Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
ANTI PSYCHOTIC DRUG ............................................. Psychosis: Describe variety of mental disorder,characterised by loss of touch with in reality usualy occurs due to dopamine over activiting in mesocortical,mesolimbic pathway. **Most common psychotic disorder - schizophrenia Schizophrenia: Particular kind of psychosis characterised mainly by clear sensorum but a marked thinking disturbance. Clinical Symptom: 1. a) + ve symptom b) hallucination c) delirium d) thought disorder e) abnormal behaviour f) reality distortion 2. - ve symptom: depressive symptoms - withdrawl from social contact,flattening of emotional response,poverty of speech. 3. defect of cognitive function: usually acute episodes ( +ve symptoms mainly ) frequently occur & developed into chronic schizophrenia with in predominantly -ve symptoms. Dopamine Hypothesis: a) describe that symptoms arise because of functional excess of dopaminergic activity in the CNS. b) DA - responsible for + ve symptom c) 5HT- responsible for - ve symptom d) drugs that activate DA receptor cause psychotic symptoms. Q: mention the dopeminergic pathway? short note: central dopeminergic system? Ans: 5 important pathway: a) mesolimbic & mesocortical pathway - for behaviour b) nigrostriatal pathway - co-ordination of voluntary movement c) tuberoinfundibular pathway - dopamin release inhibits prolactin secretion d) medullary-periventricular pathway - eating behaviour e) incertohypothalamic pathway - anticipatory motivational phase. Dopamine receptors: a) D1 & D5 - increase cAMP - increase D1 receptor group b) D2,D3,D4 - decrease cAMP - D2 Q. Classify anti-psychotic drug/ Enumerate typical & atypical anti-psychotic drug? Ans. Classification** Typical/traditional/1st generation a) phenothiazine derivatives: 1. aliphatic- chlorpromazine ( proto type ) 2. piperadine- thioridazine 3. piperazine- fluphenazine,prephenazine,trifluophenazine. b) thioxanthene derivatives: thiothixene c) butyrophenone derivatives: haloperidol,droperidol d) miscellaneous/ others:pimozide,molindone **Atypical or newer: - clozapine,olanzapine,loxapine,zotepine,risperidone Mechanism of action: a) dopamine receptor blocking action in brains by antipsychotic drugs.Binds with in D2 receptors mesolimbic & mesocortical region ( blocks the d2 receptor present in mesolimbic ) b) serotinin receptor blocking activity of newer atypical drugs.Exerts action through inhibition of serotonin receptor c) many of this agents blocks cholinergic,adrenergic,histamine receptor ( H1 ). so cause side effect. Thioridazine chlorpromazine l cholinergic Q. write down the pharmacological effect of chlorpromazine? Ans. 1. Antipsychotic effect: *emotional quitening *pschomotor slowing decrease motor activity,hyperactivity,aggressiveness - increase social interaction *this drug also prevent acute attack & delay subsequence attack. *usualy takes several weeks. 2. Extrapyramidal effect: penkinsons syndrome 3. Endocrine effect: a) Reproductive system: "In female* amenorrhea * galactorrhea * false-possitive pregnancy test * increased libido "In male* deccreased libido * gynacomastia **Thus occur due to increase prolactin secretion b) Abnormal pigmentation. 4. Antimitive effect: a) stop vomiting by blocking D2 receptor of CT7 of the medulla b) effecting against also 5. cardiovascular system: * decrease PVR * decrease maen arteriolar pressure * orthostatic hypotension * these are due to alpha blocking effect * ECG-QT interval prolonged - thionidazone 6. anti cholinargic effect: * M receptor blocking effect * dry mouth * blurring of vision * sedation * confusion * constipation * urinary retention 7. other effect: * sedation - H1 blocking effect - chlorpromazine, clozapine * weak diuretic effect Clinical use: a) psychiatric indication psychosis: * schizophrenia - main stay of treatment positive symptoms are effectively treated by typical drugs. negative symptoms are alleviated by atypical drugs. long term treatment prevents recurrence & allowing patient to lead normal life. * schizo-effective disorder: schizophrenia + effective disorder * psychosis with mania * atypical psychosis * psychosis with depression * tourettes syndrome - heloperidol, pimozide - to supress severe ties b) prevention of nausea & vomiting c) persistent prurities d) intractable hiccough e) as neuroleptanesthesia Q. Mention the adverse effect of chlorpromazine/phenothiazine/thioridazine? Ans. A) neurological effect: 1. parkinsons syndrome - tremor , dystoxia, akinesia due to blockage of nigrostriatal pathway.extra pyramidal reaction. 2. akathesia - uncontrolable restlessness 3. acute dystonic reaction - spastic retroedis,torticolis 4. tardive dyskinesia - most important side effect *late syndrome *occurs due to relative cholinergic deficiency secondary to super sensitivity of dopamine receptor in caudate - putamen treatment switch to newer agent,avoid all drugs with central anticholinergic activity. 5. seizure - very rare B) CNS/ANS effect: 1. blurred vision,dry mouth,sedation,confusion,constipation 2. orthostatic hypotension,mesoridazone C) metabolic & endocrine effect: 1. weight gain 2. hyperprolactinaemia result in 3. amenorrhea 4.galactorrhoea 5.infertility 6.loss of livido,impotency,infertility in male 7.hyperglycaemia - secondary to weight gain associated insulin resistence D) toxic or allergic reaction: 1.agranulocytosis - clozapine 2. cholestatic jaundice 3. skin - skin eruption, pruritis, pigmentation, photo sensitivity E) occular complication: 1. deposits in anterior portion of eye - chlorpromazine 2. increase the normal process of aging F) cardiac toxicity: 1. major ventricular arrythmias - thioridazine 2. cardiac conduction block - thioridazine 3. Q-T prolongation, ziprasidone ** it neuroleptic malignant syndrome,, ** occurs in patient who are extremely sensitive to retropyramidal effect.. Mechanism of action: Due to excessive rapid blockage of post synaptic dopamine receptor. C/F: fever, muscle regidity, altered BP & pulse Use in pregnancy: better to avoid in pregnancy. Drug interaction: potentiates the action of alchol,barbiturates,narcotic,analgesics,anticholinergics,anaesthetics,antihypertensive. A)Typical Antipsychotics: 1. blocks 70-80% D2 receptor 2. alloviates mainly possitive symptoms 3. decrease motor activity B)Atypical Antipsychotics: 1. blocks 40-60% D2 receptor & also blocks 70-90% 5HT receptor 2. alloviates both possitive & negative symptoms 3. loss extrapyramidal effect - due to loss D2 block. 4. rate of relapse - low 5. more selective D2 receptor blocker.. ( Eg - clozopine, risperidone )