This document discusses antipsychotic medications. It begins by defining psychotic disorders like schizophrenia and their symptoms. It then describes the dopamine, serotonin, and glutamate hypotheses for the causes of schizophrenia. The rest of the document summarizes different classes of antipsychotic medications, including their mechanisms of action, uses, and side effects. It covers both typical/first generation antipsychotics like chlorpromazine as well as atypical/second generation antipsychotics like clozapine, risperidone, and quetiapine.
A compiled Power point presentation on "Antipsychotic drugs" suitable for Undergraduate level medical students and also PG students in the subject of Pharmacology.
A compiled Power point presentation on "Antipsychotic drugs" suitable for Undergraduate level medical students and also PG students in the subject of Pharmacology.
ANTIDEPRESSANTS: All you need to know...by RxVichu! :)RxVichuZ
This is my 50th powerpoint.......
Deals with Important tips while using ANTIDEPRESSANTS, their special precautions, ADRs and differential mechanisms.
Will be worthwhile for a precise insight!!
Thanking all viewers who have supported me all my ways to reach this 50th milestone!!
Regards,
Vishnu. :)
Introduction to An Overview of Antipsychotic Drugs
Definition of psychosis, Causes of psychosis, Symptoms of psychosis, Classification of anti psychotic drugs, Mechanism of action, Pharmacokinetics, Adverse effects, Therapeutic uses, Contraindications, New inventions
Presented by
T. Niranjan Reddy
Department of Pharmacology
Anti psychotics & anti manic drugs, psychosis, neurosis, delusions, hallucinations, schizhophrenia, positive and negative symptoms of schizophrenia, dopamine hypothesis,
ANTIDEPRESSANTS: All you need to know...by RxVichu! :)RxVichuZ
This is my 50th powerpoint.......
Deals with Important tips while using ANTIDEPRESSANTS, their special precautions, ADRs and differential mechanisms.
Will be worthwhile for a precise insight!!
Thanking all viewers who have supported me all my ways to reach this 50th milestone!!
Regards,
Vishnu. :)
Introduction to An Overview of Antipsychotic Drugs
Definition of psychosis, Causes of psychosis, Symptoms of psychosis, Classification of anti psychotic drugs, Mechanism of action, Pharmacokinetics, Adverse effects, Therapeutic uses, Contraindications, New inventions
Presented by
T. Niranjan Reddy
Department of Pharmacology
Anti psychotics & anti manic drugs, psychosis, neurosis, delusions, hallucinations, schizhophrenia, positive and negative symptoms of schizophrenia, dopamine hypothesis,
Outlines some of the relationships between trauma and psychosis and schizophrenia, which are usually ignored by the mental health establishment. This is a presentation that will be given at the Oregon State Hospital on April 22, 2009.
I also provide a 6 hour online course on this topic, with 6 CE credits, go to https://www.udemy.com/working-with-trauma-dissociation-and-psychosis/ for more information, to watch some free previews, and to register.
Cognitive Behavior Therapy (CBT) for Psychosiscitinfo
Presented by: Dawn I. Velligan, Ph.D.
Professor, Department of Psychiatry
Director, Division of Schizophrenia and Related Disorders
Meredith L. Draper, Ph.D.
Assistant Professor, Department of Psychiatry
University of Texas Health Science Center, San Antonio
This presentation outlines the process for dealing with adverse preclinical / nonclinical events in order to 1) optimize the chances of successful drug development, or 2) to create a scientific basis for early termination of drug development. Conclusion: There is no single answer for all problems.
Pharmacological screening of Anti-psychotic agentsAbin Joy
Presentation contents are:
Introduction, Definition of psychosis, Classification of anti-psychotics, MOA of anti-psychotic agents and screening models.
Introduction to pre clinical screening of drugsKanthlal SK
Various Techniques and Methods for screening of new chemical entities in preclinical aspects (both invitro & invivo) for effective and safe clinical usage.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
2. Psychotic disorders (psychosis):
Severe psychiatric illness with distortion of thought and
perception.
Classification of psychotic disorders:
Schizophrenia
Schizoaffective disorder – disorder of both thought and mood
Delusional disorder – includes paranoid psychosis
Substance-induced psychotic disorder – use/withdrawal of
amphetamines, cocaine, alcohol, LSD
Cognitive disorder — organic brain syndrome
3. Schizophrenia
Split mind
– Highly disabling Chronic (relapsing & remitting) disorder of
thought
– Characterised by acute psychotic episodes
• Typical feature – loss of touch with reality
& selective attention deficit
• Prevalence – 1% of population
• Risk: 10% →1st degree relatives
10% → Dizygotic twins
50% → Monozygotic twins
• Onset in adolescence/early adulthood
4. Schizophrenia
—Split mind
—Highly disabling chronic (relapsing and remitting) disorder
of thought
—Characterised by acute psychotic episodes
• Typical feature – loss of touch with reality
& selective attention deficit.
