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newSchoolWorks.com › VoTechWorks › Health & Personal Services › Pharmacy Technician › Pharmacology and the Top 200 Drugs › Lesson 6
HLT-PHAR41-02 · Lesson 6 · 15 clock hours · theory

Central nervous system and psychiatric drugs

Objective. Classify antidepressants, antipsychotics, anxiolytics, anticonvulsants, sleep aids and ADHD medicines, noting which are controlled substances.

⚠ Pending professional review

This lesson, its worked examples and its practice questions has not yet been verified by a licensed pharmacist or by a certification or approval body. It is a study draft and may contain errors. Do not use it to make decisions about any patient or medication. Always follow your instructor, your supervising professional, and current official references and regulations.

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Central Nervous System and Psychiatric Drugs

The central nervous system (CNS) and psychiatric drug category is one of the largest and most complex groups in pharmacy practice. Technicians must be able to classify these drugs by therapeutic category, recognize common brand and generic names, identify controlled substances, and flag look-alike or sound-alike name pairs that create safety risks.

Antidepressants

Antidepressants are used for major depressive disorder, anxiety disorders, obsessive-compulsive disorder (OCD), and other conditions. There are several subclasses.

Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed antidepressants. They block the reuptake of serotonin in the synapse. Examples include fluoxetine (Prozac), sertraline (Zoloft), escitalopram (Lexapro), citalopram (Celexa), and paroxetine (Paxil). SSRIs are not controlled substances.

Serotonin-norepinephrine reuptake inhibitors (SNRIs) block reuptake of both serotonin and norepinephrine. Examples include venlafaxine (Effexor XR), duloxetine (Cymbalta), and desvenlafaxine (Pristiq). SNRIs are not controlled substances.

Tricyclic antidepressants (TCAs) are older agents with more side effects. Examples include amitriptyline (Elavil), nortriptyline (Pamelor), and imipramine (Tofranil). TCAs are not controlled substances but carry overdose risks.

Monoamine oxidase inhibitors (MAOIs) such as phenelzine (Nardil) and tranylcypromine (Parnate) have significant dietary and drug interactions and are used infrequently. Not controlled substances.

Atypical antidepressants include bupropion (Wellbutrin, Zyban), mirtazapine (Remeron), and trazodone (Desyrel). None are controlled substances, though bupropion is also used for smoking cessation and, off-label, for ADHD.

Antipsychotics

Antipsychotics treat schizophrenia, bipolar disorder, and are used as adjunct therapy in other psychiatric conditions.

First-generation (typical) antipsychotics include haloperidol (Haldol) and chlorpromazine (Thorazine). They carry a risk of extrapyramidal side effects (EPS).

Second-generation (atypical) antipsychotics have a lower EPS risk and include risperidone (Risperdal), quetiapine (Seroquel), olanzapine (Zyprexa), aripiprazole (Abilify), and clozapine (Clozaril). Clozapine requires a special REMS program because of the risk of agranulocytosis.

Antipsychotics are not controlled substances.

Anxiolytics

Anxiolytics reduce anxiety. The two main subclasses are benzodiazepines and non-benzodiazepine anxiolytics.

Benzodiazepines enhance the effect of GABA and are Schedule IV controlled substances. Common examples include alprazolam (Xanax), lorazepam (Ativan), diazepam (Valium), clonazepam (Klonopin), and chlordiazepoxide (Librium). They carry risks of dependence, tolerance, and respiratory depression, especially when combined with opioids.

Buspirone (Buspar) is a non-benzodiazepine anxiolytic that is not a controlled substance and has no significant dependence risk.

Anticonvulsants (Antiepileptics)

Anticonvulsants treat seizure disorders and are also used for bipolar disorder, neuropathic pain, and migraine prevention.

Common agents include phenytoin (Dilantin), valproic acid (Depakote), carbamazepine (Tegretol), levetiracetam (Keppra), lamotrigine (Lamictal), and gabapentin (Neurontin).

Pregabalin (Lyrica) is classified as a Schedule V controlled substance under federal law. Gabapentin is not federally scheduled, though some states have placed it under state scheduling.

Phenytoin and carbamazepine are narrow therapeutic index (NTI) drugs, meaning small changes in dose can cause toxicity or loss of effectiveness.

Sleep Aids

Benzodiazepine receptor agonists (Z-drugs) are the most commonly prescribed prescription sleep aids. They include zolpidem (Ambien), zaleplon (Sonata), and eszopiclone (Lunesta). All are Schedule IV controlled substances.

Ramelteon (Rozerem) is a melatonin receptor agonist used for insomnia and is not a controlled substance.

Doxepin (Silenor) at low doses is approved for insomnia and is not a controlled substance.

