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    Psychotropic Drugs

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    Bahaa Shaaban
    The document summarizes key points about psychotropic drugs including antipsychotics, benzodiazepines, and their effects, mechanisms, toxicities, and management. It covers classification, therapeutic effects, absorption, distribution, metabolism, excretion, pathophysiology, clinical effects of poisoning, investigations for cases of overdose, and treatment approaches including decontamination and use of antagonists like bromocriptine and flumazenil.

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    Attribution Non-Commercial (BY-NC)
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    Psychotropic Drugs

    Uploaded by

    Bahaa Shaaban
    188 views29 pages
    The document summarizes key points about psychotropic drugs including antipsychotics, benzodiazepines, and their effects, mechanisms, toxicities, and management. It covers classification, therapeutic effects, absorption, distribution, metabolism, excretion, pathophysiology, clinical effects of poisoning, investigations for cases of overdose, and treatment approaches including decontamination and use of antagonists like bromocriptine and flumazenil.

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    © Attribution Non-Commercial (BY-NC)

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    The document summarizes key points about psychotropic drugs including antipsychotics, benzodiazepines, and their effects, mechanisms, toxicities, and management. It covers classification, therapeutic effects, absorption, distribution, metabolism, excretion, pathophysiology, clinical effects of poisoning, investigations for cases of overdose, and treatment approaches including decontamination and use of antagonists like bromocriptine and flumazenil.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPS, PDF, TXT or read online from Scribd
    Download as pps, pdf, or txt
    188 views29 pages

    Psychotropic Drugs

    Uploaded by

    Bahaa Shaaban
    The document summarizes key points about psychotropic drugs including antipsychotics, benzodiazepines, and their effects, mechanisms, toxicities, and management. It covers classification, therapeutic effects, absorption, distribution, metabolism, excretion, pathophysiology, clinical effects of poisoning, investigations for cases of overdose, and treatment approaches including decontamination and use of antagonists like bromocriptine and flumazenil.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPS, PDF, TXT or read online from Scribd
    Download as pps, pdf, or txt
    of 29

    Learning Objectives

    The student will be able to:


    Classify psychotropics.
    List different types of antipsychotics
    Acquire knowledge in neuroleptic toxicokinetics
    Recognize toxic effects of neuroleptics.
    Determine the investigations required for each case.
    Apply measures for management of poisoned patients.
    Illustrate some case reports
    Acquire knowledge about the serious side effect of
    neuroleptics; NMS.
    Anti Anti Sedative Mood CNS
    psychotic anxiety Hypnotics stabilizing stimulants
    Effect of Antipsychotic drugs

    Therapeutic effects: Many


    Many
    side
    side
    Antipsychotic
    effects
    effects
    Anti-anxiety effect
    Anti-emetic effect
    Hypothermic effect
    sedative effects NO
    NO
    addiction
    addiction
    ..habituation
    habituation
    Neuroleptic drugs

    Typical A typical
    Traditional agents Novel agents

    Less EPS
    Less TD
    Effective in R
    :Catecholamine-1

    Glycine -1 Epinephrine
    GABA -2 Nor-epinephrine
    Dopamine

    Serotonin -2
    Absorption, Metabolism and Excretion of Neuroleptics drugs

    Absorption

    Distribution They
    Theyarearehighly
    highlylipophilic.
    lipophilic.
    85%
    85% of the drug inplasma
    of the drug in plasma
    isisbound to albumin.
    bound to albumin.

    Excretion
    Metabolism
    Pathophysiology
    of
    Neuroleptic Agents

    Block other Quinidine-like action


    Block neuroreceptors: on the heart
    Dopamine 2-receptors

    Anterior pituitary M1 H1 α1 ventricular


    ventriculararrhythmias
    arrhythmias
    Basal ganglion
    CRTZ Anticholinergic
    Anticholinergic hypotension,
    hypotension,
    Hypothalamus effects
    effects meiosis
    meiosis
    Limbic .s sedation
    sedation
    hypotension
    hypotension
    Pathophysiology of Neuroleptic Agent
    ,tachycardia Clinical
    hypotension picture of
    arrhythmias acute poisoning
    ECG changes

    -Anti
    Neurological Cardiovascular Coma
    cholinergic

    dry Mouth and skin Hypotension


    constipation hypothermia
    dilated pupils Mellaril ,arrhythmia
    Extra N.B PPP
    convulsions
    pyramidal PPP Chlorpromazine .Resp
    .( block)
    Extra pyramidal Manifestations

    --11 --22 3-
    3- --44
    Parkinsonism Akathisia Tardive
    Tardive
    Parkinsonism Dystonia
    Dystonia Akathisia
    dyskinesia
    dyskinesia

    .Masked face-1 Feeling


    Feelingof
    of
    .Tremor-2 restlessness
    restlessness
    .Rigidity-3
    1- Torticollis (neck),
    Slowness of-4
    2-occulogyriccrises.
    .Movements
    3- Arched back
    Dopamine in-5
    4- dysphagia
    B.G
    5- dysarthria,
    6- peri-oral-spasm
    Rabbit syndrome
    Parkinsonism occulogyriccrises.

