psychotics

1. Psychiatric Agents

2. © Johns Hopkins University, Baltimore, Maryland /// Contributed by: Andrew Healey, 2001
Classes of Drugs to cover briefly
 Sedative and hypnotic drugs
 Benzodiazepines – know MOA (not
explicitly taught)
 Antidepressants and antimanic
drugs
 Antianxiety Drugs

3. © Johns Hopkins University, Baltimore, Maryland /// Contributed by: Andrew Healey, 2001
Sedatives
 reduce activity or excitement
 some degree of drowsiness
common.

4. © Johns Hopkins University, Baltimore, Maryland /// Contributed by: Andrew Healey, 2001
Benzodiazepines –
 daytime sedation
 sedation before anethesia
 sleep inducement
 relief of anxiety and tension
 skeletal muscle relaxation
 anticonvulsant activity

5. © Johns Hopkins University, Baltimore, Maryland /// Contributed by: Andrew Healey, 2001
Benzodiazepines
 absorbed well from GI tract
 distributed widely
 some also given parenterally
 all metabolized in liver, excreted
primarily in urine.

6. © Johns Hopkins University, Baltimore, Maryland /// Contributed by: Andrew Healey, 2001
Benzodiazepines
 help regulate emotional activity
 calm or sedate without causing
drowsiness
 higher dosages, induce sleep
 increase time asleep
 + sleep is deeper, more refreshing
 decrease time spent in REM sleep

7. © Johns Hopkins University, Baltimore, Maryland /// Contributed by: Andrew Healey, 2001
Barbituates
 sedatives and hypnotics
 “barbital” always in the name
 reduce overall CNS alertness
 standard pharmacokinetics
 appear to act through CNS

8. © Johns Hopkins University, Baltimore, Maryland /// Contributed by: Andrew Healey, 2001
Barbituates –
 daytime sedation (short periods only)
 hypnotic effects (insomnia)
 preop sedation and anesthesia
 relief of anxiety
 anticonvulsant

9. © Johns Hopkins University, Baltimore, Maryland /// Contributed by: Andrew Healey, 2001
Barbituates – PT
 Caution
– tolerance
– psychological / physical dependence
 benzodiazepines relatively effective and
safe and effective > almost replaced
them as sedatives / hypnotics

10. © Johns Hopkins University, Baltimore, Maryland /// Contributed by: Andrew Healey, 2001
Antidepressants
 “Affective disorders”
– disurbances in mood, characterized by
depression or elation
 MAO inhibitors
 tricyclic antidepressants (TCA)
 other antidepressants

11. © Johns Hopkins University, Baltimore, Maryland /// Contributed by: Andrew Healey, 2001
MAO inhibitors
 Excreted mainly in GI tract, and a bit by
the kidneys
 – inhibit monoamine oxidase,
– enzyme that normally metabolizes the
norepinephrine and serotonin
– NE and serotonin stick around longer
– can interact with more receptors, longer

12. © Johns Hopkins University, Baltimore, Maryland /// Contributed by: Andrew Healey, 2001
MAO inhibitors
 also used to treat phobias and other
psychiatric conditions
 lots of drug-drug and drug-food
interactions
 lots of caution when using them!!

13. © Johns Hopkins University, Baltimore, Maryland /// Contributed by: Andrew Healey, 2001
Tricyclic Antidepressants
 amitriptyline
 imipramine hydrochloride
 can read about this large class of
very common antidepressants

14. © Johns Hopkins University, Baltimore, Maryland /// Contributed by: Andrew Healey, 2001
Selective Serotonin Reuptake
Inhibitors
 serotonin sticks around longer in
synapse
 “feel good” molecule
 SSRIs have typically PK and are
highly protein bound

15. © Johns Hopkins University, Baltimore, Maryland /// Contributed by: Andrew Healey, 2001
SSRIs
 used to treat major depressive
episodes
 obsessive-compulsive disorder
 Zoloft > post-traumatic stress
disorder

16. © Johns Hopkins University, Baltimore, Maryland /// Contributed by: Andrew Healey, 2001
SSRIs
 Prozac (fluoxetine hydrochloride)
 Paxil (paroxetine hydrochloride)
 very effective, very interesting
 very important
 can take weeks before see therapeutic
benefit!!

17. © Johns Hopkins University, Baltimore, Maryland /// Contributed by: Andrew Healey, 2001
Anxiolytics
 Some of the most commonly
prescribed drugs
 Benzodiazepines
 Barbituates
 Buspirone

18. © Johns Hopkins University, Baltimore, Maryland /// Contributed by: Andrew Healey, 2001
Buspirone
 absorbed rapidly, extensive 1st pass
 metabolized to at least 1 active
metabolite
 eliminated in urine and feces
 mechanism of action unclear

19. © Johns Hopkins University, Baltimore, Maryland /// Contributed by: Andrew Healey, 2001
Let’s review…
 We only glazed the surface
 Wide variety of drugs in use a lot
 Sedative and hypnotic drugs
 Benzodiazepines – know MOA
 Antidepressants and antimanic drugs
 Antianxiety drugs