Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Anti Psychoticdoncua

1,238 views

Published on

Published in: Health & Medicine
  • Be the first to comment

Anti Psychoticdoncua

  1. 2. ANTI-PSYCHOTIC DRUGS DON D. CUA, MD Department of Pharmacology
  2. 3. TYPES OF PSYCHOSIS <ul><li>SCHIZOPHRENIA </li></ul><ul><li>AFFECTIVE DISORDERS (DEPRESSION/MANIA) </li></ul><ul><li>ORGANIC PSYCHOSES (CAUSED BY HEAD INJURY, ALCOHOLISM, OTHERS) </li></ul>
  3. 4. SCHIZOPHRENIA <ul><li>A clinical syndrome characterized by profound disruption in cognition and emotion, affecting the most fundamental attributes: language, thought, perception, affect and sense of self. </li></ul><ul><li>“ clear sensorium but marked thinking disturbance.” </li></ul>
  4. 5. THE NATURE OF SCHIZOPHRENIA <ul><li>1% population, begins at an early age, with strong hereditary factor </li></ul><ul><li>SEX : Equally prevalent in men and women </li></ul><ul><li>AGE : MEN-between 15 and 25 </li></ul><ul><li>WOMEN-between 25 and 35 </li></ul>
  5. 6. <ul><li>POSITIVE SYMPTOMS </li></ul><ul><li>Delusions Disorganized behavior </li></ul><ul><li>Hallucinations Disorganized speech/thinking </li></ul><ul><li>Thought disorder Catatonic behaviors </li></ul><ul><li>NEGATIVE SYMPTOMS </li></ul><ul><li>Withdrawal from social contacts </li></ul><ul><li>Flattening of emotional responses </li></ul><ul><li>Alogia, Avolition-Apathy, Anhedonia-Asociality </li></ul><ul><li>Attention deficit </li></ul>
  6. 7. Diagnostic Criteria for Schizophrenia DSM IV <ul><li>A. Two or more of the following ( one-month period ) </li></ul><ul><li>delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior and negative symptoms. </li></ul><ul><li>B. Social/occupational dysfunction : one or major areas of functioning such as work, interpersonal relations, or self-care, are markedly below the level achieved prior to the onset. </li></ul><ul><li>C. Continuous signs of the disturbance persist for at least SIX months. </li></ul>
  7. 8. THE DOPAMINE HYPOTHESIS <ul><li>SCHIZOPHRENIA: WITH EXCESSIVE DOPAMINERGIC ACTIVITY; NORe and GABA </li></ul><ul><li>ANTI-PSYCHOTIC DRUGS BLOCK POSTSYNAPTIC D2 RECEPTORS IN CNS </li></ul><ul><li>DRUGS THAT INCREASE DOPA AGGRAVATE SCHIZOPHRENIA </li></ul><ul><li>DOPAMINE RECEPTOR DENSITY ↑ in schizos </li></ul><ul><li>POSITRON EMISSION TOMOGRAPHY (PETS) </li></ul><ul><li>↑ Dopamine Receptor Density </li></ul><ul><li>HOMAVANILLIC ACID (HAV) </li></ul><ul><li>CHANGE IN AMOUNT </li></ul>
  8. 9. CLASSIFICATION OF ANTIPSYCHOTIC DRUGS: <ul><li>TYPICAL ANTIPSYCHOTICS: </li></ul><ul><li>A. PHENOTHIAZENE DERIVATIVE </li></ul><ul><li>3 ring structure, 2 benzene rings are linked by sulfur & nitrogen atom </li></ul><ul><li>N position 10 is replaced by carbon atom with a double bond to the side chain </li></ul>
  9. 10. ALIPHATIC DERIVATIVE: <ul><li>CHLORPROMAZINE </li></ul><ul><li>TRIFLUPROMAZINE </li></ul><ul><li>PIPERIDINE DERIVATIVE: </li></ul><ul><li>THIORIDAZINE </li></ul><ul><li>MESORIDAZINE </li></ul><ul><li>PIPERACETAZINE </li></ul><ul><li>NOTE: Decrease incidence of EPS side effects due to  antimuscarinic activity </li></ul>
