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576 sEctiON iii Psychiatry ` Psychiatry—PharMacology

Atypical antidepressants
Bupropion Inhibits NE and DA reuptake. Also used for smoking cessation. Toxicity: stimulant effects
(tachycardia, insomnia), headache, seizures in patients with bulimia and anorexia nervosa.
Favorable sexual side effect profile.
Mirtazapine α -antagonist ( release of NE and 5-HT), potent 5-HT and 5-HT receptor antagonist, and H
1
3
2
2
antagonist. Toxicity: sedation (which may be desirable in depressed patients with insomnia),
 appetite, weight gain (which may be desirable in underweight patients), dry mouth.
Trazodone Primarily blocks 5-HT , α -adrenergic, and H receptors; also weakly inhibits 5-HT reuptake. Used
2 1 1
primarily for insomnia, as high doses are needed for antidepressant effects. Toxicity: sedation,
nausea, priapism, postural hypotension. Think traZZZobone due to sedative and male-specific
side effects.
Varenicline Nicotinic ACh receptor partial agonist. Used for smoking cessation. Toxicity: sleep disturbance,
depressed mood, suicidal ideation. Varenicline helps nicotine cravings decline.
Vilazodone Inhibits 5-HT reuptake; 5-HT receptor partial agonist. Used for MDD. Toxicity: headache,
1A
diarrhea, nausea, anticholinergic effects. May cause serotonin syndrome if taken with other
serotonergic agents.

Vortioxetine Inhibits 5-HT reuptake; 5-HT receptor agonist and 5-HT receptor antagonist. Used for MDD.
3
1A
Toxicity: nausea, sexual dysfunction, sleep disturbances, anticholinergic effects. May cause
serotonin syndrome if taken with other serotonergic agents.

Opioid detoxification Intravenous drug users at  risk for hepatitis, HIV, abscesses, bacteremia, right-heart endocarditis.
and relapse
prevention
Methadone Long-acting oral opiate used for heroin detoxification or long-term maintenance therapy.
Buprenorphine Sublingual form (partial agonist) used to prevent relapse.
Naloxone Short-acting opioid antagonist given IM, IV, or as a nasal spray to treat acute opioid overdose,
particularly to reverse respiratory and CNS depression.
Naltrexone Long-acting oral opioid antagonist used after detoxification to prevent relapse. Use naltrexone for
the long trex back to sobriety.

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