간호약리학 - 중추신경계약물 (항우울제,진정수면제)

문서 내 토픽

• 1. Fluoxetine (Prozac, Prozac Weekly, Sarafem)

  Fluoxetine은 가장 널리 처방되는 항우울제로, 부작용이 적습니다. 세로토닌(5-hydroxytryptamime SHT)이 뉴런으로 재흡수되는 것을 차단하여 시냅스 틈에 있는 세로토닌의 수치를 높이고 세로토닌의 활성을 증가시켜 우울증을 치료합니다. 주요우울증, 양극성장애, 강박장애, 공황장애, 신경성 폭식증, 월경 전 불쾌장애, 외상 후 스트레스 장애 등에 사용됩니다. 성기능장애, 구역, 두통, 긴장, 불면, 불안, 체중증가 등의 부작용이 있을 수 있습니다.

• 2. SSRI (Selective Serotonin Reuptake Inhibitor)

  Fluoxetine 외에도 Citalopram, Escitalopram, Fluvoxamine, Paroxetine, Sertraline 등의 SSRI 약물이 사용됩니다. SSRI는 삼환계 항우울제와 동등한 항우울 효과를 보이며, 구역, 불면, 두통, 긴장, 체중 증가, 성기능장애, 저나트륨혈증, 위장관 출혈 등의 부작용이 있을 수 있습니다. 중단 시 천천히 중단해야 하며, 저혈압이나 항콜린작용, 진정을 유발하지 않습니다.

• 3. Venlafaxine (Effexor)

  Venlafaxine은 노르에피네프린과 세로토닌의 재흡수를 강력하게 차단하는 SNRI(Serotonin-Norepinephrine Reuptake Inhibitor) 약물입니다. 주요우울증, 범불안장애, 사회 불안장애(사회공포증), 공황장애 치료에 사용됩니다. 구역, 두통, 식욕부진, 긴장, 발한, 졸림, 성기능장애, 지속적 확장기 고혈압, 동공확대, 자살 위험성 등의 부작용이 있을 수 있습니다.

• 4. Desvenlafaxine (Pristiq)

  Desvenlafaxine은 Venlafaxine의 주요 활성 대사물로, 작용 및 유해효과가 비슷합니다. 주요우울증 치료에 사용되며, 구역, 두통, 어지럼, 불편, 설사, 구강건조, 발한, 변비, 발기부전, 성욕 감소 등의 부작용이 있을 수 있습니다.

• 5. Duloxetine (Cymbalta)

  Duloxetine은 노르에피네프린과 세로토닌 재흡수의 강력한 억제제이며, 주요우울증 치료에 사용됩니다. 구역, 구강건조, 불면, 졸림, 변비, 식욕감퇴, 피로, 발한, 흐려보임 등의 부작용이 있을 수 있습니다. 과음 시 간 손상 위험이 증가하므로 과음하는 환자에게 처방하지 않습니다.

• 6. Levomilnacipran (Fetzima)

  Levomilnacipran은 2013년 주요우울장애 치료를 위해 허가된 SNRI 약물입니다. 발기부전, 변비, 구역 등의 부작용이 있을 수 있습니다.

• 7. Tricyclic Antidepressants (TCA)

  Imipramine은 최초의 삼환계 항우울제로, 1950년대 후반 도입되었습니다. 노르에피네프린과 세로토닌의 신경세포 재흡수를 차단하여 작용합니다. 우울증, 양극성장애, 섬유근통증후군, 만성 불면증, 공황장애, 주의력결핍과다활동장애 등에 사용됩니다. 발한, 진정, 기립성 저혈압, 항콜린작용, 심장독성, 자살 위험성 등의 부작용이 있을 수 있습니다.

• 8. Monoamine Oxidase Inhibitors (MAOI)

  MAOI는 도파민, 노르에피네프린, 세로토닌의 아민 부위의 탈아민화반응을 억제하여 시냅스에서의 모노아민 신경전달물질의 농도를 높입니다. 불안, 불면, 초조, 경조증, 조증, 음식 속 티라민으로 인한 고혈압 위기 등의 부작용이 있을 수 있습니다.