  10. 11. PIPERAZINE DERIVATIVE: <ul><li>FLUPHENAZINE </li></ul><ul><li>PERPHENAZINE </li></ul><ul><li>TRIFLUOPERAZINE </li></ul><ul><li>Most potent phenothiazene & thioxanthene antipsychotic compound NOTE :  EPS but  tendency to produce sedation or autonomic side effects. </li></ul>
  11. 12. B. THIOXANTHENE DERIVATIVES : <ul><li>ALIPHATIC DERIVATIVE: </li></ul><ul><li>CHLORPROTHIXENE </li></ul><ul><li>PIPERAZINE DERIVATIVE: </li></ul><ul><li>CHLOPENTHIXOL </li></ul><ul><li>FLUPENTIXOL </li></ul><ul><li>THIOTHIXENE </li></ul>
  12. 13. C. BUTYROPHENONE : <ul><li>HALOPERIDOL </li></ul>
  13. 14. CLASSIFICATION OF ANTIPSYCHOTIC DRUGS <ul><li>1. TYPICAL ANTI-PSYCHOTICS </li></ul><ul><li>A . Phenothiazine Derivatives </li></ul><ul><li>Aliphatic Derivative : CHLORPROMAZINE </li></ul><ul><li>Piperidine Derivative : THIORIDAZINE </li></ul><ul><li>Piperazine Derivative : FLUPHENAZINE, PERPHENAZINE, TRIFLUOPERAZINE </li></ul><ul><li>B . Thioxanthene Derivative : THIOTHIXENE </li></ul><ul><li>C. Butyrophenone : HALOPERIDOL </li></ul>
  14. 15. <ul><li>2. ATYPICAL ANTI-PSYCHOTICS </li></ul><ul><li>CLOZAPINE </li></ul><ul><li>LOXAPINE </li></ul><ul><li>RISPERIDONE </li></ul><ul><li>MOLINDONE </li></ul><ul><li>SERTINDOLE </li></ul><ul><li>ZIPRASIDONE </li></ul><ul><li>OLANZAPINE </li></ul><ul><li>QUETIAPINE </li></ul><ul><li>PIMOZIDE </li></ul>CLASSIFICATION OF ANTI-PSYCHOTIC DRUGS
  15. 16. DIFFERENCES AMONG ANTI-PSYCHOTIC DRUGS <ul><li>CHLORPROMAZINE alpha1=5HT2 > D2 >D1 </li></ul><ul><li>HALOPERIDOL D2>D1=D4>alpha1>5HT2 </li></ul><ul><li>CLOZAPINE D4=alpha1>5HT>D2=D1 </li></ul><ul><li>RISPERIDONE D2=5HT2 </li></ul><ul><li>OLANZAPINE 5HT2> or= D1, D2, alpha2 </li></ul>
  16. 17. DOPAMINE RECEPTORS D1 like family <ul><li>D1: CHROMOSOME 5 ; INCREASE cAMP…> </li></ul><ul><li>activation of adenyl cyclase </li></ul><ul><li>D5 : CHROMOSOME 4 ; INCREASE cAMP </li></ul><ul><li>D2 like family </li></ul><ul><li>D2: CHROMOSOMES 11 : DECREASE cAMP …> blocks calcium channels </li></ul><ul><li>…… > opens potassium channels </li></ul><ul><li>D3: CHROMOSOME 11 : DECREASE cAMP </li></ul><ul><li>D4: DECREASE cAMP </li></ul>
  17. 18. DOPAMINERGIC SYSTEM <ul><li>1. MESOLIMBIC-MESOCORTICAL substancia nigra………>limbic system BEHAVIOR </li></ul><ul><li>2. NIGROSTRIATAL </li></ul><ul><li>substancia nigra….>caudate & putamen VOLUNTARY MOVEMENTS </li></ul><ul><li>3. TUBEROINFUNDIBULAR </li></ul><ul><li>arcuate nuclei & periventricular neurons,> hypothalamus & post pituitary </li></ul><ul><li>INHIBITS PROLACTIN SECRETION </li></ul>
  18. 19. DOPAMINERGIC SYSTEM <ul><li>4. MEDULLARY-PERIVENTRICULAR motor nuclei of the vagus </li></ul><ul><li>EATING BEHAVIOR </li></ul><ul><li>5. INCERTOHYPOTHALAMUS </li></ul><ul><li>from the medial zona incerta to the hypothalamus and the amygdala REGULATE THE ANTICIPATORY MOTIVATIONAL PHASE OF COPULATORY BEHAVIOR IN RATS </li></ul>