• Prevalence – 1% of population
• Risk — 10% in 1st degree relatives
10% in Dizygotic twins
50% in Monozygotic twins
• Onset in adolescence/early adulthood
5. Etiology – unclear
Genetic: No single schizophrenia gene
Neuregulin – 1 (NRG – 1 mis-sense mutation)
Dsybindin
DISC-1
DAAO activator (G72)
Environmental: Aberrant intrauterine brain development
(infections, hypoxia?)
– Cannabis consumption in adolescence
6/30/2014 5
6. Dysbindin (??, located pre and post synaptically, glutamate neurotransmission?)
COMT (catechol-o-methyl transferase)
Neuregulin1 (transmembrane protein many isoforms)
Disc1 (neuronal migration, maturation, neurite outgrowth)
6/30/2014 6
8. Hydrotherapy: “The pouring of cold water in a stream, from
a height of at least four feet onto the forehead, is one of the
most certain means of subsiding violent, maniacal
excitement”... wrote an anonymous physician in the early
1800’s.
Dr Egas Moniz – Prefrontal lobectomy
In 1947, French surgeon Laborit discovered Promethazine
used as anti-histaminic, had a calming effect on patients
In 1953, Delay & Denikar used Laborit’s observation to
modify Promethazine structure into first effective anti-
psychotic medication, Chloropromazine
In-patients at Mental Hospitals dropped by 1/3rd.
6/30/2014 8
History
11. Dopamine Hypothesis
Repeated administration amphetamine, induces psychosis
resembling positive symptoms of schizophrenia
Carlson (1963) first proposed that drugs such as chlorpromazine &
haloperidol alleviate schizophrenic symptoms by blocking DA
receptors & thereby ↓ DA function
These antipsychotic medications, have been the main stay for
treatment for nearly 50 years, have in common their ability to block
D2 receptors.
12. 6/30/2014 12
↑ DA receptor density (Post-mortem, PET)
↑ Homovanillic acid (HVA) in plasma, urine & CSF
1.Mesolimbic – ↑ activity of D2 receptor →
Positive symptoms
2.Mesocortical – ↓ activity of D1 receptors →
Negative symptoms
15. Dopamine tract Innervation Function D-antagonist effects
Mesolimbic
Limbic areas,
Nucleus accumbens
Arousal, memory,
stimulus processing,
behavior, spontaneity,
motivation, assertively,
self-confidence
Psychosis relief
Mesocortical
Cortex – frontal and
prefrontal
Communication,
cognition, social
functions and stress
response
Psychosis relief
Nigrostriatal
Caudate nucleus,
Putamen
Extrapyramidal system
and movement
coordination
Movement disorders
Tubero
infundibular
Pituitary gland
Prolactin secretion
regulation
Hyperprolactineamia,
galactorhea,
gynecomastia
Dopaminergic systems in CNS
16. Serotonin Hypothesis
Correlation between DA affinity & antipsychotic efficacy has become
weaker as a result of recently developed atypical antipsychotic
medications that also show substantial affinity for 5HT2 receptors
The role of 5-HT in schizophrenia is based on the findings of LSD a
central 5-HT agonist , produces hallucinations and sensory disturbances
similar to psychosis.
Atypical neuroleptics like clozapine and olanzapine are potent 5-HT2A
agonists.
19. Glutamate Hypothesis
Preclinical as well as clinical studies provide evidence of
hypofunction of NMDA receptors as a primary, or at least, a
contributory process in the pathophysiology of schizophrenia
Several clinical trials with agents that act at the glycine modulatory
site on the NMDA receptor have revealed consistent reductions in
negative symptoms and variable effects of cognitive and positive
symptoms
These studies also provide evidence that suggests the effects of
clozapine on negative symptoms and cognition may be through
activation of the glycine modulatory site on the NMDA
receptor.
36. ARRIVAL OF ATYPICAL
ANTIPSYCHOTIC
• “German psychiatrists in the early 1960s opposed the
theory that EPS and antipsychotic efficacy were linked.
Their work led to introduction of Clozapine, an
antipsychotic with no EPS.”
• Clozapine was briefly marketed and quickly withdrawn
for two reasons:
– The embarrassment of not having any EPS, and
– Agranulocytosis
6/30/2014 36
39. CLOZAPINE (1989)
• 1st Atypical antipsychotic
• Selectively blocks D4 receptors & has weak D2 blocking property
• Also blocks α1 + α2 receptors & more strongly blocks 5-HT2
receptors in cortex
• In addition has significant H1 blocking property
• Useful for positive and negative symptoms and refractory cases
• t1/2 -12 hrs
• In 2002 FDA approved this drug for reducing suicidal risk in
schizophrenia.