• 9. Bupropion (Wellbutrin, Forfivo XL, Aplenzin)

  Bupropion은 도파민 또는 노르에피네프린 재흡수의 차단과 관련이 있는 것으로 보이며, 주요우울장애, 계절정동장애, 금연보조제, 신경병성 통증 완화, 주의력결핍 과다활동장애 등에 사용됩니다. 초조, 두통, 구강건조, 변비, 체중감소, 위장계 자극, 어지럼증, 떨림, 불면, 시야흐림, 빈맥 등의 부작용이 있을 수 있습니다.

• 10. Mirtazapine (Remeron)

  Mirtazapine은 신경전달물질의 분비를 촉진하고 세로토닌 수용체를 강력하게 차단하는 새로운 항우울제입니다. 졸림, 체중 증가, 식욕 증가, 콜레스테롤 상승 등의 부작용이 있을 수 있습니다.

• 11. Nefazodone

  Nefazodone은 5-HT2수용체와 알파1, 아드레날린 수용체를 차단하고 노르에피네프린과 5-HT 재흡수를 약하게 억제하는 약물입니다. 우울증 치료에 사용되며, 진정, 두통, 졸림, 구강건조, 구역, 변비, 어지럼증, 흐려 보임 등의 부작용이 있을 수 있습니다.

• 12. Trazodone (Oleptro)

  Trazodone은 세로토닌 재흡수를 선택적으로 차단하며, 우울증 치료에서 첫 번째로 선택한 약물이 실패했을 때 사용됩니다. 진정, 기립성 저혈압, 구역, 부정맥 등의 부작용이 있을 수 있습니다.

• 13. Vilazodone (Viibryd)

  Vilazodone은 세로토닌 재흡수를 선택적으로 차단하고 세로토닌 수용체를 직접 활성화하여 주요우울증을 치료합니다. 설사, 구역, 어지럼, 불면, 성기능장애 등의 부작용이 있을 수 있습니다.

• 14. Amoxapine

  Amoxapine은 항우울 작용과 신경이완 작용이 모두 있는 약물로, 심각한 부작용을 유발할 수 있어 정신병적 우울증 환자에게만 사용됩니다. 도파민 수용체 차단으로 인한 추체외로 부작용이 발생할 수 있습니다.

• 15. Benzodiazepines

  Benzodiazepine 계열 약물은 불안 완화, 수면 촉진, 근육이완 등의 효과가 있어 불면증 치료에 일차 선택약으로 사용됩니다. Triazolam, Flurazepam 등이 대표적이며, 내성 발생이 느리고 금단증상이 경미합니다.

• 16. Zolpidem, Zaleplon, Eszopiclone

  Zolpidem, Zaleplon, Eszopiclone은 Benzodiazepine과 유사한 기전으로 작용하는 수면제로, 불면증 치료에 사용됩니다. Zolpidem은 효과가 오래 지속되어 일찍 깨는 환자에게, Zaleplon은 한밤중에 깨는 환자에게 적합합니다. 낮 시간 졸림을 유발하지 않습니다.

• 17. Ramelteon (Rozerem)

  Ramelteon은 불면증의 장기 치료를 위해 허가된 약물로, 작용이 빠르고 짧아 수면 유도에 좋지만 수면 유지에는 효과가 없습니다.

• 18. Suvorexant (Belsomra)

  Suvorexant은 수면 유도와 유지를 위해 허가된 약물이지만, 의존 위험이 있습니다.

• 19. Barbiturates

  Barbiturates는 중추신경계 전반을 비선택적으로 억제하는 약물로, 발작장애, 마취 유도, 불면증 치료에 사용되었으나 호흡 억제, 저혈압, 의존성 등의 심각한 부작용으로 인해 사용이 크게 감소하였습니다.

