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    Anti Psychotic

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    Asep Cece Irham
    Haloperidol is used to treat schizophrenia by blocking dopamine receptors in the brain. The patient developed side effects like tremors and rigidity because haloperidol also blocks dopamine receptors in other areas outside of the brain. To address the side effects, the doctor could consider changing to another antipsychotic medication or adding a medication to counteract the extrapyramidal symptoms. Haloperidol is effective at treating the positive symptoms of schizophrenia by controlling dopamine signaling in the mesolimbic pathway.

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    Anti Psychotic

    Uploaded by

    Asep Cece Irham
    68 views38 pages
    Haloperidol is used to treat schizophrenia by blocking dopamine receptors in the brain. The patient developed side effects like tremors and rigidity because haloperidol also blocks dopamine receptors in other areas outside of the brain. To address the side effects, the doctor could consider changing to another antipsychotic medication or adding a medication to counteract the extrapyramidal symptoms. Haloperidol is effective at treating the positive symptoms of schizophrenia by controlling dopamine signaling in the mesolimbic pathway.

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    Anti psychotic

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    Haloperidol is used to treat schizophrenia by blocking dopamine receptors in the brain. The patient developed side effects like tremors and rigidity because haloperidol also blocks dopamine receptors in other areas outside of the brain. To address the side effects, the doctor could consider changing to another antipsychotic medication or adding a medication to counteract the extrapyramidal symptoms. Haloperidol is effective at treating the positive symptoms of schizophrenia by controlling dopamine signaling in the mesolimbic pathway.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    68 views38 pages

    Anti Psychotic

    Uploaded by

    Asep Cece Irham
    Haloperidol is used to treat schizophrenia by blocking dopamine receptors in the brain. The patient developed side effects like tremors and rigidity because haloperidol also blocks dopamine receptors in other areas outside of the brain. To address the side effects, the doctor could consider changing to another antipsychotic medication or adding a medication to counteract the extrapyramidal symptoms. Haloperidol is effective at treating the positive symptoms of schizophrenia by controlling dopamine signaling in the mesolimbic pathway.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 38

    DRUGS USED FOR

    TREATMENT PSYCHIATRIC
    DISORDERS
    (PSYCOTROPIC DRUGS)

    Dr. TRULLY SITORUS, MSi


    DEPARTMENT OF PHARMACOLOGY
    & THERAPY
    NEUROBEHAVIOUR SYSTEM
    CASE
    Mr X began haloperidol therapy for schizophrenia and
    within several week developed bradykinesia, rigidity
    and tremor
    His psychosis were well controlled
    What
    Whatisisthe
    themechanism
    mechanismof ofaction
    action
    of
    ofhaloperidol?
    haloperidol?
    Why
    Whyhaloperidol
    haloperidolcan
    cancontrol
    control
    schizophrenia?
    schizophrenia?
    Why
    Whyhe hegot
    gotbradykinesia,
    bradykinesia,rigidity
    rigidity
    and
    andtremor?
    tremor?
    How
    Howto tohandle
    handlethe
    theproblem?
    problem?
    Should
    Shouldititchange
    changeto toothers
    othersdrugs?
    drugs?
    SCHIZOPHRENIA
    Is a psychotic illness characterized by multiple
    symptoms affecting thought preceptions and
    emotion

    The symptoms of SZ is divided to :


     Positive symptom

     Negative symptom
    Symptoms of SZ
    POSITIVE SYMPTOMS
    • hallucinations
    • Delusions
    • Thought disorders
    •Bizzare behaviour

    NEGATIVE SYMPTOMS
    • Poverty of speech
    Which is a restrictions in the amount of spontaneous speech
    • Flatteing of affect (Loss of normal expression of emotion)
    • Social withdrawal
    •Apathy (reduced drive, energy and interest)
    • Attention deficit
    PATHOGENESIS OF SZ
    Hypothesis :
    Neurotransmitter alternation in mesolimbic
    and mesocortical areas

    neurotransmitter

    : dopamine
    5 HT
    NE
    glutamate
    Mechanism of action of SZ-drugs

    SZ
    D D D
    S
    S D
    Drugs S S D D D
    D Drugs
    block block
    Serotonin dopamine
    Receptor receptor

    Symptom
    DRUGS USED FOR TREATMENT SZ
    Precipitate F Non pharmacologist
    How
    Howtoto
    treat
    treatthe
    the dopamine
    dopamine
    SZ
    SZ Drugs :
    others
    others Dopamine antagonist