  19. 20. ANTI-PSYCHOTIC AGENTS <ul><li>PSYCHOLOGICAL EFFECTS </li></ul><ul><li>> sleepiness, restlessness, impaired performance & judgment </li></ul><ul><li>NEUROPHYSIOLOGIC EFFECTS </li></ul><ul><li>> hypersyncrony focal /unilateral </li></ul><ul><li>ENDOCRINE EFFECTS </li></ul><ul><li>> amenorrhea, galactorrhea, increase libido, false(-) pregnancy test </li></ul><ul><li>>decrease libido in males, gynecomastia </li></ul>
  20. 21. ANTI-PSYCHOTIC AGENTS <ul><li>CARDIOVASCULAR EFFECTS </li></ul><ul><li>orthostatic hypotension </li></ul><ul><li>high resting pulse rate </li></ul><ul><li>increase PR, decrease stroke volume, decrease mean arterial pressure </li></ul><ul><li>decrease peripheral resistance </li></ul>
  21. 22. PHARMACOKINETICS <ul><li>READILY BUT INCOMPLETELY ABSORBED </li></ul><ul><li>FIRST PASS METABOLISM </li></ul><ul><li>HIGHLY LIPID SOLUBLE </li></ul><ul><li>LARGE VOLUME OF DISTRIBUTIION </li></ul><ul><li>PROTEIN BOUND </li></ul><ul><li>COMPLETELY METABOLIZED </li></ul><ul><li>Except mesoridazine (major metabolites of thioridazine) </li></ul><ul><li>LITTLE EXCRETED UNCHANGED </li></ul><ul><li>T ½ is 10 -24 hours </li></ul>
  22. 23. CLINICAL INDICATIONS <ul><li>A. PSYCHIATRY INDICATIONS </li></ul><ul><li>SCHIZOPHRENIA </li></ul><ul><li>SCHIZO-AFFECTIVE DISORDERS </li></ul><ul><li>MANIC EPISODES IN BIPOLAR DISORDERS </li></ul><ul><li>GILLES DE LA TOURETTE SYNDROME </li></ul><ul><li>SENILE DEMENTIA </li></ul><ul><li>B. NON-PSYCHIATRIC INDICATIONS </li></ul><ul><li>ANTI-EMETIC EFFECT </li></ul><ul><li>ANTI-PRURITIC EFFECT </li></ul><ul><li>PRE-OPERATIVE ANESTHESIA </li></ul><ul><li>NEUROLEPTIC ANESTHESIA </li></ul>
  23. 24. SIDE EFFECTTS OF NEUROLEPTIC DRUGS <ul><li>A. NEUROLOGIC EFFECTS </li></ul><ul><li>1. ACUTE DYSTONIA : s pasm of muscles tongue, face, neck, back, may mimic seizures </li></ul><ul><li>During the first 1 -5 days of Rx </li></ul><ul><li>Mechanism unknown </li></ul><ul><li>Rx: anti-parkinson’s agents </li></ul><ul><li>2. AKATHISIA : m otor restlessness </li></ul><ul><li>5 -60 days </li></ul><ul><li>Mechanism unknown </li></ul><ul><li>Rx with diphenhydramine </li></ul>
  24. 25. <ul><li>3. PARKINSONISM </li></ul><ul><li>bradykinesia, rigidity, tremor, mask facies, </li></ul><ul><li>shuffling gait seen in 5-30 days </li></ul><ul><li>Mechanism : antagonism of dopamine </li></ul><ul><li>Rx: anti-parkinson’s agents </li></ul><ul><li>4. NEUROLEPTIC MALIGNANT SYNDROME </li></ul><ul><li>catatonia, stupor, fever, unstable BP, </li></ul><ul><li>myoglobulinemia after weeks of treatment </li></ul><ul><li>Mechanism : antagonism of dopamine </li></ul><ul><li>Rx: Stop neuroleptic immediately; dandrolene; bromocriptine, Anti-parkinsons- not effective </li></ul>
  25. 26. <ul><li>5. PERIODIC TREMOR RABBIT SYNDROME </li></ul><ul><li>Peri-oral tremors after months or years of treatment </li></ul><ul><li>Mechanism : unknown </li></ul><ul><li>Rx: Anti-parkinson’s Drugs </li></ul><ul><li>6. TARDIVE DYSKINESIA </li></ul><ul><li>Supersensivity of D receptors (cholinergic def) </li></ul><ul><li>oral-facial dyskinesia, choreoathetosis, dystonia </li></ul><ul><li>After months or years of RX </li></ul><ul><li>Worse on withdrawal </li></ul><ul><li>Mechanism : excess function of dopamine </li></ul><ul><li>Rx: prevention crucial </li></ul><ul><li>Rx: unsatisfactory </li></ul>
