2. General Principles of
Psychopharmacology
- There is no one-diagnosis-one-drug
abuse.
- Drug selection is related not only to
diagnosis but also to the meaning to
patient and family influences.
- Instructions about the treatment benefits
and risks is a must for the patient ,
relatives and nursing staff.
3. Pharmacological Actions
( Pharmacodynamics- Pharmacokinetics )
Pharmacodynamics, include:
- Receptors mechanisms( agonist, antagonist,
partial agonist, vs. lithium) .
- The dose response curve ( dose response,
potency, & clinical efficacy).
- Therapeutic index = median toxic dose
median effective dose ( high, SSRI vs. low,
lithium).
- Tolerance, dependence & withdrawal
receptors.
4. Pharmacological Actions
( Pharmacodynamics- Pharmacokinetics )
Pharmacokinetics
- Absorption: Oral ( drug concentration, GIT ph, &
motility). I.M.( DEPOT, 1- WKS). I.V( Fast, high risk of
S.E).
- Distribution : High (CBF, lipid solubility, & receptor
affinity). Vary with age, sex, AT.
- Metabolism : metabolic routes( oxidation,
reduction, hydrolysis, & conjugation). Active and
inactive metabolites. End by liver in feces,
sweat , saliva, etc. Half life . Clearance.
- Cytochrome P450 enzymes.
6. CLINICAL GUIDELINE
Optimum Results = 5 Ds.
- Diagnosis: reinvestigate.
- Drug selection : diagnosis, drug history,
tolerable S.E, lethal dose, & abuse
potential.
- Dose : low – slow ., effectiveness vs. S.E.
- Duration : 3 – 6 wks, long term
administration.
- Dialogue: Drug information.
7. Special Considerations
- Children : high metabolism, low – slow, /kg.
- Geriatric : low metabolism , 1/3 adult dose,
drug interaction and medical state.
- Pregnancy & lactation: avoid drugs esp. in
1st trimester, avoid absolutely ( lithium ,
anticonvulsant in pregnancy) . ECT is good.
- Hepatic and renal problems: half the
dose.
8. TREATMENT OF COMMON S.E
- Sexual dysfunction : bupopione , Viagra, reassurance,
yohimbex, amantadine, cryptoheptadine.
- Anxiety in SSRI.
- Insomnia of SSRI.
- GIT upset.
- headache.
- Wt gain .
- somnolence.
- Dry mouth.
- Blurred vision.
- Orthostatic hypotension.
- Urinary retention , constipation.
9. MEDICATION – INDUCED MOVEMENT DISORDERS
Movement disorder Drug responsible Treatment
Tremor APD, sympathomimetics, propranolol
TCA, alcohol, MAO
Dystonia APD,TCA, DIPHENYL BZD, A CH
HYDRAMINE,
METOCLOPRAMODE
Akathesia APD,TCA, levo dopa, propranolol
reserpine
METOCLOPRAMODE
Parkinsonism APD,TCA, reserpine, Dec medications., change, A
fluxetine, lithium, phenytoin, CH.
alcohol withdrawal.
TARDIVE DYSKINESIA APD, > 4 Y, age, female ????
Neuroleptic M. syndrome APD Dantrium, fluid,
bromocriptine,
10. DRUG TREATMENT OF
EXTRAPYRAMIDAL DISORDERS
Drug name Usual daily dose indications
benztropine 1-4 mg , twice per day Acute dystonia,
parkinsonism,
biperdin 2- 6 mg, tid akathesia.
procyclidine 2.5 – 5 mg 2-4 /d
Dipheny hydramine 25 mg QID Acute dystonia,
parkinsonism, rabbit
syndrome.
Amantadine 100 – 300 mg parkinsonism, rabbit
syndrome.
CLONAZEPAM 1mg bid dystonia, akathesia.
LORAZEPAM 1mg tid
11. Classification of
Psychotherapeutic Drugs
- Antipsychotic drugs.
- Antidepressant .
- Anti manic or mood stabilizers.
- Anti anxiety , anxiolytic drugs.
- Others ( geriatric , child , addiction , general
medications).
