PSYCHOTROPIC DRUGS PSYCHOTROPIC DRUGS Drugs with depressive type
- Slides: 67
PSYCHOTROPIC DRUGS
PSYCHOTROPIC DRUGS Drugs with depressive type of action 1. 2. 3. 4. Neuroleptics (antipsychotics) Tranquilizers (anxiolytics) Sedative drugs Normotymics (tymoleptics, tymoanaleptics) Drug with stimulative action 1. 2. 3. 4. Antidepressants Psychomotor stimulants Nootropic drugs Drugs which increase general tone (adaptogens) Psychotomimetics (psychodysleptics) 1. 2. LSD Cannabis sativa L.
NEUROLEPTICS Derivatives of phenotiazine: aminazine, triftiazine, etaperazine, tioridazine Derivatives of tioxanten: chlorprotixen Derivatives of butyrophenon: haloperidol, droperidol Derivatives of piperasinedibenzodiazepine: clozapine Derivatives of indole: reserpin, sulpyrid (eglonil)
NEUROLEPTICS “Typical” – derivatives of phenotiazine, tioxanten, butyrophenon – they cause disorders of extrapyramidal system function – syndrome of parkinsonism “Atypical” – derivatives of indole, benzodiazepine – they cause those negative reactions very rarely
Aminazine (chlorpromazine) 1951 – aminazine was introduced into clinical practice It brought considerable changes into situations of psychiatric clinics Before appearance of aminazine for treatment of psychologically sick patients insulin or electric shock were widely used, in some cases - lobotomy
Phenothiazine derivatives
Thioxanten derivateves
Butyrophenon derivatives
piperasine-dibenzodiazepine derivatives (Clozapin, Clozapine, Faza. Clo, Leponex, Zaponex, Clopin Eco. )
Mechanism of action of neuroleptics Influence on dopamine (D 2), noradrenergic, serotoninergic, GABAergic, cholinergic receptors
Properties of neuroleptics Antipsychotic action - they eliminate productive symptoms of psychosis (delirium and hallucinations), affective disorders They eliminate psychomotor excitation consciousness is present
1 Lung Cancer, 2 Criminality, 3 Stroke, 4 Breast Cancer, 5 Same Sex Attraction, 6 Leukemia, 7 Malformation, 8 Alzheimer’s, 9 Ulcerative Colitis, 10 Rheumatoid Arthritis, 11 Alcoholism, 12 Schizophrenia, 13 Depression, 14 Suicide attempt, 15 Diabetes type I, 16 Divorce, 17 Crohn’s disease, 18 Asthma, 19 Hypertension, 20 Co twin is best friend, 21 Diabetes type II, 22 Autism, 23 Opposite Sex Attraction, 24 Phenylketonuria
Administration of antipsychotic action of neuroleptics Treatment of psychosis Schizophrenia Maniac-depressive psychosis Alcohol psychosis Reactive psychosis In a case of psychomotor excitation of various etiology
Delirium tremens – alcohol psychosis
Influence of neuroleptics on psychical activity 1. Drugs with psychosedative action – they cause condition of psychomotor indifference (apathy, decreasing of moving activity, retarded emotions and wishes, disappearance of initiative) Aminazine, clozapine (leponex), chlorprotyxen, haloperidol, droperidol Peculiarities of usage: psychosis with manifestations of excitation Contraindications: psychosis with retardness, inertia, depression, stupor, apatho-abulic syndrome
Neuroleptics with psychosedative action
Influence of neuroleptics on psychical activity 2. Drugs which stimulate psychical activity (increase mimics and liveliness, increase moving activity, improve the mood) Triftazin, ethaperazin, moditen, majeptil Peculiarities of usage: psychosis with psychomotor retardness, apatho-abulic conditions, stupor conditions Contraindications: affective disturbances, mania, psychomotor excitation
Drugs which stimulate psychical activity
Other properties and indications for administration of neuroleptics Drugs with psychosedative action – for potentiation of action of hypnotic drugs, opioid and nonopioid analgesics, drugs for general anesthesia, local anesthetics, for example, neuroleptanalgesia Anti-emetic action (elimination of vomiting of central origin): brain tumors, radial and chemical therapy, intestinal impassability, intoxication with heart glycosides, apomorphine and other drugs Decreasing of body temperature (only in the case of simultaneous hypothermia) Decreasing of blood pressure (alpha-adrenoblocking properties – aminazine, droperidol) – in case of hypertensive crisis, lungs, brain edema
