CNS by Dr. Nadeem Korai

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CNS by Dr. Nadeem Korai

  1. 1. CENTRAL NERVOUS SYSTEMDr. Nadeem akhtarMBBS.M.PhilAsst. Professor PharmacologyAmna Inayat Medical CollegeShaikhupura
  2. 2. ANTI-DEPRESSANTSDrugs which are prescribedto relieve depression
  3. 3. Depression• Low mood• Depressed feelings• Lonely living• Lack of energy• Other physical problems
  4. 4. • 17 % world wide prevalence• 4 th number in the list of 10 world widecommon diseases ,noted by WHO• This will be on second number in 2020
  5. 5. Typical pic of depressed individual
  6. 6. Pathophysilogy• 1. Amines hypothesis• 2.Neurotrophic hypothesis
  7. 7. Physical or Pharmacological treatment• A)Trycyclic antidepressants (TCAs)• Imipramine• Clomipramine• Amitriptyline
  8. 8. Mode of action• They inhibit re-uptake mechanisms• Terminate synaptic actions of NE & 5-HT in thebrain
  9. 9. Effects• A.N.S• produce anticholinergic actions• C.V.S• Ventricular dysrythmias• Hypertension (rarely)
  10. 10. Drug interactions• Antagonize the centrally acting drugantihypertensive agents e.g Clonidine• If given with MAOS, patient develop severehypertension
  11. 11. Indications• Major depressive disorder (MDD)• Panic disorder (PD)• Obsessive compulsive disorder (OCD)• Enuresis• Chronic fatigue• Diabetic neuropathy• Eating disorders
  12. 12. Adverse effects• Dryness of mouth• Constipation• Tachycardia• Blurring of the vision• Retention of urine• Postural hypotension• Sedation• Weight gain• Tremors• Sexual problems
  13. 13. Contra-indications• Glaucoma• Pregnancy• Benign prostate hypertrophy (BPH)
  14. 14. Selective serotonin reuptake inhibitors(SSRIs)• Fluxetine• Citalopram• Escitalopram• Paroxitine
  15. 15. Mode of action• Highly selective on 5-HT receptors• Minimal inhibitory effect on NE transportersor blocking actions on adrenergic orcholinergic receptors
  16. 16. Adverse effects• Minimal anticholinergic action and mildconstipation• Suicidal ideation with long term use• Erectile dysfunction
  17. 17. Monoamine oxidase inhibitors• Phenalzine• tranylcypromine
  18. 18. Mode of action• Increase amine level by interfering their• metabolism at nerve endings and• increasing storage of NE & 5-HT
  19. 19. usage• Indicated when other treatment fail• Dangerous drug-drug or drug & foodinteractions can develop
  20. 20. Serotonin-norepinephrine reuptakeinhibitors (SNRIs)• Venlafaxine• Duloxetine• Milancipran
  21. 21. 5-HT2 Antagonists• Trazodone• Nefazodone

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