  26. 27. ADVERSE EFFECTS <ul><li>B. BEHAVIORAL EFFECTS </li></ul><ul><li>Pseudo-depression; toxic confusional state </li></ul><ul><li>C. AUTONOMIC NERVOUS SYSTEM EFFECTS </li></ul><ul><li>urinary retention, dry mouth, loss of accomodation, constipation </li></ul><ul><li>( MUSCARINIC CHOLINERGIC BLOCKADE ) </li></ul><ul><li>orthostatic hypotension, impotence, failure to ejaculate </li></ul><ul><li>( ALPHA ADRENORECEPTOR BLOCKADE ) </li></ul>
  27. 28. ADVERSE EFFECTS <ul><li>D. METABOLIC & ENDOCRINE EFFECTS </li></ul><ul><li>Weight gain, hyperglycemia, hyperprolactinemia, amenorrhea-galactorrhea syndrome, infertility, impotence in males </li></ul><ul><li>E. TOXIC OR ALLERGIC REACTIONS </li></ul><ul><li>Agranulocytosis (clozapine) , cholestatic jaundice, </li></ul><ul><li>skin eruptions </li></ul><ul><li>F. CARDIAC TOXICITY </li></ul><ul><li>Ventricular arrythmias (thioridazine) </li></ul><ul><li>G. OCULAR COMPLICATIONS : </li></ul><ul><li>“ browning of vision” </li></ul>
  28. 29. ANTI-MANIC AGENTS <ul><li>MANIA -- STATE OF ELEVATED MOOD & PSYCHOMOTOR ACCELERATION, </li></ul><ul><li>WITH EXCESS CATHECHOLAMINES ACTIVITY </li></ul><ul><li>TREATMENT : LITHIUM CARBONATE </li></ul><ul><li>CATHECOLAMINE RELEASE FROM ADRENERGIC NERVE TERMINALS </li></ul>
  29. 30. LITHIUM <ul><li>INDICATIONS: </li></ul><ul><li>BIPOLAR DISORDERS </li></ul><ul><li>THYROTOXICOSIS </li></ul><ul><li>INAPPROPRIATE ADH SECRETION </li></ul>
  30. 31. LITHIUM PHARMACOKINETICS <ul><li>ABSORPTION : virtually complete within 6 -8 hrs; peak plasma levels in 30 min to 2 hrs </li></ul><ul><li>DISTRIBUTION : in total body water; slow entry into intracellular compartment. No protein binding </li></ul><ul><li>METABOLISM : None </li></ul><ul><li>EXCRETION : virtually entirely in urine; plasma half life is about 20 hours </li></ul>
  31. 32. LITHIUM PHARMACODYNAMICS <ul><li>EFFECTS ON ELECTROLYTES & IONS TRANSPORT : </li></ul><ul><li>Substitute for sodium in generating action potentials </li></ul><ul><li>EFFECTS ON NEUROTRANSMITTERS </li></ul><ul><li>Enhance effects of serotonin? </li></ul><ul><li>Decrease norepinephrine & dopamine turnover </li></ul><ul><li>Block dopamine receptor supersensitivity </li></ul><ul><li>Augment synthesis of acetylcholine? </li></ul><ul><li>EFFECTS ON SECOND MESSENGERS </li></ul><ul><li>effect on Inositol 1,4,5 triphospate (IP3 )/ </li></ul><ul><li>Diacylglycerol (DAG)-needed in alpha a and muscarinic transmission </li></ul>
  32. 33. <ul><li>Lithium inhibits several important enzymes in the normal recycling of membrane phosphoinositides. </li></ul><ul><li>(-) IP2----IP1 </li></ul><ul><li>(-) IP1----inositol </li></ul><ul><li>It will lead to a depletion of PIP2(phosphotidylinositol-4,5-bis-phosphate) which is the membrane precursor of IP3 and DAG </li></ul><ul><li>LITHIUM could cause a selective depression of the overactive circuits. </li></ul>
