06 Psychotherapeutic Agents Upd
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- 1.Antidepressantsand Antipsychotics
- The therapy of emotional and mental disorders
- are normal human emotions
- The ability to cope with these emotions can range from occasional depression or anxiety to constant emotional distress to the point ofinterfering with the ability to carry on normal daily living.
- When these emotions significantly affect an individuals ability to carry out normal daily functions, treatment with a psychotherapeutic drug is a possible option.
- Three main emotional and mental disorders:
- A major emotional disorder that impairs the mental function of the affected individual to the point that the individual cannot participate in everyday life.
- Hallmark:loss of contact with reality
- Major emotional disorders that impair the mental function of the affected individual to the point that the individual cannot participate in everyday life.
- Mania:abnormally pronounced emotions
- Depression:abnormally reduced emotions
- Bipolar affective disorder:exhibits both maniaand depression
- Mental disorders are associated with abnormal levels of endogenous chemicals, such as neurotransmitters, in the brain.
- Brain levels of certain catecholamines play an important role in maintaining mental health.
- Other biochemicals are necessary for normalmental function.
- Biogenic Amine Hypothesis
- Depression and mania are due to an alteration in neuronal and synaptic catecholamine concentration at adrenergic receptor sites in the brain.
- Depression: deficiency of catecholamine, especially norepinephrine
- tricyclics, tetracyclics, SSRIs, MAOIs
- Monoamine oxidase inhibitors (MAOIs)
- Second-generation antidepressantsand SSRIs
- Tricyclic antidepressantsprimary: amitriptyline (Elavil), doxepin (Sinequan),imipramine (Tofranil)
- Tricyclic antidepressantssecondary: desipramine (Norpramin), nortriptyline (Aventyl), protriptyline (Vivactil)
- Tetracyclic antidepressants:amoxapine (Asendin), maprotiline (Ludiomil)
- Block reuptake of neurotransmitters, causing accumulation at the nerve endings.
- It is thought that increasing concentrations of neurotransmitters will correct the abnormally low levels that lead to depression.
- Blockade of norepinephrine:
- antidepressant, tremors, tachycardia, additive pressor effects with sympathomimetic drugs
- antidepressant, nausea, headache, anxiety,sexual dysfunction
- Childhood enuresis (imipramine)
- Obsessive-compulsive disorders (clomipramine)
- dizziness, postural hypotension, constipation, delayed micturation, edema, muscle tremors
- Lethal70 to 80% die before reachingthe hospital
- CNS and cardiovascular systems aremainly affected
- Death results from seizures or dysrhythmias
- Decrease drug absorption with activated charcoal
- Speed elimination by alkalinizing urine
- Manage seizures and dysrhythmias
- Considered second-line treatment for depression not responsive to cyclics
- Disadvantage:potential to cause hypertensive crisis when taken with tyramine
- tranylcypromine (Parnate)
- Inhibit the MAO enzyme system in the CNS
- Amines (dopamine, serotonin, norepinephrine) are not broken down, resulting in higher levels in the brain
- Result:alleviation of symptoms of depression
- Depression, especially types characterized by reverse vegetative symptoms such as increased sleep and appetite
- Depression that does not respond to other agents such as tricyclics
- Few side effectsorthostatic hypotension most common
- Symptoms appear 12 hours after ingestion
- Tachycardia, circulatory collapse,seizures, coma
- Treatment: protect brain and heart,eliminate toxin
- Ingestion of foods and/or drinks withthe amino acid TYRAMINE leads to hypertensive crisis, which may leadto cerebral hemorrhage, stroke,coma, or death
- Avoid foods that contain tyramine!
- Aged, mature cheeses (cheddar, blue, Swiss)
- Smoked/pickled or aged meats, fish, poultry (herring, sausage, corned beef, salami, pepperoni, pat)
- Red wines (Chianti, burgundy, sherry, vermouth)
- Italian broad beans (fava beans)
- Fewer side effects than tricyclics, but not superior in overall efficacy or onset of action
- bupropion (Wellbutrin, Zyban)
- selective serotonin reuptake inhibitors (SSRIs)
- Selectively inhibit serotonin reuptake
- Little or no effect on norepinephrine or dopamine reuptake
- Results in increased serotonin concentrations at nerve endings
- Advantage over tricyclics and MAOIs: Little or no effect on cardiovascular system
- Used for depressionvery few serious side effects
- Bipolar affective disorder
- Obsessive-compulsive disorder
- Treatment of various substance abuse problems (bupropion [Zyban] is used for smoking cessation treatment)
- CNS Headache, dizziness,tremor, nervousness,insomnia, fatigue
- GI Nausea, diarrhea, constipation, dry mouth
- Other Sweating, sexualdysfunction
- Highly bound to plasma proteins
- Compete with other protein-binding drugs, resulting in more free, unbound drug to cause a more pronounced drug effect
- Drugs used to treat serious mental illness
- Behavioral problems or psychotic disorders
- Thioxanthenes: chlorprothixene, thiothixene (Navane)
- Butyrophenones: haloperidol (Haldol)
- Dihydroindolones: molindone (Moban)
- Dibenzoxazepine: loxapine (Loxitane)
- Phenothiazines: three structural groups
- Aliphatic: chlorpromazine (Thorazine), triflupromazine (Vesprin)
- Piperidine: mesoridazine (Serentil), thioridazine (Mellaril)
- Piperazine: fluphenazine (Prolixin), perphenazine (Trilafon), prochlorperazine (Compazine), trifluoperazine (Stelazine)
- Largest group of psychotropic agents