Psychopharmacology

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Psychopharmacology

  1. 1. PSYCHOPHARMACOLOGY By: Ahmed Albehairy, M.D Trainer in EBP
  2. 2. General Principles of Psychopharmacology- There is no one-diagnosis-one-drug abuse.- Drug selection is related not only to diagnosis but also to the meaning to patient and family influences.- Instructions about the treatment benefits and risks is a must for the patient , relatives and nursing staff.
  3. 3. Pharmacological Actions( Pharmacodynamics- Pharmacokinetics )Pharmacodynamics, include:- Receptors mechanisms( agonist, antagonist, partial agonist, vs. lithium) .- The dose response curve ( dose response, potency, & clinical efficacy).- Therapeutic index = median toxic dose median effective dose ( high, SSRI vs. low, lithium).- Tolerance, dependence & withdrawal receptors.
  4. 4. Pharmacological Actions ( Pharmacodynamics- Pharmacokinetics )Pharmacokinetics- Absorption: Oral ( drug concentration, GIT ph, & motility). I.M.( DEPOT, 1- WKS). I.V( Fast, high risk of S.E).- Distribution : High (CBF, lipid solubility, & receptor affinity). Vary with age, sex, AT.- Metabolism : metabolic routes( oxidation, reduction, hydrolysis, & conjugation). Active and inactive metabolites. End by liver in feces, sweat , saliva, etc. Half life . Clearance.- Cytochrome P450 enzymes.
  5. 5. Pharmacological Actions ( Pharmacodynamics- Pharmacokinetics ) Pharmacokinetics, - Cytochrome P450 enzymes.- ?- Rapid vs. poor metabolizers.- Cyt P 450 Polymorphisms.- 1A2, 2C19, 2C9, 2D6 , 3A3, 4, 5, 7.- Tables ( substrates, inhibitors, & inducers).- Inhibitors e.g. 1A2 Fluvoxamine ------ clomipramine, clozapine, haloperidol. 2C19 Fluxetine, paroxetine -----citalopram, diazepam, propranlol, imipramine.- Inducers e.g. 2C19 Carbamezapine ------- citalopram, diazepam, propranlol, imipramine. 3A3 Carbamezapine ------- carbamezapine, clozapine , TCA, trazodone, verapamil.
  6. 6. CLINICAL GUIDELINEOptimum Results = 5 Ds.- Diagnosis: reinvestigate.- Drug selection : diagnosis, drug history, tolerable S.E, lethal dose, & abuse potential.- Dose : low – slow ., effectiveness vs. S.E.- Duration : 3 – 6 wks, long term administration.- Dialogue: Drug information.
  7. 7. Special Considerations- Children : high metabolism, low – slow, /kg.- Geriatric : low metabolism , 1/3 adult dose, drug interaction and medical state.- Pregnancy & lactation: avoid drugs esp. in 1st trimester, avoid absolutely ( lithium , anticonvulsant in pregnancy) . ECT is good.- Hepatic and renal problems: half the dose.
  8. 8. TREATMENT OF COMMON S.E- Sexual dysfunction : bupopione , Viagra, reassurance, yohimbex, amantadine, cryptoheptadine.- Anxiety in SSRI.- Insomnia of SSRI.- GIT upset.- headache.- Wt gain .- somnolence.- Dry mouth.- Blurred vision.- Orthostatic hypotension.- Urinary retention , constipation.
  9. 9. MEDICATION – INDUCED MOVEMENT DISORDERSMovement disorder Drug responsible TreatmentTremor APD, sympathomimetics, propranolol TCA, alcohol, MAODystonia APD,TCA, DIPHENYL BZD, A CH HYDRAMINE, METOCLOPRAMODEAkathesia APD,TCA, levo dopa, propranolol reserpine METOCLOPRAMODEParkinsonism APD,TCA, reserpine, Dec medications., change, A fluxetine, lithium, phenytoin, CH. alcohol withdrawal.TARDIVE DYSKINESIA APD, > 4 Y, age, female ????Neuroleptic M. syndrome APD Dantrium, fluid, bromocriptine,
  10. 10. DRUG TREATMENT OF EXTRAPYRAMIDAL DISORDERSDrug name Usual daily dose indicationsbenztropine 1-4 mg , twice per day Acute dystonia, parkinsonism,biperdin 2- 6 mg, tid akathesia.procyclidine 2.5 – 5 mg 2-4 /dDipheny hydramine 25 mg QID Acute dystonia, parkinsonism, rabbit syndrome.Amantadine 100 – 300 mg parkinsonism, rabbit syndrome.CLONAZEPAM 1mg bid dystonia, akathesia.LORAZEPAM 1mg tid