  33. 34. LITHIUM ADVERSE EFFECTS <ul><li>CNS EFFECTS: dizziness, mild ataxia </li></ul><ul><li>NEUROMUSCULAR EFECTS: fine tremors </li></ul><ul><li>CVS EFFECTS: ventricular arrythmias </li></ul><ul><li>GIT EFFECTS: nausea, vomiting, diarrhea </li></ul><ul><li>GUT EFFECTS: polyuria </li></ul><ul><li>ENDOCRINE EFFECTS: hypothyroidism </li></ul><ul><li>ALLERGIC REACTION: pruritus, rash </li></ul><ul><li>OVERDOSE TOXICITY: vomiting, drowsiness, decrease consciousness and seizures </li></ul><ul><li>Rx: dialysis </li></ul>
  34. 35. <ul><li>The TWO most common side effects </li></ul><ul><li>UNCOUPLING OF THE </li></ul><ul><li>VASOPRESSIN and TSH RECEPTORS </li></ul><ul><li>FROM THEIR G PROTEINS </li></ul>
  35. 36. LITHIUM CONTRAINDICATIONS <ul><li>A. MARKED DEHYDRATION OR SODIUM DEPLETION </li></ul><ul><li>B . SIGNIFICANT RENAL OR CARDIAC DISEASES </li></ul><ul><li>C. PREGNANCY </li></ul><ul><li>D. RENAL CONCENTRATION ABILITY </li></ul><ul><li>Nephrogenic diabetes insipidus with polyuria </li></ul>
  36. 37. LITHIUM DRUG INTERACTIONS <ul><li>THIAZIDE DIURETICS : DECREASE RENAL CLEARANCE OF LITHIUM </li></ul><ul><li>NSAID : DECREASE LITHIUM CLEARANCE </li></ul><ul><li>ANTIPYSCHOTIC AGENTS : INCREASE </li></ul><ul><li>NEUROTOXICITY </li></ul>
  37. 38. DEPRESSION <ul><li>I . REACTIVE OR SECONDARY DEPRESSION </li></ul><ul><li>Core Depression Syndrome: depression, anxiety, tension, bodily complaints, guilt (> 60%) </li></ul><ul><li>II . ENDOGENOUS DEPRESSION </li></ul><ul><li>Core Depression Syndrome plus ABNORMAL vital signs rhythm of sleep, motor activity, libido, decrease appetite ( 25%) </li></ul><ul><li>III. DEPRESSION ASSOCIATED WITH BIPOLAR AFFECTIVE DISORDER </li></ul><ul><li>(10-15%) </li></ul>
  38. 39. <ul><li>Pathogenesis of Major Depression </li></ul><ul><li>DECREASED FUNCTIONAL AMINE-DEPENDENT SYNAPTIC TRANSMISSION </li></ul>
  39. 40. ANTI-DEPRESSANTS <ul><li>A .TRICYCLIC ANTI-DEPRESSANTS(TCA) </li></ul><ul><li>THREE-RING NUCLEUS- </li></ul><ul><li>(anti-muscarinic, anti-H and @(-)adrenergic) </li></ul><ul><li>IMIPRAMINE. AMITRYPTYLINE </li></ul><ul><li>( mixedNorE and serotonin uptake inhibitors ) </li></ul><ul><li>DOXAPIN, NORTRIPTYLINE , DESIPRAMINE, CLOMIPRAMINE , PROTRIPTYLINE, TRIMIPRAMINE </li></ul><ul><li>Note: toxicity due alpha adrenergic blocking activity </li></ul><ul><li>B . HETEROCYCLIC: SECOND & THIRD GENERATIONS </li></ul><ul><li>1. SECOND GENERATIONS </li></ul><ul><li>AMOXAPINE ( dopamine receptor antagonist ) MAPROTILINE </li></ul><ul><li>TRAZODON, BUPROPION </li></ul><ul><li>2. THIRD GENERATIONS </li></ul><ul><li>MIRTAZAPINE, VENLAFAZINE,NEFAZODONE </li></ul>
  40. 41. ANTI-DEPRESSANTS <ul><li>C. SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRI) </li></ul><ul><li>FLUOXETINE </li></ul><ul><li>PAROXETINE </li></ul><ul><li>SERTRALINE, CITALOPRAM, FLUVOXAMINE </li></ul><ul><li>D. MONOAMINE OXIDASE INHIBITORS (MAOI) </li></ul><ul><li>PHENELZINE, TRANYLCYPROMINE </li></ul><ul><li>MOCLOBEMIDE ,SELEGILINE </li></ul><ul><li>NOTE: MAO-A —amine oxidase responsible for NORe, serotonin and tyramine </li></ul><ul><li>MAO-B ---selective for dopamine( SELEGILINE ) </li></ul>