Side effects of neuroleptics Extrapyramidal disorders: muscular hypertonus, general constraint, tremor of hands, tongue, mandible, head, seizure contractions of muscles, vegetative crisis For treatment – cyclodol (levodopa is contraindicated because it diminishes therapeutic effect of neuroleptics) Orthostatic collapse Complicated nose breathing, hypostatic, aspirate pneumonia Dyspeptic disorders: anorexia, changes of taste Abdominal pain Constipation Damage of the liver (cholestasis) Granulocytopenia (especially clozapin) Hyperglycemia, dysmenorrhea, galactorrhea, hyperthyrosis, gynecomastia, impotence Aminazine has a considerable irritative action
syndrome of parkinsonism
Parkinsone syndrome treatment Cyclodolum Levodopa is contraindicated
TRANQUILIZERS Agonists of benzodiazepine receptors: - derivatives of benzodiazepine – chlozepid, sybazon, phenazepam, gidazepam Agonists of serotonine receptors: buspyrone Drugs with other mechanisms of action: - derivatives of diphenilmethan: amisyl - derivatives of propanediole: meprotan
TRANQUILIZERS
Properties of tranquilizers Anxiolytic properties – eliminate feeling of anxiety, restlessness, fear, aggressiveness, irritability, cause peace, careness, decreasing of moving activity Hypnotic (somnolent) action Myorelaxing action (of central genesis) Antiseizure action
Duration of action of tranquilizers Drugs of long lasting action: diazepam, phenazepam, chlozepid Drugs of medium action duration: lorazepam, alprazolam Drugs of short action duration: midazolam
“DAY” TRANQUILIZERS Gidazepam Mezapam (rudotel) Grandaxyn (tophizopam) Trioxazyn Buspyron
Administration of tranquilizers Anxiolytic action Treatment of neurosis, accompanied by fear, anxiety, exertion, increased irritability, insomnia In case of headache and heart pain of neurotic origin, so called organic neurosis In case of abstinence in alcohol and drugs addicts In case of diencephalons crisis (sybazon) Tranquilizers do not diminish productive symptoms of psychosis!
Usage of tranquilizers Hypnotic action – they cause sleep, which is very close to physiological one according to its parameters Nitrazepam Phenazepam Diazepam Chlozepid Depression of CNS – for atharalgesia Sibazon Midazolam
Administration of tranquilizers Anti-seizure and myorelaxing action (depression of CNS structures, braking polysynaptic spinal reflexes) sybazon, fenazepam In a case of seizures of any etiology (epileptic status, tetanus, poisoning with seizure causing poisons) sibazon is introduced intravenously (intramuscularly) – 2 -4 ml of 0, 5 % solution repeatedly (maximum daily dose – 14 ml) To eliminate muscle tension in a case of radiculitis, arthritis, myositis, bursitis
Seizures (tetanus) drug of a first choice - Sibazon
SIDE EFFECT OF TRANQUILIZERS Psychological and physical addiction Prophylaxis: 1. Duration of treatment course should not be more than 2 months 2. Repeated course – not earlier than after 3 weeks break Sleepiness, reeling walk, retarded reactions tranquilizers should not be administered in ambulatories to people whose professions are connected with quick reactions Paradox reaction of excitation, insomnia Dizziness, decreasing of libido, disturbances of menstrual cycle Uncontrolled urination, defecation, ataxia, dysarthria Acute poisoning in case of overdosing
FLUMAZENIL (ANEXAT) ANTAGONIST OF TRANQUILIZERS
Combination of tranquilizers with alcohol-containing drinks is absolutely contraindicated (pathological alcohol intoxication)
SEDATIVE DRUGS Bromides Drugs of plant origin: valerian, dog nettle, melissa, passiflora etc. They do not cause addiction, somnolence, myorelaxation, ataxia
Valeriana
PASSIFLORA
Leonurus L. dog nettle
ADMINISTRATION OF SEDATIVE DRUGS Neurosis Neurasthenia Hysteria Increased irritability Insomnia Primary stages of essential hypertension
Bromism Cause – accumulation of bromide ions in organism in case of their prolonged administration as a result of material accumulation Symptoms: rhinitis, cough, conjunctivitis, skin rash, general weakness, memory disorders Treatment: sodium chloride (10 -20 g / day), a lot of drinking (3 -5 l / day), regular and frequent cleaning of skin and digestive tract
Hypnotic agents
DRUGS FOR GENERAL ANESTHESIA
General anesthesia = Narcosis (from the Greek narkosis – numbness, rigidity) – Generalized reversible depression of the central nervous system such that perception of all senses is ablated, condition which is characterized by loss of consciousness, pain feelings, depression of reflexes and relaxation of skeletal muscles and which is obtained by administration of drugs for general anesthesia