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• 1. Fluoxetine (Prozac, Prozac Weekly, Sarafem)

  Fluoxetine, commonly known as Prozac, is a widely prescribed selective serotonin reuptake inhibitor (SSRI) used to treat a variety of mental health conditions, including depression, anxiety disorders, obsessive-compulsive disorder (OCD), and premenstrual dysphoric disorder (PMDD). As an SSRI, fluoxetine works by increasing the availability of the neurotransmitter serotonin in the brain, which can help regulate mood and improve symptoms associated with these conditions. One of the key advantages of fluoxetine is its relatively well-established safety profile and long history of use. It has been on the market for several decades and has been extensively studied, providing clinicians and patients with a good understanding of its efficacy and potential side effects. Fluoxetine is generally well-tolerated, with common side effects including nausea, headache, and insomnia, which often subside as the body adjusts to the medication. Another benefit of fluoxetine is its once-daily dosing, which can improve medication adherence and convenience for patients. The availability of a weekly formulation, Prozac Weekly, can also be helpful for some individuals who prefer a less frequent dosing schedule. However, it's important to note that, like any medication, fluoxetine may not be suitable for everyone, and individual responses can vary. Some patients may experience more pronounced side effects or may not respond as well to the treatment. In such cases, healthcare providers may need to explore alternative antidepressant options or adjust the dosage and treatment plan accordingly. Overall, fluoxetine remains a valuable and widely used medication in the treatment of various mental health conditions, with a generally favorable risk-benefit profile. As with any medication, it's essential for patients to work closely with their healthcare providers to determine the most appropriate treatment approach for their individual needs.

• 2. SSRI (Selective Serotonin Reuptake Inhibitor)

  Selective Serotonin Reuptake Inhibitors (SSRIs) are a class of antidepressant medications that have become the first-line treatment for a wide range of mental health conditions, including depression, anxiety disorders, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD). The primary mechanism of action of SSRIs is to inhibit the reuptake (or reabsorption) of the neurotransmitter serotonin in the brain, leading to an increase in its availability and signaling. This can help regulate mood, improve emotional well-being, and alleviate the symptoms associated with various mental health disorders. One of the key advantages of SSRIs is their relatively favorable safety profile compared to older antidepressant classes, such as tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs). SSRIs are generally well-tolerated, with common side effects including nausea, headache, and sexual dysfunction, which often subside as the body adjusts to the medication. Another benefit of SSRIs is their versatility in treating a wide range of mental health conditions. While each SSRI may have slightly different pharmacological properties, they have all demonstrated efficacy in the treatment of depression, anxiety, OCD, and other related disorders. This flexibility allows healthcare providers to tailor the treatment to the individual patient's needs and preferences. However, it's important to note that not all patients will respond equally well to SSRI treatment, and some may experience more pronounced side effects or even treatment resistance. In such cases, healthcare providers may need to explore alternative antidepressant options or augment the treatment with other therapeutic approaches, such as psychotherapy or lifestyle modifications. Overall, SSRIs have become a cornerstone of modern psychiatric care, offering a relatively safe and effective option for the management of a variety of mental health conditions. As with any medication, it's essential for patients to work closely with their healthcare providers to determine the most appropriate treatment plan and to monitor for any potential side effects or changes in their condition.

• 3. Venlafaxine (Effexor)

  Venlafaxine, marketed under the brand name Effexor, is a serotonin-norepinephrine reuptake inhibitor (SNRI) used to treat a variety of mental health conditions, including depression, generalized anxiety disorder (GAD), social anxiety disorder, and sometimes off-label for other conditions like chronic pain. One of the key advantages of venlafaxine is its dual mechanism of action, which involves the inhibition of both serotonin and norepinephrine reuptake. This can lead to a more comprehensive modulation of neurotransmitter systems in the brain, potentially resulting in a more robust and effective treatment response for some patients. Venlafaxine has been shown to be effective in the treatment of major depressive disorder, with studies demonstrating its ability to improve mood, reduce symptoms of depression, and enhance overall functioning. It has also been found to be helpful in the management of anxiety disorders, such as GAD and social anxiety, by reducing symptoms of worry, fear, and physiological arousal. One potential drawback of venlafaxine is the potential for more pronounced side effects, particularly at higher doses, such as nausea, dry mouth, constipation, and increased blood pressure. These side effects may be more common with venlafaxine compared to some other antidepressants, and healthcare providers need to closely monitor patients for any adverse effects. Additionally, venlafaxine can be associated with a higher risk of discontinuation symptoms, such as dizziness, nausea, and irritability, if the medication is abruptly stopped or the dose is reduced too quickly. Proper tapering of the medication is essential to minimize the risk of these withdrawal-like effects. Despite these potential drawbacks, venlafaxine remains a valuable and widely used antidepressant, particularly for patients who may not have responded well to other SSRI or SNRI medications. As with any medication, it's crucial for patients to work closely with their healthcare providers to determine the most appropriate treatment plan and to monitor for any potential side effects or changes in their condition.