  41. 42. ANTI-DEPRESSANTS PHARMACODYNAMICS <ul><li>ACTION OF ANTIDEPRESSANTS ON BIOGENIC AMINE NEUROTRANSMITTERS </li></ul><ul><li>TCA (-) NorE and serotonin reuptake pump </li></ul><ul><li>“ OFF-SWITCHES” of the amine transmission </li></ul><ul><li>MAO inhibitors (-) major degradation pathway resulting </li></ul><ul><li>to accumulation of amines in presynaptic stores for the amino neurotransmitters and increase release </li></ul><ul><li>Trazodone,Nefazodone and Mirtazepine (-) 5HT2a or 5HT2c </li></ul><ul><li>Mirtazepine (-) alpha 2 NorE receptors </li></ul><ul><li>( Increase therapeutic effects ) </li></ul>
  42. 43. <ul><li>B . RECEPTOR & POSTRECEPTOR EFFECTS </li></ul><ul><li>Increase in neurotransmitter in the synapse acting on postsynaptic receptor giving ultimate effect. </li></ul><ul><li>by decreasing cAMP rather than increase. </li></ul><ul><li>and decreasing postsynaptic B adrenoreceptors as clinical improvement is seen. </li></ul><ul><li>C . EFFECTS OF SPECIFIC ANTIDEPRESSANTS </li></ul>
  43. 44. PHARMACOKINETICS <ul><li>A. TRICYCLICS </li></ul><ul><li>Incompletely reabsorbed </li></ul><ul><li>First pass metabolism </li></ul><ul><li>Large volume of distribution </li></ul><ul><li>Metabolized due to transformation of tricyclic nucleus and alteration of the aliphatic side chain </li></ul><ul><li>( hydroxylation and conjugation and demethylation ) </li></ul><ul><li>B. HETEROCYCLICS </li></ul><ul><li>Variable bioavailability </li></ul><ul><li>High protein binding </li></ul><ul><li>Variable and large volume of distribution </li></ul><ul><li>Active metabolites </li></ul>
  44. 45. PHARMACOKINETICS <ul><li>C. SSRI : FLUOXETINE </li></ul><ul><li>Well absorbed </li></ul><ul><li>PPC: 4 – 8 hrs </li></ul><ul><li>Inhibits drug metabolizing enzymes </li></ul><ul><li>D. MAOI </li></ul><ul><li>Readily absorbed </li></ul>
  45. 46. CLINICAL INDICATIONS <ul><li>DEPRESSION </li></ul><ul><li>PANIC DISORDER ( Imipramine ) </li></ul><ul><li>OBSESSIVE COMPULSIVE( SSRI-Fluoxetine ) </li></ul><ul><li>ENURESIS ( TCA ) </li></ul><ul><li>CHRONIC PAIN ( TCA,Phenothiazine ) </li></ul><ul><li>OTHERS: Eating Disorder (Bulemia)( SSRI ) </li></ul><ul><li>Cataplexy associated with narcolepsy, school phobia, attention deficit syndrome </li></ul><ul><li>NOTE: Serotonin Syndrome-hyperthermia,muscle rigidity and myoclonus </li></ul>
  46. 47. ADVERSE EFFECTS <ul><li>TRICYCLICS </li></ul><ul><li>Sedation : sleepiness </li></ul><ul><li>Sympathomimetic : tremors, insomnia </li></ul><ul><li>Anti-muscarinic : blurred vision, constipation confusion, urinary incontinence </li></ul><ul><li>Psychiatric : psychoses aggravated </li></ul><ul><li>CVS : orthostatic hypotension </li></ul><ul><li>Neurologic : Seizures </li></ul><ul><li>Metabolic-Endocrine : weight gain, sexual disturbance </li></ul>
