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Farmakologija CNS-a
Psihofarmaci su lijekovi koji djeluju na
psihičku funkciju, ponašanje i doživljaje.
Antipsihotici
 Liječenje šizofrenije, psihoza, manija, paranoje.
 Dopaminska hipoteza o nastanku psihoza-
poremećaj metabolizma dopamina u CNS-u višak
dopamina na dopaminskim receptorima
 Antipsihotici blokiraju postsinaptičke dopaminske
D2 receptore
 Blokatori D2 receptora mogu biti selektivni i neselektivni
 Neželjeni efekti mogu biti: žutica, agranulocitoza, tremor, sedacija,
ginekomastija, galaktoreja, ortostatska hipotenzija, suha usta,
opstipacija, tardivna diskinezija
 Predstavnici:hlorpromazin, flufenazin, haloperidol, klozapin
Antidepresivi
 Osjećaj beskrajne tuge, zabrinutosti, straha, bez interesa za okolinu,
usporeno mišljenje, nesanica, smanjen libido, gubitak apetita,
suicidalne misli
 Reaktivna i endogena depresija
 Uzrok nedostatak noradrenalina, dopamina i serotonina na
postsinaptičkim receptorima
 Blokatori ponovnog preuzimanja noradrenalina i serotonina- triciklični
antidepresivi (imipramin, amitriptilin)
 Inhibitori monoaminooksidaze (selegilin)- CHEESE efekat
 Nova generacija (fluoksetin, mianserin)
 Dejstvo lijeka kasni dvije sedmice!
 Neželjeni efekti: prekomjerna sedacija, suha usta, prekomjerna
tjelesna težina
 Bipolarni poremećaj
Anksiolitici, sedativi i hipnotici
 Barbiturati i benzodiazepini stimulišu GABA receptor u mozgu
posredstvom GABA-e, za posljedicu Cl- joni ulaze u neuron i on
postaje hiperpolarizovan i manje podražljiv
 Diazepam, bromazepam
 Neželjeni efekti:pospanost, nemogućnost koordinacije pokreta,
tolerancija, ovisnost
 Nikako kombinovati sa alkoholom!
Antiepileptici
 Epilepsija- posljedica nenormalnih bioelektričnih pražnjenja u mozgu,
usljed hematoma, promjene elektrolitnog sastava tjelesnih tečnosti ili
oštećenja
 Parcijalne, primarno generalizovane i sekundarno generalizovane
 Barbiturati i benzodiazepini djeluju inhibitorno tako što olakšavaju
vezivanje GABA za receptor, a Na-valproat sprječava razgradnju GABA-
e
 Neželjeni efekti:agranulocitoza i hepatitis
Analgetici- lijekovi za suzbijanje bola
Opioidni analgetici
 Stimulacijom opioidnih receptora, na koje fiziološki djeluju endorfini
 Za najjače bolove, djeluju i na prag bola i na emotivni odgovor na bol
 Morfin, fentanil, metadon, kodein
 Mogu izazvati respiratornu depresiju, toleranciju i fizičku ovisnost-
apstinencijalni sindrom
Nesteroidni antiinflamatorni analgetici (NSAIL)
 Za suzbijanje blagog do umjerenog bola
 Inhibiraju enzim ciklooksigenazu-enzim koji stvara prostaglandine-
faktori upalnih procesa i nastanka bola
 Većina djeluje i antiinflamatorno, antireumatski i antipiretski
 Paracetamol, acetil-salicilna kiselina, ibuprofen
 Neželjeni efekat-oštećenje sluznice GIT-a
Antiparkinsonici
 Parkinsonova bolest- usporenost pokreta, povećana napetost
muskulature, tremor i poremećaj u održavanju ravnoteže.
 Dopaminergični neuroni ubrzano propadaju, smanjuje se količina
dopamina, a povećava se količina acetilholina
 Antiholinergici- blokiraju acetilholinske receptore
Triheksifenidil, prociklidin
Neželjeni efekti: suha usta, tahikardija, midrijaza, retencija urina
Levodopa
 Prolazi krvno-moždanu barijeru, dekarboksiluje se i pretvara u
dopamin. Koristi se u kombinaciji sa karbidopom, koja inhibira
perifernu DOPA-dekarboksilazu
Amantadin
 Povećava oslobađanje dopamina iz nervnih završetaka, sprječava
njegovo ponovno preuzimanje i djeluje antiholinergički
Selegilin, bromokriptin...