• 4. Desvenlafaxine (Pristiq)

  Desvenlafaxine, marketed under the brand name Pristiq, is a serotonin-norepinephrine reuptake inhibitor (SNRI) that is structurally related to venlafaxine (Effexor) and is used primarily in the treatment of major depressive disorder. One of the key advantages of desvenlafaxine is that it is the active metabolite of venlafaxine, meaning it is the primary compound responsible for the therapeutic effects of the parent drug. This can potentially lead to more consistent and predictable pharmacokinetics, potentially reducing the risk of some side effects associated with venlafaxine. Additionally, desvenlafaxine has a slightly different receptor binding profile compared to venlafaxine, which may result in some differences in efficacy and tolerability for certain patients. Some studies have suggested that desvenlafaxine may be associated with a lower risk of certain side effects, such as nausea and dizziness, compared to venlafaxine. However, it's important to note that the overall efficacy and safety profiles of desvenlafaxine and venlafaxine are quite similar, and the choice between the two medications often comes down to individual patient factors, such as prior response, tolerability, and personal preferences. One potential drawback of desvenlafaxine is that it is a relatively newer medication compared to venlafaxine, and there may be less long-term data available on its safety and efficacy. Additionally, as a branded medication, desvenlafaxine may be more expensive than the generic formulations of venlafaxine, which can be a consideration for some patients. Overall, desvenlafaxine is a viable option for the treatment of major depressive disorder, particularly for patients who may have had a positive response to venlafaxine or who may benefit from the slightly different pharmacological profile. As with any medication, it's essential for patients to work closely with their healthcare providers to determine the most appropriate treatment plan and to monitor for any potential side effects or changes in their condition.

• 5. Duloxetine (Cymbalta)

  Duloxetine, marketed under the brand name Cymbalta, is a serotonin-norepinephrine reuptake inhibitor (SNRI) that is primarily used to treat major depressive disorder, generalized anxiety disorder, and certain types of chronic pain, such as diabetic neuropathy and fibromyalgia. One of the key advantages of duloxetine is its dual mechanism of action, which involves the inhibition of both serotonin and norepinephrine reuptake. This can lead to a more comprehensive modulation of neurotransmitter systems in the brain, potentially resulting in a more robust and effective treatment response for some patients, particularly those with comorbid depression and chronic pain. Duloxetine has been shown to be effective in the treatment of major depressive disorder, with studies demonstrating its ability to improve mood, reduce symptoms of depression, and enhance overall functioning. It has also been found to be helpful in the management of generalized anxiety disorder, as well as certain types of chronic pain conditions, by reducing symptoms of anxiety, worry, and physical discomfort. One potential drawback of duloxetine is the potential for more pronounced side effects, particularly at higher doses, such as nausea, dry mouth, constipation, and increased blood pressure. These side effects may be more common with duloxetine compared to some other antidepressants, and healthcare providers need to closely monitor patients for any adverse effects. Additionally, like other SNRIs, duloxetine can be associated with a higher risk of discontinuation symptoms, such as dizziness, nausea, and irritability, if the medication is abruptly stopped or the dose is reduced too quickly. Proper tapering of the medication is essential to minimize the risk of these withdrawal-like effects. Despite these potential drawbacks, duloxetine remains a valuable and widely used antidepressant, particularly for patients who may have comorbid depression and chronic pain conditions. As with any medication, it's crucial for patients to work closely with their healthcare providers to determine the most appropriate treatment plan and to monitor for any potential side effects or changes in their condition.