“Gentlemen, this is no humbug. ” 1846 TG Morton: First public demonstration of ether administration for excision of neck mass
CLASSIFICATION OF GENERAL ANESTHETICS Intravenous agents primarily used for induction • Barbiturates (Thiopental-sodium) • Benzodiazepines (Midasolam, diazepam) • Etomidate • Ketamine • Propofol • Propanidid • Sodium oxybutyrate • Predion
Unitary Hypothesis General anesthesia can be caused by a remarkable number of structurally diverse molecules
Molecular Mechanism(s) of General Anesthesia Xe Isoflurane Halothane . . . Molecular (lipids & receptors) Cellular (synapses)
Effects of General Anesthesia Low Dose Effects High Dose Effects • Amnesia • Deep sedation • Euphoria • Muscle relaxation • Analgesia • Diminished motor responses • Hypnosis • Diminished autonomic responses • Excitation • Hyperreflexia • Myocardial protection from ischemia • Cardiovascular/respiratory depression • Hypothermia
Measures of Anesthetic Potency • MAC: minimum alveolar concentration • MAC is the concentration of anesthetic that produces immobility in 50% of patients exposed to a noxious stimulus. • MACawake: MAC at which response to commands are lost • amnesia, loss of awareness • MACBAR: blunt autonomic response • MACintubation: response to intubation
Surgical interventions are performed on 1 st and 2 nd levels, approximately till half of 3 rd level of third stage of narcosis
Ftorothane (halothane) Power of narcosis action of ftorothan is higher than of ether, it has a large width of narcotic action, doesn’t irritate mucous membranes of breath tracts, doesn’t cause laryngeal and bronchial spasm, speed of development of narcosis – 3 -5 min. , after narcosis depression is not expressed Side effects and complications hypotension and cardiac arrest, sensitization (increased sensitivity) of myocardium towards catecholamines acute damage of liver – halothane hepatitis, teratogenic action
Nitrogenous oxide Small power and width of narcosis action, stage of excitation is present, quick entry and exit from narcosis (1 -2 min) Administration as an analgesic: pregnancy, teeth extraction, bandaging in case of burns, cleaning and revisions of wounds, iscemic heart attacks and myocardium infarction, colics, traumas, acute pancreatitis, pain relief in post-operative period
Induction Speed
Anesthetic of the Future: Xenon • Rare gas extracted from air • Very expensive to produce • Close to ideal anesthetic • Low blood and tissue solubility (rapid induction/recovery) • Potent • Not metabolized • Nonflammable • Minimal side effects
Drugs for noninhalative narcosis
Thiopental-sodium After administration of the drug narcosis develops in 1 -2 min. , awakening occurs in 20 -30 min. Administration introduction narcosis, basis narcosis, mononarcosis in case of short-lasting operative interventions (dentistry, gynecology, traumatology), anti-seizure drug. Side effects cough, laryngeal and bronchial spasm In case of rapid introduction – depression of centers of medulla oblongata. In case of contact of the drug with skin, it’s separation may occur, contact with nervous trunk or near it – irreversible paralysis, contact with an artery – thrombosis with the following gangrene of the extremity
Propanidid (sombrevin) Narcosis develops after 30 -40 sec from the beginning of intravenous introduction of the drug (“on the edge of the needle”). Stage of surgical narcosis lasts for 3 -4 min Administration for mononarcosis during short operative interventions in surgery, dentistry, gynecology, urology, painful diagnostic procedures, sometimes – for introduction into narcosis Side effects and complications Frequent breathing (tachypnoe) with the following stopping of breathing (apnoe), phlebitis and thrombosis in the place of introduction anaphylactic reactions
Sodium oxybutyrate in case of intravenous introduction narcosis develops after 15 -40 min. id administered orally sleep comes after 30 -60 min. duration of narcosis is 1, 5 -3 hours. It manifests antihypoxia properties Administration mononarcosis – to perform long-lasting surgeries but with small traumatic effect premedication, introduction and basis narcosis. drug of choice for narcosis in case of intoxications, sepsis, disturbance of functions of parenchymatous organs, analgesia during child-delivery. to decrease psycho-motor excitation, seizures, insomnia Side effects motor excitation seizure twitching of extremities and tongue vomiting hypopotassiumemia.