OTC sleep aids often contain diphenhydramine (e.g., ZzzQuil, Unisom SleepTabs), which is antihistamine-based and not a controlled substance.

ADHD Medications

Attention-deficit/hyperactivity disorder (ADHD) is treated primarily with stimulants and one non-stimulant agent.

Stimulants are the first-line treatment. Amphetamine-based agents include mixed amphetamine salts (Adderall, Adderall XR) and lisdexamfetamine (Vyvanse); these are Schedule II controlled substances. Methylphenidate-based agents include methylphenidate (Ritalin, Concerta) and dexmethylphenidate (Focalin); also Schedule II.

Atomoxetine (Strattera) is a non-stimulant SNRI-like agent for ADHD and is not a controlled substance.

Look-Alike/Sound-Alike Name Pairs

Several CNS drug names are easily confused:

Always verify the full drug name, strength, and indication before processing any order.

Controlled Substance Summary for This Class

| Schedule | Examples |

|----------|----------|

| Schedule II | Amphetamine salts, lisdexamfetamine, methylphenidate |

| Schedule IV | Benzodiazepines (alprazolam, diazepam, lorazepam, clonazepam), Z-drugs (zolpidem, eszopiclone, zaleplon) |

| Schedule V | Pregabalin |

| Not scheduled | SSRIs, SNRIs, antipsychotics, atomoxetine, buspirone, ramelteon |

Recognizing controlled status is essential for legal dispensing, proper recordkeeping, and patient safety.

Key terms10

SSRISelective serotonin reuptake inhibitor; a class of antidepressants that block serotonin reuptake in the synapse (e.g., fluoxetine, sertraline).
SNRISerotonin-norepinephrine reuptake inhibitor; antidepressants that block reuptake of both serotonin and norepinephrine (e.g., venlafaxine, duloxetine).
BenzodiazepineA Schedule IV class of CNS depressants that enhance GABA activity, used for anxiety and seizures (e.g., alprazolam, diazepam); carry dependence risk.
Atypical antipsychoticSecond-generation antipsychotic agents with lower risk of extrapyramidal side effects compared to older agents (e.g., risperidone, quetiapine, olanzapine).
Z-drugA benzodiazepine receptor agonist used for insomnia (zolpidem, zaleplon, eszopiclone); classified as Schedule IV controlled substances.
Narrow therapeutic index (NTI)A drug characteristic in which the difference between an effective dose and a toxic dose is small, requiring careful monitoring (e.g., phenytoin, carbamazepine).
REMSRisk Evaluation and Mitigation Strategy; an FDA-required safety program for drugs with serious risks, such as clozapine for agranulocytosis monitoring.
Extrapyramidal side effects (EPS)Movement-related adverse effects (tremor, rigidity, restlessness) caused especially by first-generation antipsychotics.
Schedule IIThe most restrictive DEA controlled substance schedule for drugs with accepted medical use; includes stimulant ADHD medications such as amphetamine salts and methylphenidate.
Look-alike/sound-alike (LASA)Drug names that resemble one another visually or phonetically, creating a risk of dispensing errors (e.g., clonazepam vs. clonidine).
In class: Class sorting · Controlled vs non-controlled flags · Look-alike name pairs in this group
Materials: Drug references
Check: Quiz ≥ 80%

Practice check8

Answer each question, then check it. Nothing is recorded; this is your own practice.

PTCE domain: Medications
1. A prescriber writes for escitalopram 10 mg daily. Which drug class does escitalopram belong to?
PTCE domain: Federal Requirements
2. Which of the following ADHD medications is classified as a Schedule II controlled substance?
PTCE domain: Federal Requirements
3. A technician receives a prescription for zolpidem 10 mg at bedtime. Which statement about this drug is correct?
PTCE domain: Federal Requirements
4. Which anticonvulsant is classified as a Schedule V controlled substance under federal law?
PTCE domain: Federal Requirements
5. A patient's profile shows a prescription for clonazepam. The pharmacist asks the technician to flag this drug's schedule. Which answer is correct?
PTCE domain: Patient Safety and Quality Assurance
6. A technician is filling a prescription and notices the drug name looks similar to another drug. Which pair represents a look-alike/sound-alike risk within the CNS drug category?
PTCE domain: Patient Safety and Quality Assurance
7. Which of the following antipsychotic agents requires enrollment in a Risk Evaluation and Mitigation Strategy (REMS) program due to the risk of agranulocytosis?
PTCE domain: Order Entry and Processing
8. A prescriber orders duloxetine 60 mg daily for a patient with depression and diabetic neuropathy. When entering the order, the technician should classify duloxetine as which type of drug?
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