    arched back
    Torticollis
    Investigations:
    Toxicological analysis: Non-toxicological
    1-Qualitative and semi- investigations:
    quantitative 1- Abdominal x-ray
    estimation by TLC.  radio-opaque
    2- Quantitative shadow in the
    estimation by the use stomach.
    of HPLC. 2- ECG arrhythmia
    3- Color test : Forrest
    Rapid Urine.
    Treatment of Acute Poisoning
    3- Decontamination (D):
    1- Care of respiration. No emesis (antiemetic ) ?
    If the patient is conscious or
    2- Care of circulation comatosed: do
    gastric lavage
    * Hypotension first with warm water
    circulatory shock. then with NaHCO3 5%.
    * Treat cardiac arrhythmias powdered activated charcoal
    repeated dosing)
    sodium sulphate as cathartic
    3-Treat extra pyramidal manifestations
    By the use of antiparkinsonian drugs e.g.
    Benztropine Mesylate (cogentin) 1-2 mg IV .
    4-If there is cardiac arrhythmias
    Treat by phenytoin sodium.
    with monitoring for 2 days.
    5- No role of elimination (E):
    Diuresis, peritoneal or hemodialysis are
    ineffective in removing the drug as it is
    highly bound to plasma proteins.
    Neuroleptic Malignant Syndrome (NMS)

     Definition:
    Is a serious complication of neuroleptic treatment
    Lithium , TCAs , stopping of Levo-dopa or Carbidopa
    used in treatment of Parkinsonism .
     Cause : diminution of dopamine neurotransmitter.
     It is characterized by:
     Hyperpyrexia.
     Autonomic dysfunction.
    (tachycardia, sweating, salivation, hypertension).
     Fluctuation of the level of consciousness.
     Tremors, Rigidity.
     Treatment : Bromocriptine (Parlodel) as it stimulates synthesis
    of dopamine.
    They have the following effects:

    ::Therapeutic
    Therapeutic effects
    effects .. 11
    ::Anti-
    Anti- anxiety
    anxiety effect
    effect
    inin the
    the treatment
    treatment of
    of
    .Neurosis
    .Neurosis
    .Anti-
    .Anti- spasmodic
    spasmodic effect
    effect
    Anti-
    Anti- convulsant
    convulsant effect
    effect
    .).)Diazepam
    Diazepam = = valium
    valium((
    hypnotic
    hypnotic effect
    effect
    .Lorazepam
    .Lorazepam (Ativan)
    (Ativan)
    Important member of anti-anxiety drugs

    I- Meprobamate group
    Equanil.

    II- Benzodiazepine group


    Diazepam ( Valium)
    Lorazepam ( Ativan)
    Rohypnol
    Absorption, Metabolism and Excretion
    of ANTI ANXIETY DRUGS

    Absorption

    Distribution

    Excretion

    Metabolism
    Pathophysiology of Benzodiazepine

    GABA
    Clinical picture of acute poisoning

     CNS: headache, drowsiness, apathy, ataxia


    coma.
     Cardiovascular : hypotension and syncope.

     Gastrointestinal: nausea, may be vomiting.

     Allergic reactions : urticaria, skin rash.

     Suicidal attempt with large doses may lead to rapid sleep,


    later coma due to vasomotor and respiratory depression.
    Investigations :
    1-Toxicological analysis 2- Routine investigations

     Qualitative and Blood gases


    semiquantitative
    acid-base status
    detection of benzo.
    metabolites in urine
    using immunoassay
    techniques.
     Quantitative estimation
    of the blood level.
    Treatment of Benzodiazepine overdose:

    1- Care of respiration ( A - B ).
    2- Care of circulation (C).
    3-Decontamination (D) .
    conscious: induce vomiting.
    comatosed: endotracheal tube before
    gastric lavage.
    powdered activated charcoal,
    sodium sulphate as cathartics.
    4- No role of elimination (E ) :
    Diuresis.
    peritoneal dialysis.
    Hemodialysis are
    5- Antidote Flumazenil = Anexate

    Mechanism:
    It is a Competitive Benzodiazepine Receptor Antagonist
    it displaces Benzodiazepines from the receptors and binds
    to them).
    Dose:
    A
    the dose is 0.5 mg IV or by I.V infusion
    B.R

    repeated after half to one hour until the patient awakes


    or up to a total of 1-2 mg.
    The onset of action occurs within 1-2 minutes
    with a peak at 6-10 minutes.
    Withdrawal syndrome :

    Time :
    After prolonged administration of benzodiazepines.
    From 3- 6 days following cessation of Benzodiazepines.
    S &S:
    Anorexia, nausea, vomiting.
    Apprehension, restlessness, insomnia.
    Tremors may be convulsions.
    To avoid:
    Gradual dose reduction over a period of 10-15 days
    should be done.

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