Ketamine hydrochloride (ketalar, kalipsol) During intravenous introduction of the drug narcosis develops after 1530 sec, lasts for 8 -10 min, during intramuscular introduction – after 2 -3 min, lasts for 20 -30 min Administration introduction and basis narcosis mononarcosis during surgeries which don’t need muscular relaxation as a part of combined narcosis Side effects during coming out of narcosis – unpleasant dreams, delirium, hallucination, seizures, nausea, vomiting, increasing of blood pressure, increasing of frequency and power of heart contractions The drug is able to raise intracranial pressure, oxygen consumption by brain and intraoccular pressure
PROPOFOL (DIPRIVAN) drug with ultra-short action Narcosis develops after 30 -40 sec after intravenous introduction, lasts for 3 -5 min Administration Mononarcosis Polycomponent narcosis Artificial ventilation of lungs Positive moments: can’t be accumulated, doesn’t have afternarcosis depression, possesses anti-vomiting action Negative moments: doesn’t have analgesic action (it is often combined with fentanil, ketamine), possible hypotension, short apnoe
- Chapter 14 depressive disorders
- Mnemonics for personality disorders
- Grundformen der angst einfach erklärt
- What's bipolar
- Major depressive disorder
- Psychotropic medication
- Psychotropic medication
- Psychotropic medication
- Dfps psychotropic medication training
- Disadvantages of complete floor stock system
- Is hyper v type 1 or type 2
- What is the primary function of wave summation
- Type i error
- Type 2 vs type 1 error
- Rock cycle sedimentary
- Mr. p
- Sublimation in psychology
- Myotonic dystrophy
- Non smart instruments
- ıf clause type 1 exercises
- Difference between type 1 and type 2 error
- What is a null hypothesis
- Type checking and type conversion in compiler design
- Blood type offspring
- Type 1 vs type 2 fibers
- Type 2 hit
- Pot type mold & plunger type mold are the classification of
- Blood type and body type
- Pot type mold & plunger type mold are the classification of
- Conditional type 0 examples
- Name type compatibility and structure type compatibility
- Hull cutoff voltage equation
- Difference between o type and m type tubes
- Reference type and value type
- Type type revolution
- Type 1 error
- Economic importance of sunflower
- Type b
- Ccna drugs
- Schedule 1 drugs
- Antithyroid drugs classification
- Fibrinolytic drugs classification
- Fibrinolytic agents
- Thrombolytic drugs
- Thrombolytic drugs mechanism of action
- Thrombolytic drugs
- British model involved with drugs
- Phenylephrine mechanism of action
- Sar of anticholinergic drugs
- Premedication drugs list
- Section 17-3 practice commonly abused drugs
- Rachel beaty
- Mydriatics and miotics drugs
- Renal excretion ratio
- Remains by simon armitage context
- Principles of rational drug use
- Rate and rhythm control drugs
- Neurotransmitters and drugs
- Metabolism definition in pharmacology
- Large volume of distribution drugs
- Hagar conjugation
- Look alike drug list
- Tocolysis
- Tocolytics examples
- Tocolytic drugs
- Ppiucd tray
- Premedication drugs list
- Intracameral pilocarpine