Psychopharmacoloy

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Psychopharmacoloy

  1. 2. PSYCHOPHARMACOLOGY CHAIRPERSON DR. NAVEEN KUMAR C ASSISTANT PROFESSOR DEPARTMENT OF PSYCHIATRY NIMHANS PRESENTED BY PRAVEEN C THULASI 1 ST MSc NURSING NIMHANS
  2. 3. INTRODUCTION The advent of psychopharmacology in the last five and a half decades has brought the treatment of psychiatric disorders in the realm of scientific medicine. Introduction of chlorpromazine in 1952 revolutionized the treatment of psychiatric disorders .
  3. 4. IDEAL PSYCHOTROPIC DRUG <ul><li>Should cure underlying pathology. </li></ul><ul><li>Should benefit all patients suffering from that </li></ul><ul><li>disorder. </li></ul><ul><li>No side effects or toxicity. </li></ul><ul><li>Rapid onset of action. </li></ul><ul><li>No dependence or withdrawal symptoms on stopping. </li></ul><ul><li>No tolerance to the drug on longer duration. </li></ul><ul><li>Should not be lethal in overdoses. </li></ul><ul><li>used in both inpatient and outpatient settings </li></ul>
  4. 5. CLASSIFICATION OF PSYCHOTROPIC DRUGS <ul><li>Antipsychotics. </li></ul><ul><li>Antidepressants. </li></ul><ul><li>Mood stabilizing agents. </li></ul><ul><li>Anti anxiety and hypnotics. </li></ul><ul><li>Anti epileptics. </li></ul><ul><li>Antiparkinsonians . </li></ul>
  5. 6. PHARMACOLOGICAL ACTION OF PSYCHOTROPIC DRUGS <ul><li>Agonist action at a receptor. </li></ul><ul><li>Antagonist action at a receptor. </li></ul><ul><li>Partial agonist action at a receptor. </li></ul><ul><li>Action via second messengers. </li></ul><ul><li>Altered neurotransmitter storage. </li></ul><ul><li>Increased neurotransmitter release. </li></ul><ul><li>Inhibition of neurotransmitter reuptake. </li></ul><ul><li>Inhibition of endogenous metabolism. </li></ul>
  6. 7. ANTIPSYCHOTICS <ul><li>Indications: organic psychiatric disorders, non-organic psychotic disorders, child psychiatric disorders, neurotic and other psychiatric disorders, medical disorders. </li></ul><ul><li>Classes of drugs: phenothiazine(CPZ), thioxanthines (thiothixene), butyrophenones (haloperidol),diphenylbutylpiperidines (pimozide), indolicderivatives (molindone), dibenzoxazepines(loxapine),atypical antipsychotics ( clozapine, amisulpride, risperidone, olanzapine, quetiapine, aripiprazole) </li></ul>
  7. 8. SIDE EFFECTS OF ANTIPSYCHOTICs <ul><li>Autonomic side effects: dry mouth, constipation, urinary retention, impotence, orthostatic hypotension. </li></ul><ul><li>EPSE : parkinsonian syndrome, dystonia, akathesia, </li></ul><ul><li>neuroleptic malignant syndrome. </li></ul><ul><li>Other CNS effects: seizures, sedation, depression or pseudo depression. </li></ul><ul><li>Metabolic and Endocrine side effect: weight gain, diabetes, galactorrhea with or without amenorrhea </li></ul><ul><li>Allergic side effects: cholestatic jaundice, agranulocytosis. </li></ul><ul><li>Cardiac , Ocular and Dermatological side effects. </li></ul>
  8. 9. ANTI DEPRESSANTS <ul><li>Indication: depression, child psychiatric disorders </li></ul><ul><li>( ADHD, Enuresis etc.),other psychiatric disorders </li></ul><ul><li>( OCD, PTSD, alcohol dependence etc.), medical disorders ( chronic pain, migraine, peptic ulcer disease). </li></ul><ul><li>Class of drugs: cyclic antidepressants (imipramine, amitriptylline), SSRIs (fluoxetine, sertraline), SNRIs, NSREs, NaSSA, NDRIs, SARIs, NARIs, MAOIs </li></ul>