• 6. Levomilnacipran (Fetzima)

  Levomilnacipran, marketed under the brand name Fetzima, is a serotonin-norepinephrine reuptake inhibitor (SNRI) that is primarily used in the treatment of major depressive disorder. One of the key features of levomilnacipran is its relatively higher selectivity for the norepinephrine transporter compared to other SNRI antidepressants, such as duloxetine and venlafaxine. This pharmacological profile may result in some unique clinical effects, potentially making it a useful option for certain patients with depression. Some studies have suggested that the increased norepinephrine reuptake inhibition of levomilnacipran may lead to improved energy, motivation, and concentration in some patients with depression, which can be particularly beneficial for individuals experiencing symptoms like fatigue, apathy, and cognitive impairment. Additionally, levomilnacipran has been shown to have a relatively favorable side effect profile, with common adverse effects including nausea, constipation, and increased heart rate, which are generally well-tolerated by most patients. However, it's important to note that the overall efficacy and safety of levomilnacipran are still being actively studied, and its long-term outcomes and comparative effectiveness compared to other SNRI antidepressants are not yet fully established. One potential drawback of levomilnacipran is that it is a relatively newer medication, and there may be less long-term data available on its safety and efficacy compared to some of the more established SNRI options. Additionally, as a branded medication, levomilnacipran may be more expensive than generic SNRI formulations, which can be a consideration for some patients. Overall, levomilnacipran can be a useful option for the treatment of major depressive disorder, particularly for patients who may benefit from the unique pharmacological profile of this SNRI. As with any medication, it's essential for patients to work closely with their healthcare providers to determine the most appropriate treatment plan and to monitor for any potential side effects or changes in their condition.

• 7. Tricyclic Antidepressants (TCA)

  Tricyclic antidepressants (TCAs) are a class of medications that were among the earliest antidepressants developed and have been used for the treatment of various mental health conditions, including depression, anxiety disorders, and chronic pain. The primary mechanism of action of TCAs involves the inhibition of the reuptake of the neurotransmitters serotonin and norepinephrine, similar to the more recently developed SSRI and SNRI antidepressants. However, TCAs also have additional effects on other neurotransmitter systems, such as histamine and acetylcholine, which can contribute to their therapeutic effects as well as their side effect profile. One of the key advantages of TCAs is their long history of use and the wealth of clinical experience and data available on their efficacy and safety. TCAs have been shown to be effective in the treatment of major depressive disorder, with some studies suggesting they may be particularly helpful for individuals with more severe or treatment-resistant depression. However, TCAs are generally considered to have a less favorable side effect profile compared to newer antidepressant classes, such as SSRIs and SNRIs. Common side effects of TCAs can include dry mouth, constipation, blurred vision, sedation, and an increased risk of cardiovascular effects, such as orthostatic hypotension and cardiac conduction abnormalities. Additionally, TCAs can be more dangerous in overdose situations, with a higher risk of potentially life-threatening toxicity, which can be a concern for some patients, particularly those with a history of suicidal ideation or attempts. Despite these drawbacks, TCAs can still be a valuable treatment option, particularly for patients who have not responded well to other antidepressant classes or who may benefit from the unique pharmacological profile of these medications. As with any medication, it's essential for patients to work closely with their healthcare providers to determine the most appropriate treatment plan and to monitor for any potential side effects or changes in their condition.

• 8. Monoamine Oxidase Inhibitors (MAOI)

  Monoamine Oxidase Inhibitors (MAOIs) are a class of antidepressant medications that work by inhibiting the activity of the enzyme monoamine oxidase, which is responsible for the breakdown of certain neurotransmitters, such as serotonin, norepinephrine, and dopamine. MAOIs were among the earliest antidepressants developed and have been used in the treatment of various mental health conditions, including depression, anxiety disorders, and Parkinson's disease. They are often considered a