06 Psychotherapeutic Agents Upd

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Pharmacology

Text of 06 Psychotherapeutic Agents Upd

  • 1.Antidepressantsand Antipsychotics

2.

  • The therapy of emotional and mental disorders

3.

  • Anxiety
  • Grief
  • Depression
  • are normal human emotions

4.

  • 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.

5.

  • When these emotions significantly affect an individuals ability to carry out normal daily functions, treatment with a psychotherapeutic drug is a possible option.

6.

  • Three main emotional and mental disorders:
  • Psychoses
  • Affective disorders
  • Anxiety

7.

  • Psychosis
  • 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

8.

  • Affective Disorders
  • Major emotional disorders that impair the mental function of the affected individual to the point that the individual cannot participate in everyday life.

9.

  • Affective Disorders
  • Mania:abnormally pronounced emotions
  • Depression:abnormally reduced emotions
  • Bipolar affective disorder:exhibits both maniaand depression

10.

  • Pathophysiology
  • Biochemical Imbalance
  • Mental disorders are associated with abnormal levels of endogenous chemicals, such as neurotransmitters, in the brain.

11.

  • Pathophysiology
  • Biochemical Imbalance
  • Brain levels of certain catecholamines play an important role in maintaining mental health.
    • Dopamine
    • Serotonin
    • Histamine

12.

  • Pathophysiology
  • Biochemical Imbalance
  • Other biochemicals are necessary for normalmental function.
    • GABA
    • acetylcholine
    • lithium

13.

  • 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
    • Mania: excess amines

14. 15.

  • Drug Categories
  • Antidepressants
  • tricyclics, tetracyclics, SSRIs, MAOIs
  • Antimanic Agents
  • lithium

16.

  • Cyclic antidepressants
    • tricyclics
    • tetracyclics
  • Monoamine oxidase inhibitors (MAOIs)
  • Second-generation antidepressantsand SSRIs

17.

  • Tricyclic antidepressantsprimary: amitriptyline (Elavil), doxepin (Sinequan),imipramine (Tofranil)
  • Tricyclic antidepressantssecondary: desipramine (Norpramin), nortriptyline (Aventyl), protriptyline (Vivactil)
  • Tetracyclic antidepressants:amoxapine (Asendin), maprotiline (Ludiomil)

18.

  • 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.

19.

  • Blockade of norepinephrine:
    • antidepressant, tremors, tachycardia, additive pressor effects with sympathomimetic drugs
  • Blockade of serotonin:
    • antidepressant, nausea, headache, anxiety,sexual dysfunction

20.

  • Depression
  • Childhood enuresis (imipramine)
  • Obsessive-compulsive disorders (clomipramine)
  • Adjunctive analgesics
  • Trigeminal neuralgia

21.

  • Sedation
  • Impotence
  • Orthostatic hypotension
  • Older patients:
    • dizziness, postural hypotension, constipation, delayed micturation, edema, muscle tremors

22.

  • Lethal70 to 80% die before reachingthe hospital
  • CNS and cardiovascular systems aremainly affected
  • Death results from seizures or dysrhythmias
  • No specific antidote
    • Decrease drug absorption with activated charcoal
    • Speed elimination by alkalinizing urine
    • Manage seizures and dysrhythmias
    • Basic life support

23.

  • Highly effective
  • Considered second-line treatment for depression not responsive to cyclics
  • Disadvantage:potential to cause hypertensive crisis when taken with tyramine

24.

  • phenelzine (Nardil)
  • tranylcypromine (Parnate)
  • isocarboxazid (Marplan)

25.

  • 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

26.

  • 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

27.

  • Few side effectsorthostatic hypotension most common
  • Tachycardia Palpitations
  • Dizziness Drowsiness
  • Insomnia Headache
  • Anorexia Nausea
  • Blurred vision Impotence

28.

  • Symptoms appear 12 hours after ingestion
  • Tachycardia, circulatory collapse,seizures, coma
  • Treatment: protect brain and heart,eliminate toxin
    • Gastric lavage
    • Urine acidification
    • Hemodialysis

29.

  • Ingestion of foods and/or drinks withthe amino acid TYRAMINE leads to hypertensive crisis, which may leadto cerebral hemorrhage, stroke,coma, or death

30.

  • 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)
  • Yeast extracts
  • Red wines (Chianti, burgundy, sherry, vermouth)
  • Italian broad beans (fava beans)

31.

  • Newer
  • Fewer side effects than tricyclics, but not superior in overall efficacy or onset of action
    • trazodone (Desyrel)
    • bupropion (Wellbutrin, Zyban)
    • selective serotonin reuptake inhibitors (SSRIs)

32.

  • 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

33.

  • Used for depressionvery few serious side effects
  • Bipolar affective disorder
  • Obesity
  • Eating disorders
  • Obsessive-compulsive disorder
  • Panic attacks
  • Myoclonus
  • Treatment of various substance abuse problems (bupropion [Zyban] is used for smoking cessation treatment)

34.

  • Body System Effects
  • CNS Headache, dizziness,tremor, nervousness,insomnia, fatigue
  • GI Nausea, diarrhea, constipation, dry mouth
  • Other Sweating, sexualdysfunction

35.

  • Highly bound to plasma proteins
  • Compete with other protein-binding drugs, resulting in more free, unbound drug to cause a more pronounced drug effect

36.

  • Drugs used to treat serious mental illness
  • Behavioral problems or psychotic disorders

37.

  • Thioxanthenes: chlorprothixene, thiothixene (Navane)
  • Butyrophenones: haloperidol (Haldol)
  • Dihydroindolones: molindone (Moban)
  • Dibenzoxazepine: loxapine (Loxitane)
  • Phenothiazines: three structural groups

38.

  • Aliphatic: chlorpromazine (Thorazine), triflupromazine (Vesprin)
  • Piperidine: mesoridazine (Serentil), thioridazine (Mellaril)
  • Piperazine: fluphenazine (Prolixin), perphenazine (Trilafon), prochlorperazine (Compazine), trifluoperazine (Stelazine)
  • Largest group of psychotropic agents

39.

  • clozapine (Clo