    Psychotropic drugs
    Neuroleptic drugs

    Positive symptoms
    Negative symptoms
    PSYCHOTROPIC DRUGS/NEUROLEPTIC DRUGS
    Class Chemical Examples
    Classification
    Typical Phenothiazines Chlorpromazines
    Anti P Thioridazines
    Fluphenazines
    Butyrophenones Haloperidol
    Thioxanthines Flupentixol
    Atypical Dibenzodiazepin Clozapine
    Olanzapine

    A Psychosis Bensisoxazole Risperidone


    EFFECTS
    1. Antipsychotic actions
    (blocking dopamin receptor in the mesolimbic
    system)
     Hallucinations
     Agitation
     Sedation
     Spontaneous physical movement
    Onset of action: several weeks
    Do not depress intellectual function and motor
    incoordination is minimal
    3. Antiemetic effects
    (blocking D2 dopaminergic
    receptor of the CTZ of the medulla)
    SIDE EFFECT OF PSYCHOTROPIC
    DRUGS

    Why
    Why
    the
    theSE
    SE
    occurs?
    occurs? The
    Thedrugs
    drugs
    !! 1.
    1. Interact
    Interactwith
    withDD
    receptor
    receptor in
    in
    others
    othersarea.
    area.
    2.
    2. Interact
    Interactwith
    with
    others
    others
    neurotransmitte
    neurotransmitte
    rr
    DISTRIBUTION OF DOPAMINE
    Why
    Why the
    theSE
    SE
    occurs?!
    occurs?!

    II. NIGROSTRIATAL
    Coordinate of
    voluntary system
    I. MESOLIMBIC :
    Behaviour
    Emotion III.TUBEROIFUNDI
    BULUM
    Memory
    Prolactin
    Communication secretion
    DRUGS INTERACT WITH OTHERS
    NEURROTRANSMITTER RECEPTORS
    Why
    Why
    the
    theSE
    SE
    occurs?
    occurs?
    !!
    Why
    Why the
    theSE
    SE
    occurs?!
    occurs?!

    Psychotropic drugs

    Dopamine Serotonin
    α Adrenergik Muscarinik Histamine
    receptor receptor
    Clinical Extra Sedative Hypotensive
    potency pyramidal
    Chlorpromazine Low Medium High High

    Fluphenazine High High Low Very low

    Thioridazine High Medium Medium Medium

    Haloperidol High Very High Low Very low

    Clozapine Medium Very low Low Medium

    Olanzapine High Very low Medium Low

    Risperidon High Low low Low


    INDICATION

    I. Treatment of Schizophrenia
    The neuroleptics are the only efficacious
    treatment for SZ
     Typical. Are the most effective in treating positive
    symptom of SZ
     Atypical. Are effective in many patient resistant to the
    traditional drugs (typical) especially in treating
    negative symptom of SZ
    II. Prevention of severe and vomiting
     Neuroleptics are useful in the treatment of drugs-
    induced nausea. (Chemotherapy for cancer)
    DRUGS USED IN MOOD
    DISORDERS

    Dr. TRULLY SITORUS, MSi


    DEPARTMENT OF PHARMACOLOGY
    & THERAPY
    NEUROBEHAVIOUR SYSTEM
    MOOD DISORDERS
    Depression :
    Present as depressed mood
    diminished interest in normal activities
    Anorexia
    Fatique
    Inability to concentrate
    Manic :
    Characterized by expansive mood.
    Inflated self esteem
    Pressured speech
    Flight of ideas
    Insomnia
     Seorang pengacara berusia 42 th. Datang dengan
    keluhan utama episode sesak nafas yang sering
    timbul dan palpitasi, pada saat serangan dia merasa
    mual (nausea) dan berkeringat. Serangan ini makin
    sering timbul beberapa bulan terakhir ini. Gejalanya
    tidak berkaitan dengan aktivitas fisik, dan cenderung
    menghilang dalam beberapa menit. Pada saat itu, dia
    merasa sangat takut dan mengira dia mengalami
    serangan jantung.
     Pada pemeriksaan, dia terlihat kurus, letih dan agitasi.
    Karena berada dalam tekanan pekerjaan, dia
    mengalami gangguan tidur dan sulit berkonsentrasi.
    Suasana hatinya terasa murung dan cemas mengenai
    penyebab dari serangan ini. Dia tidak memiliki
    keinginan untuk bunuh diri secara aktif, namun
    terkadang dia berfikir kalau keluarganya akan lebih
    baik tanpa dia.
    PATHOGENESIS

