 독성
  • Lithium toxicitiy
    • Occurs when ingested lithium can’t be detoxified and excreted by the kidneys → 신장에서 해독, 배설되지않을 경우
    • level is at 1.5mEq/L(1.5mmol/L) → 혈중 리튬 농도가 1.5mmol/L 부터 증상이 나타남
  • Nystagmus, Muscle fasciculations(근육에서 일어나는 미세한, 자발적인 떨림), Deep tendon hyper-reflexia, visual or tactile(촉각) hallucinations, Oliguria or anuria, Impaired LOC, Tonic-clonic seizures or coma, leading to death

Antipsychotic Medications

• 작용
  • Affect dopamine receptors in the brain → reducing psychotic symptoms improve the thought process of psychotic symptoms(특히, Schizophrenia)
• 부작용
  • Extrapyramidal syndrome = parkinsonism, dystonia, akathisia, tardive dyskinesia, tremor
  • Anticholinergic effect
  • Drowsiness, photosensitivity
  • Agranulocytosis(leukopenia) symptom → 면역력 약화 : sore throat, fever, malaise
• 중재
  • Urine color change to pinkish-red brown
  • V/S, liver, kidney function, glucose monitor
  • Sunsreen, hat, clothse due to photosensitivity
  • F/U CBC
• 독성
  • Neurolepic Malignant syndrome
    • Occur at any time during therapy
    • Autonomic dysfunction, hyperpyrexia, HTN, tachycardia, tachypnea, diaphoresis, drooling, altered LOC, seizure, sever extrapyramidal side effects, muscle rigidity