??????? Less valid categories
12. PREPRATIONS OF BZD RECEPTORS AGONIST AND ANTAGONIST
DRUG DOSE HALF LIFE USUAL ADULT
EQUAVILANT DOSE
CLONAZEPAM 0.5 LONG 1-6 MG /D BID
DIAZEPAM 5 LONG 4-40MG /D BID - QID
ALPRAZOLAM 0.25 INTERMEDIATE 0.5-10MG/DBID TO
QID
LORAZEPAM 1 INTERMEDIATE 1-6 MG /D TID
CHLORDIAZEPO 10 INTERMEDIATE 10 – 150 MG TID OE
XIDE QID
FLURAZEPAM 5 SHORT 15-30 MG
CLORAZEOATE 7.5MG SHORT 15 – 60 MG BID OR
QID
MIDAZOLAM 1.25- 1.7 SHORT 5 – 50 MG
PARENTRAL
FLUMEZANIL 0.05 SHORT 0.2- 0.5 MG
/MININJECTION
OVER 3- 10 MIN
13. TYPICAL ANTIPSYCHOTICS
DRUG POTENCY EQUIVALA ADULT SEDATION EXTRAPYRAMIDAL
NCY TO DOSE EFFECT
100MG OF MG
CLORPRO
MAZINE
CHLORPR LOW 100 300-800 HIGH LOW
OMAZINE
TRIFLUPE HIGH 3.5 6-20 MEDIUM HIGH
RAZINE
FLUPHENA HIGH 1.5-3 1-20 MEDIUM HIGH
ZINE
THIORIDA LOW 100 200-700 HIGH LOW
ZINE
HALOPERI HIGH 2.5 6-20 LOW HIGH
DOL
PIMOZIDE HIGH 1 1-10 LOW HIGH
14. ATYPICAL ANTIPSYCHOTICS
- NAME .
- ?????
- CLOZAPINE - RISPERIDONE-
OLANZAPINE – QUITIAPINE –
ZIPRASIDONE – ARIPIPRAZOLE.
- DOSE.
- PRCAUTIONS ( MEDICAL STATE OF THE
PATIENT , S.E, DRUG INTERACTIONS).
18. PSYCHOTROPICS IN PROBLEM AREAS
APD AD ANXIOLY ANTI OTHERS
TICS CNVALSE
N
HEART SULPRIDE,O MIANSERIN BZD, BZD, ACOMPRO
PROBLEM LANZAPINE, E, BUSPAR LAMOTRIGI SATE ,
QUATIAPIN MIRTAZEPI N, MEMANTI
E, NE, SSRI, TOPRAMAIT NE
ZUCLOPENT TRAZODONE E,
H VALPROATE
LIVER SULPRIDE, MIANSERIN LORAZEPAM CARBAMEZ, LITHIUM,
PIMOZIDE, E, , TOPRAMAIT MEMANTI
ARIPEPRA, PAROXETIN TEMAZEPAM E NE
HALDOL E
RENAL LOXAPINE MIANSERIN BZD PHENYTOIN ANTICHOL
E, TCA, N INEESTRA
TRAZODON SE
DIABETU ARIPIPAZ, SSRI. BZD, ACOMPRO
SULPRIDE, TRAZODONE BUSPAR SATE ,,
S
PIMOZIDE, MODAFINI
HALDOL L
19. PSYCHOTROPICS IN PROBLEM AREAS
APD AD ANXIOLY ANTI OTHER
TICS CNVALSE S
N
BREAST SULPRIDE TCA, BZD CARBAMEZ
FLUPENTHE APINE,
FEED
XOLE VALPROATE
EPILEPSY SULPRIDE, SSRI BZD
AMISULPRI
DE,
HALDOL,
PIMOZIDE,
QUATIAPIN
E
RISPERIDO
NE
GLAUCO HALDOL, TRAZODON ACOMPR
RISPERIDO E, OSATE ,
MA
NE, VENLAFAXI MEMANT
SULPRIDE NE INE
LITHIUM
20. AVOID THE FOLLOWINGS
BREAST FEEDING: ARIPRPRAZOLE, CLOZAPINE, OLANZAPINE,
RISPERIDONE, MAAOI, VENLAFAXINE, BUSPIRONE, OTHER
ANTIEPILEPTICS.
HEAR PROBLEM , CLOZAPINE, PIMOZIDE, THIORIDAZINR, ZIPRASIDONE,
TCA, VENLAFAXINE, DISULFRAM , .
DIABETUS: OLANZAPINE, MAOI.
EPILEPSY, CHLORPROMAZINE, CLOZAPINE, BUPROPION
GLAUCOMA: OLANZAPINE, TCA.
LIVER PROBLEM: ZOTEPINE, MAOI, BZD, VALPROATE,
PHENYTOIN, BARBITURATE.
RENAL PROBLEMS:AMISULPRIDE, RISPERIDONE, SULPRIDE, FLUXETINE,
VENLAFAXINE, BUSPIRONE, AVOID ANTI CONVULSANT OTHER THAN
PHENYTOIN.