  47. 48. Foods that interact with MAOI <ul><li>High in tyramine content : </li></ul><ul><li>BEER </li></ul><ul><li>BROAD BEANS, LAVA BEANS </li></ul><ul><li>CHEESE </li></ul><ul><li>CHICKEN LIVER </li></ul><ul><li>SAUSAGES </li></ul><ul><li>RED WINE </li></ul><ul><li>YEAST </li></ul>
  48. 49. <ul><li>MAO INHIBITORS </li></ul><ul><li>headache, drowsiness, dry mouth, weight gain, postural hypotension, sexual disturbance </li></ul><ul><li>AMOXAPIN </li></ul><ul><li>Tricyclic & anti-psychotic effects </li></ul><ul><li>MAPROTILINE </li></ul><ul><li>Tricyclic effects </li></ul><ul><li>TRAZODONE & NEFAZODONE : drowsiness, dizziness, insomnia, nausea and agitation </li></ul><ul><li>BUPROPION </li></ul><ul><li>dizziness, dry mouth, tremor </li></ul><ul><li>FLUOXETINE </li></ul><ul><li>Anxiety, insomnia, tremors, decrease libido, GIT effects </li></ul>
  49. 50. OVERDOSE TOXICITY <ul><li>Coma with shock, metabolic acidosis, respiratory depression, sudden apnea, agitation, delirium </li></ul><ul><li>Hypertensive crisis </li></ul><ul><li>Cardiac conduction defects such as arrhythmias </li></ul><ul><li>DRUG INTERACTIONS </li></ul><ul><li>MAO Inhibitors and sympathomimetics and opiates </li></ul><ul><li>Anti-hypertensive drugs—exaggerated hypotension </li></ul><ul><li>TCA—increase concentration with cimetidine and phenothiazines </li></ul>
  50. 51. DRUGS WITH SPECIAL IMPORTANCE <ul><li>Desipramine —less sedating, low anti-muscarinic effects </li></ul><ul><li>Amitryptyline -more sedating and marked anti-muscarinic effects </li></ul><ul><li>Maprotiline -seizures </li></ul><ul><li>Trazodone —prolonged penile erection </li></ul><ul><li>Fluoxetine —minimal sedative effects, very low anti-muscarinic effects </li></ul><ul><li>Nefazodone -less sedating, no SSRI </li></ul>
  51. 52. Drugs that Interact with MAOI <ul><li>A. INDIRECTLY ACTING SYMPATHOMIMETICS: amphetamines, ephedrine, metaraminol, phenylpropanolamine </li></ul><ul><li>B . OTHER ADRENORECEPTOR AGENTS & RELATED AGENTS : levodopa, methyldopa, guanethidine, reserpine </li></ul><ul><li>C. OPIOID ANALGESICS & DERIVATIVES : morphine, codeine, meperidine, dextromethorphan </li></ul><ul><li>D. MISCELLANEOUS DRUGS : buspirone, fluoxetine, LSD </li></ul>
  52. 53. <ul><li>Who is wise and understanding among you? Let him show it by his good life, by deeds done in humility that comes from wisdom. </li></ul><ul><li>James 3: 13 </li></ul>THANK YOU!!!
  53. 54. MAJOR AFFECTIVE /MANIC DEPRESSIVE DISORDERS <ul><li>Abnormal emotion or mood </li></ul><ul><li>Disorders of affect & depression, dysphoria, elation or mania </li></ul><ul><li>Bipolar or non-bipolar </li></ul><ul><li>Can occur as a mild disorder or can be associated with other psychiatric or medical illnesses </li></ul>
  54. 55. NEUROSES: <ul><li>Less pervasive psychiatric disorders </li></ul><ul><li>Comprehend reality, suffering & disability are sometimes severe </li></ul><ul><li>Acute or transient, persistent or recurrent </li></ul><ul><li>Mood changes- anxiety , panic, depression </li></ul><ul><li>Limited abnormalities of thought- obsessions, irrational fears </li></ul><ul><li>Behavior – rituals, compulsions, hysterical conversions </li></ul>

×