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Antipsychotic drugs

Antipsychotic drugs by Dr. Nagaveni Gorla

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Antipsychotic drugs

  1. 1. Dr. Nagaveni ASST.PROF PHARMACOLOGY
  2. 2. Psychiatric conditions are divided into-  Psychosis,  Neurosis  Affective disorders.
  3. 3.  PSYCHOSES:  Loss of ability to recognize reality  Severe distortion of thinking process  Delusions and hallucinations E.g. Schizophrenia  It could be due to:  An organic cause  Functional cause .
  4. 4. NEUROSIS:  Anxiety  Phobias  Obsessive compulsive disorders  hysteria  reactive depression
  5. 5. Affective disorders ( mood disorders):  Endogenous depression  Mania Bipolar unipolar
  6. 6. Limbic system Mania Depression Schizophrenia Increased NA activity Depletion of NA or 5-HT Increased DA activity
  7. 7. What are psychotropic drugs: The drugs that affects the mental function are called psychotropic agents.
  8. 8.  Neuroleptic or antipsychotic drugs or antischizophrenic drugs  Anxiolytic drugs  Antidepressants  Antimanic drugs
  9. 9.  TRANQUILLIZER is a drug that brings about tranquility by calming, soothing and quietening effects.  major: neuroleptics and barbiturates  minor: Benzodiazepines
  10. 10.  Also called anti-schizophrenic or major tranquilizers.  Definition: The drugs which are effective in the treatment of schizophrenia and other agitated states.
  11. 11.  It is a type of functional psychoses in which severe personality changes and thought disorders.
  12. 12. POSITIVE SYMPTOMS NEGATIVE SYMPTOMS  Delusions  Auditory hallucinations  Distortion of thought  Abnormal behavior  Flattening of emotional response  Poverty of speech  Inability to get pleasure from any activity  Lack of energy to work  Failure to pay attention
  13. 13. 1. Genetic predisposition. 2. Abnormalities in amine neurotransmitter function.  Dopamine (DA) Hypothesis: Excessive dopaminergic activity  5-HT Hypothesis:
  14. 14.  TYPICAL ANTIPSYCHOTICS:  Phenothiazines: Chlorpromazine, Thioridazine, Trifluperazine  Thioxanthines: Flupenthixol, Thiothixine,  Butyrophenones: Haloperidol, Droperidol ATYPICAL OR NOVEL ANTIPSYCHOTICS Clozapine Olanzapine Quetiapine Risperidone, Ziprasidone Aripiprazole
  15. 15.  Competitive blockade of post synaptic D2 receptors  Blockade of D4 and 5-HT2A receptors by atypical anti psychotic drugs
  16. 16.   Blockade of D2 in mesolimbic system - Antipsychotic effect  Blockade of D 2 in NST – extra pyramidal effects.  Blockade of D2 in CTZ – antiemetic.  Blockade of D2 in ant.pituitary – hyperprolactinemia  Blockade of D2 in cortex – Sedation  Blockade of D2 in hypothalamus – Hypothermia
  17. 17.  Other actions: AUTONOMIC NERVOUS SYSTEM:  Blocks alpha receptors Orthostatic hypotension & tachycardia  cholinergic receptor blockade: dry mouth, blurred vision, tachycardia, urinary retention HISTAMINE RECEPTOR BLOCKADE: Sedation LOCAL ANESTHETIC ACTION
  18. 18.  Due to extension of pharmacological actions  Hypersensitivity reactions
  19. 19.  Due to extension of pharmacological actions CNS:  Sedation, drowsiness, mental confusion, convulsions  Increased appetite and weight gain
  20. 20. ANS:  Antiadrenergic: postural hypotension, tachycardia, inhibition of ejaculation Anticholinergic: Dry mouth, blurred vision, urinary retention, constipation, ENDOCRINE: Hyperprolactinemia, gynaecomastia, galactorrhoea in males Amenorrhea and infertility in females
  21. 21. Extrapyramidal side effects:  Acute dystonias  Akathisia  Parkinsonism  Nueroleptic malignant syndrome  Tardive dyskinesia  Perioral tremors
  22. 22. Dystonias: Charecterized by spasm of muscles of tongue, face neck and back. Treated by anti histaminic –Anti Cholinergic drug – Promethazine. 2. Akathisia: Characterized by uncontrollable motor restlesness. Treated by a non –selective beta blocker-propronolol. 3. Parkinsonism: Due to disturbance in the balance between DA-Ach balance in the basal ganglia due to D2 receptor blockade. Rx-centrally acting anti cholinergics – Benzhexol,Procyclidine,Benztropine.
  23. 23. . Neuroleptic - malignant syndrome (NMS): Characterized by Hyperthermia, muscular rigidity, autonomic dysfunction with tachycardia, sweating, urinary incontinence and labile BP.  Management:  Discontinuation of neuroleptic  Supportive therapy for fever and muscular rigidity.  Peripherally acting muscle relaxant – Dantrolene.
  24. 24. Perioral tremors(Rabbit syndrome) : occurs after long term Rx with potent classical neuroleptic. Characterized by rapid chewing movements. Rx -Anti cholinergic- Anti parkinsonian drugs. Tardive dyskinesia: Characterized by repetitive involuntary movements of eyelids and face Supersensitivity of DA rec caudate
  25. 25. B. DUE TO HYPERSENSITIVITY REACTIONS  Agrnulocytosis  Cholestatic jaundice.  Photosensitivity  Contact dermatitis
  26. 26. 1) With CNS depressants 2) Levodopa 3) Metoclopramide 4) The drugs producing anticholinergic side effects ( Antidepressants and antihistamines ) 5) With morphine
  27. 27.  Schizophrenia  Manic depressive psychosis  Behavioral disorders in children  Vomiting  Hiccups  Drug dependence  Pre-anesthetic medication.  To induce hypothermia in cardiac surgery  Tourette’s syndrome
  28. 28. ADVANTAGES:  Relieve the negative symptoms  Effective for Resistant cases  less extra pyramidal side effects  Less ANS side effects  Less hyperprolactinemia  Suitable for levodopa induce psychosis
  29. 29. DISADVANTAGES:  More weight gain  Seizures with clozapine  Agranulocytosis with clozapine  Hyperlipidemia and hyperglycemia with clozapine and olanzapine
  30. 30.  Antipsychotic  Anti-manic Anti-anxiety  Anti-emetic  Anti-GH,  Anti-arrhythmic  Anti-hiccough  Anti fertility  Anti-dopaminergic  Anti-serotinergic  Anti-cholinergic  Anti-histaminic  Anti-adrenergic  Anti-allergic  Anti-shock, anti- tetany,  LA, increase PL

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