  11. 11. Classification ofPsychotherapeutic Drugs- Antipsychotic drugs.- Antidepressant .- Anti manic or mood stabilizers.- Anti anxiety , anxiolytic drugs.- Others ( geriatric , child , addiction , general medications). ??????? Less valid categories
  12. 12. PREPRATIONS OF BZD RECEPTORS AGONIST AND ANTAGONISTDRUG DOSE HALF LIFE USUAL ADULT EQUAVILANT DOSECLONAZEPAM 0.5 LONG 1-6 MG /D BIDDIAZEPAM 5 LONG 4-40MG /D BID - QIDALPRAZOLAM 0.25 INTERMEDIATE 0.5-10MG/DBID TO QIDLORAZEPAM 1 INTERMEDIATE 1-6 MG /D TIDCHLORDIAZEPO 10 INTERMEDIATE 10 – 150 MG TID OEXIDE QIDFLURAZEPAM 5 SHORT 15-30 MGCLORAZEOATE 7.5MG SHORT 15 – 60 MG BID OR QIDMIDAZOLAM 1.25- 1.7 SHORT 5 – 50 MG PARENTRALFLUMEZANIL 0.05 SHORT 0.2- 0.5 MG /MININJECTION OVER 3- 10 MIN
  13. 13. TYPICAL ANTIPSYCHOTICSDRUG POTENCY EQUIVALA ADULT SEDATION EXTRAPYRAMIDAL NCY TO DOSE EFFECT 100MG OF MG CLORPRO MAZINECHLORPR LOW 100 300-800 HIGH LOWOMAZINETRIFLUPE HIGH 3.5 6-20 MEDIUM HIGHRAZINEFLUPHENA HIGH 1.5-3 1-20 MEDIUM HIGHZINETHIORIDA LOW 100 200-700 HIGH LOWZINEHALOPERI HIGH 2.5 6-20 LOW HIGHDOLPIMOZIDE HIGH 1 1-10 LOW HIGH
  14. 14. ATYPICAL ANTIPSYCHOTICS- NAME .- ?????- CLOZAPINE - RISPERIDONE- OLANZAPINE – QUITIAPINE – ZIPRASIDONE – ARIPIPRAZOLE.- DOSE.- PRCAUTIONS ( MEDICAL STATE OF THE PATIENT , S.E, DRUG INTERACTIONS).
  15. 15. DEPOT FORMS??MODECATEFLUNOXOLCLOPOXOLHALOPERIDOLPERIDOLIMAPRISPERIDAL GENERIC NAME, DOSE, DURATION
  16. 16. CLO IMI NOR CITA FLU FLU SER PAR TRA BUP VEN MIR TIAA MIP PRA TIPT LO XETI VOX TER OXE ZOD ROP LAF TAZ NEP RAM MIN VLLI NE AMI ALIN TINE ONE ION AXI API TIN INE E NE NE E E NE NENE R +++ +++ +++ + ++ ++ ++ +++ + + ++ + -I +5HT +++ +++ ++ +++ +++ +++ +++ +++ ++ +- +++ + -RI + + + + ++DRI + + + +- + + + + +- ++ + - -5HT1 + + ++ +- +- +- +- +- +++ +- +- - -BL5HT2 +++ +++ +++ + ++ + + +- +++ +- +- +++ -BL + +ACH +++ +++ ++ - + +- +- +- - - - ++ -BLH1 +++ +++ +++ ++ + - - +- ++ - - +++ -BL ++A1 +++ +++ +++ + + + + + +++ - - ++ -BLA2 + + + +- +- + + + ++ +- +- +++ -BLD2 ++ + + +- + ++ +- +- + - - + -BL
  17. 17. LITHIUMMECHANISMINDICATIONSPRECATIONSINTERACTIONSSTOP??????
  18. 18. PSYCHOTROPICS IN PROBLEM AREAS APD AD ANXIOLY ANTI OTHERS TICS CNVALSE N HEART SULPRIDE,O MIANSERIN BZD, BZD, ACOMPROPROBLEM LANZAPINE, E, BUSPAR LAMOTRIGI SATE , QUATIAPIN MIRTAZEPI N, MEMANTI E, NE, SSRI, TOPRAMAIT NE ZUCLOPENT TRAZODONE E, H VALPROATE LIVER SULPRIDE, MIANSERIN LORAZEPAM CARBAMEZ, LITHIUM, PIMOZIDE, E, , TOPRAMAIT MEMANTI ARIPEPRA, PAROXETIN TEMAZEPAM E NE HALDOL E RENAL LOXAPINE MIANSERIN BZD PHENYTOIN ANTICHOL E, TCA, N INEESTRA TRAZODON SEDIABETU ARIPIPAZ, SSRI. BZD, ACOMPRO SULPRIDE, TRAZODONE BUSPAR SATE ,, S PIMOZIDE, MODAFINI HALDOL L
  19. 19. PSYCHOTROPICS IN PROBLEM AREAS APD AD ANXIOLY ANTI OTHER TICS CNVALSE S NBREAST SULPRIDE TCA, BZD CARBAMEZ FLUPENTHE APINE, FEED XOLE VALPROATEEPILEPSY SULPRIDE, SSRI BZD AMISULPRI DE, HALDOL, PIMOZIDE, QUATIAPIN E RISPERIDO NEGLAUCO HALDOL, TRAZODON ACOMPR RISPERIDO E, OSATE , MA NE, VENLAFAXI MEMANT SULPRIDE NE INE LITHIUM
  20. 20. AVOID THE FOLLOWINGS BREAST FEEDING: ARIPRPRAZOLE, CLOZAPINE, OLANZAPINE, RISPERIDONE, MAAOI, VENLAFAXINE, BUSPIRONE, OTHER ANTIEPILEPTICS. HEAR PROBLEM , CLOZAPINE, PIMOZIDE, THIORIDAZINR, ZIPRASIDONE, TCA, VENLAFAXINE, DISULFRAM , . DIABETUS: OLANZAPINE, MAOI. EPILEPSY, CHLORPROMAZINE, CLOZAPINE, BUPROPION GLAUCOMA: OLANZAPINE, TCA. LIVER PROBLEM: ZOTEPINE, MAOI, BZD, VALPROATE,PHENYTOIN, BARBITURATE. RENAL PROBLEMS:AMISULPRIDE, RISPERIDONE, SULPRIDE, FLUXETINE, VENLAFAXINE, BUSPIRONE, AVOID ANTI CONVULSANT OTHER THAN PHENYTOIN.
  21. 21. ‫شكرا علي حسن‬

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