Antipsycho, Antidep, Anxiolytics

7/30/2019 Antipsycho, Antidep, Anxiolytics

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Dr.U.P.RathnakarMD. DIH. PGDHM

Psycho pharmacologyAntipsychotics

AntidepressantsAnxiolytics


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Psychotropic drugs

Psychoses[Schizo,Mania,depression]

Severe mental illness

Not in touch with reality

Hallucinations

Delusions Abnormal behaviour

Antipsychotics,Antidepressants,

Antimanic drugs

Anxiety disorders[Neuroses]

Less severe(Extremesuffering)

In touch with reality

ANXIOLYTICS


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Antipsychotics

Classical:

1. Phenothiazines Aliphatic---Chlorpromazine

Triflupromazine

Piperidine---Thioridazine PiperazineTrifluperazine,

Fluphenazine2. Butyrophenones

Haloperidol, Trifluperidol,Penfluperidol,

3. ThioxanthinesFlupenthixol4. OthersPimozide, Loxapine

Atypical Clozapine Risperidone Olanzapine

Quetiapine Aripiprazole Ziprasidone


4/18

Antipsychotics

Chlorpromazine[CPZ]

Beneficial

D2 Blockade

ADEs D2 Blockade

Muscarinic block

Adrenergic block

H1 Block

Direct on heart

Beneficial

Antipsychotic effect

ADEs Extrapyramidal effect

Galactorrhoea,

Gynaecomastia

Anticholinergic Hypotension

Weight gain,sedation

Arrhythmia

MOA & Pharmacological actions


5/18

Actions of CPZ

In Normal person:

Indifference tosurroundings,

Psychomotorslowing,

Drowsiness,

Unpleasant effects- Neuroleptic

syndrome*

In psychotics

Reduces irrationalbehaviour

Aggression andagitation

Psychotic symptoms

Sedation-Tolerancedevelops


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ADEs effects of CPZ

Extrapyramidal effects1. Parkinsonism

2. Acute muscle dystonia3. Akathisia

4. Malignant neuroleptic syndrome

5. Tardive dyskinesia Other ADEs

Cholestatic jaundice, Agranulocytosis,

Myocarditis


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Uses of antipsychotics

Psychoses

[Scizophrenia]

a. Atypical

preferred[Less adverseeffects, more effective

in negative symptoms]

Antiemetic

Intractable hiccough

Mania


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Antipsychotics

Classical

More action on DA

receptors

Effective in positivesymptoms

More adverse effects

Atypical

Less. More in 5HT

Effective in negativesymptoms

Less ADEs


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Antidepressants

MAO-inhibitors

Moclobemide

Tricyclic antidepressants

Imipramine, Amitriptyline,

Selective Serotonin Reuptake Inhibitors

Fluoxetine, Fluvoxamine Atypical

Trazodone, mianserin


10/18

Antidepressants ADEs

Anticholinergic effect

Sedation

Weight gain

Postural hypotension

Cardiac arrhythmias

No extrapyramidal effects!


11/18

Antidepressants- uses

Endogenous depression

Obsessive compulsive- neurosis[OCN]

Phobias

Neuropathic pain

Enuresis

Migraine


12/18

Anxiolytics[Antianxiety]

1. Benzodiazepines[Acts on GABA Rec]

Diazepam, Alprazolam, Lorazepam

2. Azapirones

Buspirone-Acts on 5HT receptors

3. Betablocker

Propranolol [Used in symptoms of anxiety]


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Anxiolytics -ADEs

1. Benzodiazepines

Dependence, sedation, vertigo, confusional

states

Flumazenil-effective antagonist available

2. Azapirones

Nausea, dizziness, sedation3. Betablocker

Bradycardia, bronchospasm, masking of

symtoms of hypoglycemia


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Anxiolytics -uses

Benzodiazepines

Anxiolytics,

Sedative-

hypnotics,

Anticonvulsants

Pre anaesthetic

Muscle relaxant

Azapirones

[Buspirone]

Anxiolytics,

Beta blockers

Syptoms of

anxiety[tremors,

intestinal motility]


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Fight or Flight reaction

Fear and worry

Anxiety


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Anxiety- Disorder

Excessive fear or worry


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Anxiolytics -uses

1. Anxiety is normal response

2. It helps in vigilance & drive

3. Require treatment-when performance is

affected [Alprazolam, buspirone]

4. Require treatment to control symptoms of

anxiety [Betablockers]

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Antipsycho, Antidep, Anxiolytics