    DEPRESSION
    Serotonin
    Serotonin
    NE
    NE
    Dopamine
    Dopamine

    Drugs that increase


    serotonin
    concentration

    Symptom
    ANTIDEPRESSAN DRUGS

    1. Tricyclic antidepressants (TCAs)


    Amitriptyline
    Imipramine
    Others
    2. Selective serotonin reuptake inhibitors (SSRIs)
    Fluoxetine
    Sertaline
    Others
    3. MAOIs
    Isocarboxazid
    MECHANISM OF ACTION
    TRICYCLIC ANTIDEPRESANTS

     Mechanism of action
    1. TCAs inhibit the neuronal reuptake of
    norepinephrine, and serotonin into
    presynaptic nerve terminals.
    2. Block of the receptor :

    Serotonin α adrenergic, histamine,


    muscarinic.
    UPTAKE INHIBITION RECEPTOR AFFINITIES
    DRUG
    Histaminergi
    Norepinephrine Serotonin Muscarinic Adrenergic
    c

    TCA ++ +++ ++ + +

    SSRI 0 ++++ 0 0 0
    THE ONSET OF TCA EFFECT

    • Narrow therapeutic range


    • Steady state achieve in 2-3 week
    • The onset effect : 2-3 week
    SSRIs
    Mechanism of action
     Inhibition of Serotonin uptake into
    presynaptic nerve terminal
    Indication
     Depression :

    Bulimia nervosa, obsesive-compulsive


    disorders, anorexia nervosa, panic
    disorder, premenstrual syndrome
    TRICYCLIC ANTIDEPRESANTS

     Pharmacokinetics
    Fluoxetine is a potent inhibitor of a cyt-P-
    450 enzyme, metabolism other drug will
    decrease.

    The drugs usually give once daily in the


    morning
    MONOAMINE OXIDASE INHIBITOR
     Mechanism of action
    Block the action of enzyme that metabolize
    (degrade) monotransmitter (5HT N A
    Dopamine)
    The monoamine will increase
     Indication
     For depressed patients who are Unresponsive or
    allerrgic to other drugs
     For depressed patient who have strong anxiety
    SE :
    Drowsiness, orthostatic hypotension, blurred vision,
    dryness of the mouth, dysuria, constipation
    TREATMENT OF BIPOLAR AFFEVTIVE
    DISORDERS (BPAD)
     BPAD is characterized by Bdepression and
    mania we called as manic-depressive
    disorders

     Drug for treatment HB-disorders :

    I. Litium
    II. Carbamazepine
    Gabapentine
    LITHIUM SALT

    The mechanism of action is unknown.

    Hypothesis :
    Li act by altering the cellular
    concentration of IP3.

    The therapeutic range is very narrow.

    Side effect : Ataxia, tremors, confusion,


    and convulsion
    Takut mati
    Takut hilang kontrol
    Takut pinsan
    Takut menjadi gila
    Pusing Depersonalisasi
    Pucat / derealisasi
    Tenggorokan
    terasa tersumbat
    Nyeri dada Palpitasi

    Mual/nausea Semburat dingin/


    panas
    Mulas, ingin defekasi
    Sweating
    Gemetar
    Terasa tertusuk
    jarum

    Tungkai terasa
    lemas
    ANTIPSYCHOSIS TEST

    A. Dopamine mesolimbic 1. Movement disorders


    B. Dopamine tubero In 2. Infertility
    C. Dopamine nigrostriatal 3. Amenorrhoea
    4. Hypotensi orthostatic
    D. α1 adrenergik
    5. Sedation
    E. Muscarinic 6. Parkinsonism
    F. Histamine (Extrapyramidal)
    7. Constipation
    8. Gynecomastia
    9. Tardive dyskinesia
    10. Dry mouth
    1. Amytriptilin A. Hypotensi orthostatic
    2. Fluoxetine B. Extrapyramidal
    3. Halloperidol disorders
    4. Olanzapine C. Dry mouth,
    5. Trihexyphenidil constipation
    D. SSRIs
    E. Anticholinergic
    PATHOGENESIS OF SZ
    D D D
    Normal
    S S

    No symptom

    sz
    D D

    D D D D D

    S S S S

    Positive Negative
    Symptom Symptom
    *EFFECT – SIDE EFFECT
    RESPONS OF AP DRUGS

    EFFECT SIDE EFFECT


    (Primary effect) (secondary effect)

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