💉 Lecture 9
Psych Drugs
Phenothiazines, TCAs, Benzos, MAOIs, Lithium, Prozac, Haldol, Clozaril.
Drug Classes
⭐
ALL psych drugs cause: Low BP + Weight changes (usually gain)
| Class | Identify By | Use | Key Point |
|---|---|---|---|
| Phenothiazines | Ends in "-ZINE" | Antipsychotics (major tranq) | Small dose = antiemetic |
| TCAs | Elavil, Tofranil | Antidepressants | Takes 2–4 WEEKS to work |
| Benzodiazepines | Has "ZEP" or "-pam" | Anti-anxiety (minor tranq) | Fast! Don't use >2–4 weeks |
| MAOIs | MARplan, NARdil, PARnate | Antidepressants | Avoid tyramine foods! |
⏰ Give Major + Minor Together
Minor (Valium) works fast. Major (Elavil) takes 2–4 weeks. Give both. Stop minor when major kicks in.
Side Effects
ABCDEFG — Antipsychotic Side Effects
A–Anticholinergic | B–Blurred vision | C–Constipation | D–Drowsiness | E–EPS (tremors) | F–Fotosensitivity | G–aGranulocytosis
ABCDF → Safety teaching | G → Teach to REPORT sore throat/infection
🚨
NMS vs EPS: Both have anxiety + tremors. Differentiate by TEMPERATURE. Normal temp = EPS. 102°+ and rising = NMS (life-threatening!) → call emergency team
📌
MAOIs: Avoid tyramine → Hypertensive crisis! Avoid: BAR (Bananas, Avocados, Raisins), aged cheese, preserved meats, alcohol, chocolate, soy sauce
Specific Drugs
| Drug | Use | Key Points |
|---|---|---|
| Lithium | Bipolar mania | 3 Ps: Pee, Poop, Paresthesia. Toxic: tremors, metallic taste. Monitor Na+ (low Na = toxic) |
| Prozac | SSRI | Causes INSOMNIA → give before noon. Adolescent dose changes → watch suicide risk |
| Haldol | Antipsychotic | NMS risk (fever >105). Elderly/young → half dose. ONLY antipsychotic safe in pregnancy! |
| Clozaril | Atypical antipsychotic | No EPS but WORST aGranulocytosis → Monitor WBC frequently! |
| Zoloft | SSRI | St. John's Wort → serotonin syndrome. Warfarin → bleeding. SAD Head: Sweating, Apprehensive, Dizzy, Headache |
📖 Notes for Dummies
🧠 Think of it this way…
Psych drugs are like adjusting the brain's chemical balance. Some calm the brain (antipsychotics), some lift the mood (antidepressants), some reduce anxiety (benzodiazepines). Each comes with predictable side effects that you need to know and teach patients.
🧠
Four drug families — identify them fast:
Ends in -ZINE (Thorazine) = major antipsychotic (for serious psychosis)
Ends in -ZEP or -PAM (Valium, Ativan) = anti-anxiety (works fast, don't overuse)
MAOIs (rhyme at the start: MAR, NAR, PAR) = antidepressant (avoid tyramine!)
TCAs (Elavil, Tofranil) = antidepressant (takes 2–4 weeks)
Ends in -ZINE (Thorazine) = major antipsychotic (for serious psychosis)
Ends in -ZEP or -PAM (Valium, Ativan) = anti-anxiety (works fast, don't overuse)
MAOIs (rhyme at the start: MAR, NAR, PAR) = antidepressant (avoid tyramine!)
TCAs (Elavil, Tofranil) = antidepressant (takes 2–4 weeks)
⏰
Why give major and minor tranquilizers TOGETHER?
The benzodiazepine (minor, e.g., Valium) works within hours and calms the patient NOW. The antipsychotic (major, e.g., Elavil) takes 2–4 weeks. So you give both, then stop the minor once the major kicks in. Same idea as Heparin + Coumadin!
The benzodiazepine (minor, e.g., Valium) works within hours and calms the patient NOW. The antipsychotic (major, e.g., Elavil) takes 2–4 weeks. So you give both, then stop the minor once the major kicks in. Same idea as Heparin + Coumadin!
🌡️
NMS vs EPS — the one test question every student gets wrong:
Both show anxiety and tremors. TAKE THE TEMPERATURE. Normal temp = EPS (side effect, teachable). Rising temp = NMS (emergency, call the code team)!
Both show anxiety and tremors. TAKE THE TEMPERATURE. Normal temp = EPS (side effect, teachable). Rising temp = NMS (emergency, call the code team)!
📝 Memory shortcuts:
💊 Lithium side effects = 3 Ps (peeing, pooping, paresthesia) — feels like an electrolyte imbalance
😴 Prozac causes insomnia → always give in the MORNING
🧪 Clozaril = no tremors (no EPS) but can destroy bone marrow → check WBC often!
🌿 Zoloft + St. John's Wort = serotonin syndrome (SAD Head symptoms)
💊 Lithium side effects = 3 Ps (peeing, pooping, paresthesia) — feels like an electrolyte imbalance
😴 Prozac causes insomnia → always give in the MORNING
🧪 Clozaril = no tremors (no EPS) but can destroy bone marrow → check WBC often!
🌿 Zoloft + St. John's Wort = serotonin syndrome (SAD Head symptoms)