ANTI-PSYCHOTIC DRUGS.pptx

ANTI-PSYCHOTIC DRUGS.pptx

• 1.
  ANTI-PSYCHOTIC DRUGS (NEUROLEPTICS) DR.FOUZIA
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  PSYCHOSIS Psychosis is asymptom of mental illnesses characterized by a distorted or nonexistent sense of reality. 1-Delusions 2-Hallucinations 3-Deranged thought process 4-Clear sensorium
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  PSYCHOSIS Dopamine Excess Psychosis Schizophrenia: Syndrome characterized by massive disruption of thinking, mood and behavior and poor ability to filter various types of stimuli. Positive symptoms: Delusions, Hallucinations and illusions Negative symptoms: Diminished sociability, Poverty of speech
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  CLASSIFICATION OF ANTIPSHYCHOTICS A-Typicalantipsychotic agents (Classic drugs) D2 Antagonist •Chlorpromazine (prototypical drug) •Thioridazine •Fluphenazine •Thiothixene •Haloperidol
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  CLASSIFICATION OF ANTIPSHYCHOTICS B-Atypical antipsychotic agents (Newer agents) 5-HT2 Antagonist •Clozapine •Olanzapine •Quetiapine •Risperidone •Ziprasidone •Aripiprazole
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  RECEPTORS BLOCKED BYANTIPSHYCHOTICS Dopamine receptors: D2 ↓ c AMP Serotonin receptors: 5-HT2
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  MECHANISM OF ACTIONOF ANTIPSHYCHOTICS A-Typical antipsychotic agents (Classic drugs) Block mainly D2-Receptor α1 H1 Blocked by Chlorpromazine (prototypical drug) M B- Atypical antipsychotic agents (Newer agents) Block mainly 5-HT2-Receptor Less effect on D2-Receptor
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  PHARMACOLOGICAL EFFECTS OFCHLORPROMAZINE 1-Antipsychotic effects: ↓ “positive” symptoms 2-Extrapyramidal effects: Blockade of D2-R Dystonias Parkinson-like symptoms Akathisia (motor restlessness) Tardive dyskinesia
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  PHARMACOLOGICAL EFFECTS OFCHLORPROMAZINE 3-Antiemetic effects: Blocking D2-R of CTZ 4-Anticholinergic effects: Blurred vision, Dry mouth, Constipation, Urinary retention. 5-Blockade of α1-receptors Orthostatic hypotension 6-Pitutary D2-receptor blockage ↑Prolactin release  Hyperprolactinemia 7-H1-receptor Blockage Sedation
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  THERAPEUTIC INDICATIONS A-PSYCHIATRIC USES 1-Schizophrenia:Primary indication for antipsychotics 2-Schizoaffective Disorders 3-Bipolar affective disorder 4-Acute bipolar depression 5-To control agitation with schizophrenia and bipolar disorder 6-Tourette’s Syndrome 7- Alzheimer’ disease
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  THERAPEUTIC INDICATIONS B-NON-PSYCHIATRIC USES 1-Anti-emetic Prochlorperazine 2- Pruritus Chlorpromazine 3- Preoperative sedative Promethazine 4- Neurolept analgesia Droperidol + Fentanyl (Opioid) 5- Intractable hiccups Chlorpromazine
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  ADVERSE EFFECTS A-Reversible neurologiceffects 1-Dose-dependent EPS 2-Akathisia and dystonias B-Tardive dyskinesia C- Autonomic effects Anticholinergic , α1 blockade D-Endocrine and metabolic effects 1-↑Prolactin secretion (Typical) 2-Weight gain, hyperglycemia, hyperlipidemia (Atypical)
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  ADVERSE EFFECTS E- Neurolepticmalignant syndrome •Neuroleptic malignant syndrome (NMS) is a life-threatening idiosyncratic reaction to antipsychotic drugs characterized by fever, altered mental status, muscle rigidity, and autonomic dysfunction. •Symptoms include very high fever (102 to 104 degrees F), irregular pulse, accelerated heartbeat (tachycardia), increased rate of respiration (tachypnea), muscle rigidity, altered mental status, autonomic nervous system dysfunction resulting in high or low blood pressure F- Sedation G-Miscellaneous toxicities 1-Retinal deposits (Visual impairment) 2-Prolong the QT interval 3- Agranulocytosis (1–2%)
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  COMAPRISON OF TYPICALANDATYPICAL DRUGS TYPICAL 1-Block D2 receptor 2-High Incidence of EPS 3-For positive symptoms only 4-↑ incidence of tardive dyskinesia 5-↑ prolactin secretion 6-↑ incidence of sexual disturbances 7- Not effective in resistant cases 8-Non-psychiatric uses ATYPICAL 1-Block 5HT-2 receptor 2-Low incidence of EPS 3-For positive and negative symptoms 4-↓ incidence of tardive dyskinesia 5- Less effects on prolactin secretion 6- ↓incidence of sexual disturbances 7- Effective in resistant cases (Clozapine) 8-No non-psychiatric uses