  9. 10. SIDE EFFECTS OF ANTI- DEPRESSANTS <ul><li>Autonomic side effects: dry mouth, constipation, delirium, urinary retention. </li></ul><ul><li>Sexual side effects: impotence, anorgasmia. </li></ul><ul><li>CNS effects: sedation, withdrawal syndrome, seizures. </li></ul><ul><li>Cardiac side effects: Tachycardia, Arrhythmias. </li></ul><ul><li>Allergic side effects: Agranulocytosis. </li></ul><ul><li>Metabolic and Endocrine side effects. </li></ul><ul><li>Toxicity </li></ul>
  10. 11. MOOD STABILIZING DRUGS <ul><li>Indication: treatment acute mania, prophylaxis for BPAD, neurological disorders, seizures, schizo - affective disorders, paroxysmal pain syndrome. </li></ul><ul><li>Class of drugs: Lithium , Valproate, Carbamazepine . </li></ul>
  11. 12. SIDE EFFECTS OF MOOD STABILIZERS <ul><li>LITHIUM: therapeutic level – 0.6-1.2 mEq/L </li></ul><ul><li>prophylaxis – 0.6-1 mEq/L </li></ul><ul><li>toxic -- >2 mEq/ L </li></ul><ul><li>Neurological (tremor, muscular weakness, neurotoxicity), renal (polyuria, polydipsia), cardiovascular (T- wave depression), endocrine (goiter, hypothyroidism, abnormal thyroid function, weight gain), G I effects (nausea, vomiting, diarrhea, metallic taste and abdominal pain), side effect during pregnancy and lactation (teratogenicity, secreted through milk) </li></ul>
  12. 13. SIDE EFFECTS cont.…. <ul><li>Valproate : nausea, sedation, tremor, weight gain, thrombocytopenia, menstrual disturbances, hair loss. </li></ul><ul><li>Most serious but relatively uncommon side effects include hepatic toxicity, acute hemorrhagic pancreatitis. </li></ul><ul><li>Dialysis is the management during overdose </li></ul>
  13. 14. SIDE EFFECTS cont.….. <ul><li>Carbamazepine: diplopia, drowsiness, dizziness, photosensitivity, hypertension, leucopenia etc. </li></ul><ul><li>The most dangerous side effects include bone marrow suppression and cardiovascular collapse </li></ul>
  14. 15. ANTI ANXIETY AND HYPNOSEDATIVES <ul><li>Indication: generalized anxiety disorder, panic disorder, insomnia, narcoanalysis, premedication in anesthesia etc. </li></ul><ul><li>Classification: barbiturates (phenobarbital, thiopentone), Non barbiturates, Non-benzodiazepine anti anxiety agents(ethanol, chloral hydrate, propranolol), benzodiazepines </li></ul><ul><li>( midazolam, alprazolam, diazepam, clonazepam) </li></ul>
  15. 16. SIDE EFFECTS <ul><li>Nausea, vomiting, weakness, epigastric pain, vertigo, impotence, sedation, dry mouth, irritability, dis inhibited behavior, dependence and withdrawal. </li></ul><ul><li>Commonly abused drugs are from this group </li></ul>
  16. 17. ANTI EPILEPTICS <ul><li>Indication: seizures. </li></ul><ul><li>Drugs: phenytoin sodium, clonazepam, diazepam, lorazepam, carbamazepine, valproate sodium, lamotrigine, gabapentin. </li></ul>
  17. 18. SIDE EFFECTS OF ANTI EPILEPTICS <ul><li>Phenytoin sodium: </li></ul><ul><li>Delirium, nystagmus, ataxia, incoordination, dysarthria, hand tremors </li></ul><ul><li>Skin rash, toxic epidermal necrolysis. </li></ul><ul><li>Cerebellar atrophy, peripheral neuropathy, </li></ul><ul><li>Gingival hyperplasia. </li></ul>
  18. 19. SIDE EFFECTS OF ANTI EPILEPTICS <ul><li>Phenytoin sodium: </li></ul>
  19. 20. ANTI PARKINSONIAN <ul><li>Indication: Parkinson's disease, prevent EPS. </li></ul><ul><li>Class of drugs: THP, Levodopa and carbidopa, selegiline, pramipexole. </li></ul>
  20. 21. SIDE EFFECTS OF ANTI PARKINSONIAN <ul><li>THP: Drowsiness, head ache, vertigo, sleep disturbance, mydriasis with or without photo phobia, blurred vision, dry mouth. </li></ul><ul><li>Levodopa: hypotension, arrhythmias, nausea, hair loss, G I bleed, dis orientation and confusion. Chronic use leads to on/off oscillation, dyskinesia, freezing during movement, drug resistance. </li></ul>

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