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Automatic – homeostasis
Nor-epinephrine( adrenergic)- CATECHOLAMINES
(Dopamine ,nor-epi,epinephrine) (+)
and Acetylcholine (cholinergic)(+) ; atrophine (-)
Dopamine
Inhibitory – muscle control
GABA
Types
Serotonin
Excitatory- muscle movement Norepinephrine
Acetylcholine
Reflex arc
I. ANTI-PSYCHOTICS
SUB-CLASSIFICATIONS
PHENOTHIAZINES NON-PHENOTHIAZINES
MOA
- antagonizes dopamine in the CNS and also blocks Cholinergic, Histaminic,
Serotogenic, Adrenergic neurotransmitters
- ( anticholinergic, antihistaminic, anti-emetic ) blocks activity of the CNS
receptors and sympathetic nervous
system
INDICATION
- formerly called major tranquilizers / neuroleptics. used to
relieve psychotic symptoms( delusions , hallucinations
and looseness of association)of schjizophrenia, mania and psychotic
depression and organic mental disorders
- acute management of agitation and hyperactivity
ANTICHOLINERGIC EFFECTS
(EPS)EXTRAPYRAMIDAL SYMPTOMS
– PSEUDOPARKINSONISM-tremor , mask like facies drooling , restlesssness
– AKATHISIA- restlessness,and anxiety
– DYSTONIA-grimacing , torticollis ,oculogyric crisis, intermittent muscle spasms
- TARDIVE DYSKINESIA-lip smaking and tongue and mouth
SEIZURES
HEPATOTOXICITY*
ORTHOSTATIC HYPOTENSION
PHOTOSENSITIVITY and HYPERSENSITIVITY
ENDOCRINE DISORDERS
DYSCRASIAS *
AGRANULOCYTOSIS – sorethroat,chills,fever,malaise
LEUKOPENIA
BP and temperature
K – monitor blood levels
Seizures, NMS and EPS
L.F.T.’s
CBC with differential
medical management :
NMS – Bromocriptine or Amantadine( dopamine agonist) and
Dantrolene (Dantrium) muscular relaxant
Dystonia – Diphenhydramine,Benztropine , Diazepam, Lorazepam
Pseudoparkinsonism – Antiparkinsonian, Anticholinergic
Akathisia – Anticholinergic, Benzodiazepines, Beta-blockers,Clonidine
Tardive dyskinesia – early referral-dose reduction , no anticholinergics
CLASSIFICATIONS
2 TYPES :
Trihexypheiedil ( Artane)
Biperiden Hydrochloride ( Akineton)
Benztropine Mesylate ( Cogentin)
Diphenhydramine Hydrochloride
(Benadryl)
Misc. agent
Selegiline ( Eldepryl)
COMMON TYPES
Tranylcypromine (Parnate)
Isocarboxazid ( Marplan)
Phenelzine (Nardil)
Mechanism of
Action
Blocks the
Prolongs the action metabolic
of norepinephrine destruction of
Dopamine neurotransmitters by
Serotonin by the enzyme mono-
blocking the Inhibits reuptake and
amine oxidase destruction of
reuptake of this
neurotransmitters serotonin to prolong its
action
CNS STIMULANTS
Ritalin ( Methylphenidate)
Amphetamine ( Benzedrine)
C- anti-depressants
H- decreased signs and symptoms of depression(increased appetite and sleep
E – p.c.
K-
Monitor BP, HR and Monitor BP and food
ECG items
IV. ANTI – MANIC
EXAMPLES
Carbamazepine (Tegretol )
MOA
Exact mechanism unknown , alters the level of norepinephrine and other neurotransmitters
INDICATIONS
• Treatment of acute mania and for prophylaxis of recurrent manic and depressive
episodes in bipolar disorder
V. ANTI ANXIETY
CLASSIFICATION:
MOA: depresses Reticular Activating system and reduces anxiety by stimulating the action of
an inhibitory neurotransmitter called GABA
INDICATIONS; treatment of anxiety disorders and for short term relief of symptoms of
Anxiety; selective medications effective for skeletal muscle relaxation, pre
and post-op sedation, seizure control.