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Psychiatry Drugs

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Psychiatry Drugs

  1. 1. Psych Druuuuugs • Anti depressants • Mood Stabilisers • Anti psychotics • Anxiolytics and Hypnotics
  2. 2. Anti depressants • How do they work? Increase levels of good mood chemicals (serotonin and noradrenaline) • Where do they work? In the presynaptic cleft Specific Serotonin Reuptake Inhibitor (SSRI) Noradrenaline reuptake inhibitor (NRI) Tricyclic antidepressant (TCA) Mono Amine Oxidase Inhibitor (MAOI) Reversible Inhibitor of Mono amine oxidase A (RIMA)
  3. 3. In more detail….. • So serotonin and noradrenaline are MONOAMINE NEUROTRANSMITTERS (made at the presynaptic cleft)
  4. 4. Selective Serotonin Reuptake Inhibitors (SSRI’S) FLUOXETINE SERTRALINE PAROXETINE CITALOPRAM Side effects: • Nausea • Vomiting • Anxiety • Agitation • Insomnia • Loss of appetite • Sexual dysfunction Anorgasmia & delayed ejaculation Contra-indication: MANIA
  5. 5. Noradrenaline Reuptake Inhibitor (NRI) REBOXETINE
  6. 6. Tri Cyclic Antidepressant (TCA) AMITRYPTYLINE CLOMIPRAMINE IMIPRAMINE LOFEPRAMINE
  7. 7. Tri Cyclic Antidepressant side effects • Muscarinic acetylcholine receptor: Blurred vision Dry mouth Constipation and urinary retention QT interval prolongation ST segment elevation Heart block Arrthymias
  8. 8. Tri Cyclic Antidepressant side effects • Histaminergic receptor Weight gain Sedation
  9. 9. Tri Cyclic Antidepressant side effects • Alpha adrenergic receptor Postural Hypotension
  10. 10. Mono Amine Oxidase Inhibitors (MAOI) MAOI’s: PHENELZINE TRANYLCYPROMINE ISOCARBOXAZID RIMA’s: MOCLOBEMIDE Side effects: Similar to TCA
  11. 11. Mono Amine Oxidase Inhibitors (MAOI) Side effects • Accumulation of monoamine neurotransmitter • ‘Life Threatening Hypertensive Crisis’ • How can we prevent this happening? • Reduce other amines in the body (amines found in certain foods and drugs) • TYRAMINE rich foods: strong cheese, yeast and protein extract (marmite, Bovil, oxo) CHEESE CRISIS • TYRAMINE rich drugs: adrenaline, noradrenaline, amphetamines, cocaine, dopamine, decongestants • FOOD RESTRICTIONS WHEN ON MAOI’s
  12. 12. SEROTONIN SYNDROME • When SSRI’s are administered simultaneously with MAOI’s or (MAOI’s with opiates) SYMPTOMS: (occurs in a few minutes) • AGITATED • FEVER • SWEATING • INCREASE HR • MYOCLONUS • OVER RESPONSIVE REFLEXES
  13. 13. Contra indications for starting MAOI • Phaeochromocytoma • Cerebrovascular Disease • Hepatic Imparement • Mania
  14. 14. Recap of drugs SSRI’S FLUOXETINE SERTRALINE PAROXETINE CITALOPRAM NRI REBOXETINE TCA AMITRIPTYLINE CLOMIPRAMINE IMIPRAMINE LOFEPRAMINE MAOI’s PHENELZINE TRANYLCPROMINE RIMA MOCLOBEMIDE
  15. 15. Recap of drugs FLUOXETINE SERTRALINE PAROXETINE CITALOPRAM REBOXETINE PHENELZINE TRANYLCPROMINE MOCLOBEMIDE AMITRIPTYLINE CLOMIPRAMINE IMIPRAMINE LOFEPRAMINE
  16. 16. Recap of drugs FLUOXETINE SERTRALINE PAROXETINE CITALOPRAM REBOXETINE PHENELZINE TRANYLCPROMINE MOCLOBEMIDE AMITRIPTYLINE CLOMIPRAMINE IMIPRAMINE LOFEPRAMINE
  17. 17. Mood stabiliser - Lithium • How does it work? • Before you start taking it…. • Check patient medications before prescribing.. • How long does it take to start working? • Common side effects? • Lithium Toxicity • Monitoring • Contraindications
  18. 18. Mood stabiliser - Lithium •NOT ADDICTIVE
  19. 19. Antipsychotics Conventional (typical) antipsychotics • Cause EPSE because blocks dopamine D2 Receptors in other parts of the brain Atypical antipsychotics • First line treatment for schizophrenia Because has less effect on dopamine D2 Receptors so fewer EPSE’s
  20. 20. Indications (psych) • Schizophrenia • Schizoaffective disorder • Delusional Disorder • Depression or mania with psychotic features • Delirium • Behavioural disturbance in dementia • Severe agitation
  21. 21. Non psych indications • Motor tics (tourettes) • Nausea and vomiting • Intractable hiccups and pruritus
  22. 22. Conventional/typical antipsychotics • Chlorpromazine • Thioridazine • Trifluoperazine • Haloperidol Phenothiazines
  23. 23. Clinical side effects of using conventional/typical antipsychotics Because of non-specific blocking of receptors – Has similar side effects to TCA’s Chemoreceptor trigger zone
  24. 24. Atypical antipsychotics • Clozapine • Olanzapine • Resperidone NB all cause weight gain and increase risk of diabetes. CLOZAPINE – agranulocytosis
  25. 25. Drug Recap Chlorpromazine Thioridazine Trifluoperazine Haloperidol Resperidone Olanzapine Clozapine
  26. 26. Anxiolytic and Hypnotic drugs • BENZODIAZEPINES
  27. 27. Indication of Benzo’s • Anxiety • Alcohol withdrawal • Akathisia • Acute mania or psychosis • Epilepsy prophylaxis • (any reason someone might need to CHILL out)
  28. 28. Side effects • Drowsy, ataxia (using machinery/driving) • Can depress respiration centre so caution in chronic resp patients • Risk of developing dependence • OVERDOSE • USE WITH OTHER DRUGS (ESP ALCOHOL)
  29. 29. Benzo’s • Temazepam SA oral • Oxazepam SA oral • Lorazepam SA oral, IV, IM • Diazepam LA oral, PR, IV, IM • Chlordiazepoxide LA oral
  30. 30. FINAL DRUGS RECAP FLUOXETINE SERTRALINE PAROXETINE CITALOPRAM REBOXETINE PHENELZINE TRANYLCPROMINE MOCLOBEMIDE AMITRIPTYLINE CLOMIPRAMINE IMIPRAMINE LOFEPRAMINE CHLORPROMAZINE THIORIDAZINE TRIFLUOPERAZINE HALOPERIDOL RESPERIDONE OLANZAPINE CLOZAPINE LITHIUM CHLORDIAZEPOXIDE TEMAZEPAM OXAZEPAM LORAZEPAM DIAZEPAM

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