• Used as RESERVE DRUG in RESISTANT
SCHIZOPHRENIA
40. Side effects
• Least extrapyramidal side effects
• Major limitation is Agranulocytosis in 1-2 %
• MC in 6th – 18th week of therapy
• Risk ↑ when co-administered with carbamazepine, reversible on
stopping drug (CYP3A4)
• Orthostatic hypotension, sedation, weight gain, ↑ heart rate,
paradoxical hypersalivation & ↑ risk for seizures (2-3%)
41. • Precipitates Diabetes, Myocarditis, urinary incontinence
• Metabolised by CYP1A2, CYP2C19 & CYP3A4
• Interactions with SSRIs and valproic acid ↑ Clozapine levels
• Dose: 100-300 mg oral
42. OLANZAPINE (1996)
• Similar to clozapine ( blocks almost all receptors)
• Broad spectrum efficacy covering Schizo-affective
disorders & Mania
• Also used in children with developmental CNS disorders
& Tourette’s syndrome
• t1/2 : 24 – 30 hrs
• Lesser EPS
• Metabolised by CYP1A2 & glucuronyl transferase
• Dose related lowering of seizure threshold
• Avoid in elderly with Hypertension → risk of CVA
43. •Weight gain – MC side effect.
•↑ in glycosalated Hb, total cholesterol & triglycerides
• No agranulocytosis reported
•Dose: 2.5-20 mg oral
•Resperidone & Olanzapine → useful in calming agitated or
aggressive patients with dementia
44. RISPERIDONE (1994)
• Blocks selective D2 + 5-HT2 + α1+ α2 + H1 receptors
• Effective for positive & negative symptoms (controversial)
• Extrapyramidal side effects low (can occur at high doses)
• Uses: Schizophrenia (including adolescent schizophrenia)
Schizoaffective disorder
Mixed & manic states associated with bipolar disorder
Irritability in people with autism
45. Side effects : sedation, weight gain, ↑ BP, orthostatic
hypotension.
•↑ prolactin levels
•May cause anxiety/agitation & ↑ risk of
stroke in elderly
•Dose: 2-8 mg oral
•Can be given as depot IM (for chronic cases)
46. QUETIAPINE (1997)
• Less potent than risperidone
• Given BD due to short half life – 6hrs
• Blocks 5HT1A + 5HT2 + D2 + α1 + α2 + H1 receptors in brain
• Minimal EPS & ↑ prolactin levels
• Metabolised by CYP3A4
• Not useful for negative symptoms
• Used in Acute mania/Bipolar disorder (maintenance therapy)
• Dose: 50- 400 mg oral
47. • S/E: sedation, orthostatic hypotension, weight gain, cataract
formation, priapism , hyperventilation, hyperglycemia, peripheral
oedema.
• Anticholinergic side effects (like older drugs & Clozapine)
• Urinary incontinence & QTc prolongation can also occur
48. ZIPRASIDONE
• Combined D2 + 5-HT 2A/2C + H1+ α1
blocking property
• Also antagonist at 5HT1D & agonist at 5HT1A
• In addition has anxiolytic & antidepressant
properties(inhibit NA & 5HT reuptake)
• T1/2 - 8 hrs, BD dosing
• Efficacy rated equivalent to Haloperidol
• Uses: Schizophrenia
Mania
• Dose: 40- 160 mg oral
• Parental forms available
49. • Less weight gain & ↑ blood sugar
• Less EPS & hyperprolactinaemia
• Nausea & vomiting MC side effects
• Dose related QTc prolongation → Cardiac
Arrythmias.
50. PALIPERIDONE
• Also known as 9-hydroxyrisperidone
• DA antagonist
• Given orally or as Depot preparation (IM)
• Uses: Mania
Maintenance for bipolar disorder (at low
dose)
Schizophrenia
Schizoaffective disorder
51. • Primary active metabolite of risperidone
• MOA - unknown
• Antagonist effect at α1 & α2 adrenergic + H1receptors
• Also binds with DA & 5HT receptors
• Like risperidone, its possible use is
in people with Autism and Asperger
syndrome
• S/E: Restlessness, EPS
including involuntary
movements, tremors &
muscle stiffness
• Not approved for treatment of
dementia-related psychosis due
to ↑ death rate
52. SERTINDOLE (1995)
• Initially there were some poorly supported arguments
about improved negative symptom reduction
• Low risk for EPS, no sedation & very mild prolactin
elevation (major advantages)
• S/E: rhinitis, ↓ ejaculatory volume, orthostatic
hypotension, tachycardia & weight gain
• Concern about sudden cardiac death due to cardiac
arrhythmia led to its voluntary removal in 1998
60. ANTIPSYCHOTIC DRUG - SCREENING METHODS
IN VITRO AND EX VIVO MODELS
H Prazosin Competition Binding for alpha 1 adrenoceptors
IN VIVO MODELS
Catelepsy in Rodents
Inhibition of Amphetamine induced Stereotypy in Rats
Inhibition of Apomorphine induced sterotypy in Rats
Phenycylidine induced Bizzare pattern of Locomotor activity and stereotypy
Phenycylidine induced social withdrawal measured in the social interaction test
Conditioned avoidance reflex in Rats
Neurodevelopmental Models
Genetic Models
Single unit recording of A9 and A10 Midbrain Dopaminergic Neurons
Extrapyramidal side effects Primed Monkey Model
6/30/2014 60