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Farmakologija cns a

  • 1. Farmakologija CNS-a Psihofarmaci su lijekovi koji djeluju na psihičku funkciju, ponašanje i doživljaje.
  • 2. Antipsihotici  Liječenje šizofrenije, psihoza, manija, paranoje.  Dopaminska hipoteza o nastanku psihoza- poremećaj metabolizma dopamina u CNS-u višak dopamina na dopaminskim receptorima  Antipsihotici blokiraju postsinaptičke dopaminske D2 receptore
  • 3.  Blokatori D2 receptora mogu biti selektivni i neselektivni  Neželjeni efekti mogu biti: žutica, agranulocitoza, tremor, sedacija, ginekomastija, galaktoreja, ortostatska hipotenzija, suha usta, opstipacija, tardivna diskinezija  Predstavnici:hlorpromazin, flufenazin, haloperidol, klozapin
  • 4. Antidepresivi  Osjećaj beskrajne tuge, zabrinutosti, straha, bez interesa za okolinu, usporeno mišljenje, nesanica, smanjen libido, gubitak apetita, suicidalne misli  Reaktivna i endogena depresija  Uzrok nedostatak noradrenalina, dopamina i serotonina na postsinaptičkim receptorima
  • 5.
  • 6.  Blokatori ponovnog preuzimanja noradrenalina i serotonina- triciklični antidepresivi (imipramin, amitriptilin)  Inhibitori monoaminooksidaze (selegilin)- CHEESE efekat  Nova generacija (fluoksetin, mianserin)  Dejstvo lijeka kasni dvije sedmice!  Neželjeni efekti: prekomjerna sedacija, suha usta, prekomjerna tjelesna težina  Bipolarni poremećaj
  • 7. Anksiolitici, sedativi i hipnotici  Barbiturati i benzodiazepini stimulišu GABA receptor u mozgu posredstvom GABA-e, za posljedicu Cl- joni ulaze u neuron i on postaje hiperpolarizovan i manje podražljiv  Diazepam, bromazepam  Neželjeni efekti:pospanost, nemogućnost koordinacije pokreta, tolerancija, ovisnost  Nikako kombinovati sa alkoholom!
  • 8. Antiepileptici  Epilepsija- posljedica nenormalnih bioelektričnih pražnjenja u mozgu, usljed hematoma, promjene elektrolitnog sastava tjelesnih tečnosti ili oštećenja  Parcijalne, primarno generalizovane i sekundarno generalizovane  Barbiturati i benzodiazepini djeluju inhibitorno tako što olakšavaju vezivanje GABA za receptor, a Na-valproat sprječava razgradnju GABA- e  Neželjeni efekti:agranulocitoza i hepatitis
  • 9. Analgetici- lijekovi za suzbijanje bola Opioidni analgetici  Stimulacijom opioidnih receptora, na koje fiziološki djeluju endorfini  Za najjače bolove, djeluju i na prag bola i na emotivni odgovor na bol  Morfin, fentanil, metadon, kodein  Mogu izazvati respiratornu depresiju, toleranciju i fizičku ovisnost- apstinencijalni sindrom
  • 10. Nesteroidni antiinflamatorni analgetici (NSAIL)  Za suzbijanje blagog do umjerenog bola  Inhibiraju enzim ciklooksigenazu-enzim koji stvara prostaglandine- faktori upalnih procesa i nastanka bola  Većina djeluje i antiinflamatorno, antireumatski i antipiretski  Paracetamol, acetil-salicilna kiselina, ibuprofen  Neželjeni efekat-oštećenje sluznice GIT-a
  • 11.
  • 12. Antiparkinsonici  Parkinsonova bolest- usporenost pokreta, povećana napetost muskulature, tremor i poremećaj u održavanju ravnoteže.  Dopaminergični neuroni ubrzano propadaju, smanjuje se količina dopamina, a povećava se količina acetilholina  Antiholinergici- blokiraju acetilholinske receptore Triheksifenidil, prociklidin Neželjeni efekti: suha usta, tahikardija, midrijaza, retencija urina
  • 13. Levodopa  Prolazi krvno-moždanu barijeru, dekarboksiluje se i pretvara u dopamin. Koristi se u kombinaciji sa karbidopom, koja inhibira perifernu DOPA-dekarboksilazu Amantadin  Povećava oslobađanje dopamina iz nervnih završetaka, sprječava njegovo ponovno preuzimanje i djeluje antiholinergički Selegilin, bromokriptin...