FINAL REVISION

IPP 17
 BRANCHES
• Pharmacodynamics • Pharmacotherapeutics
• Pharmacokinetics • Pharmacogenetics
• Pharmacognosy
• Pharmacopia
• Pharmacy
• Toxicology
 DRUG

• Any substance which when

introduced into the body alters
the body’s physiological
response
 TYPES OF DRUG ACTION
• Stimulation

• Depression

• Irritation

• Replacement

• Antimicrobial

• Modification of immune status

 RECEPTORS
• a protein molecule usually found inside or
on the surface of a cell, that receives
chemical signals from outside the cell
 AFFINITY & INTRINSIC ACTIVITY
• Ability of a drug to bind to a receptor
is called "AFFINITY“
• Ability of a drug to produce
pharmacological effect after binding is
called "INTRINSIC ACTIVITY"
 AGONISTS

• Drug having affinity for

receptor & intrinsic activity is
called agonist
 ANTAGONIST
• Antagonists have affinity but no
intrinsic activity
 Routes of Drug Administration-
CLASSIFICATION
• SYSTEMIC
• Enteral

• Par-enteral
• LOCAL
 SYSTEMIC ROUTES-ENTERAL

 Oral
 Sublingual

 Rectal
 SYSTEMIC-PARENTERAL
• INJECTABLES
i. Intravenous
ii. Intramuscular
iii. Sub-cutaneous
iv. Intra-arterial
v. Intra-articular
vi. Intra-thecal
vii. Intra-dermal

 INHALATIONAL
 ABSORPTION

• Passage of drug from site

of administration into the
general circulation
 FIRST PASS EFFECT

• phenomenon of drug metabolism where

the concentration of a drug is greatly
reduced before it reaches systemic
circulation
 BIOAVAILABILITY

• fraction of an administered dose of
unchanged drug that reaches
the systemic circulation
• By definition, intravenous bioavailability
is 100%
 BIOTRANSFORMATION/
METABOLISM
• Chemical conversion of a drug to an active
or inactive compound within the living
organism

• Tends to make less polar drugs more polar

• Liver, lungs, kidneys, adrenal gland, brain

 EXCRETION OF DRUGS
• Process by which a drug or its
metabolite is eliminated from the
body
• Kidneys, lungs, intestines, bile, saliva,
sweat, skin
 Delirium
• a serious disturbance in a
person's mental abilities that
results in a decreased awareness
of one's environment and
confused thinking
 Treatment
• Pharmacologic treatment indicated for

acute agitation

• Neuroleptics/anxiolytics are often used

• duration commonly ranges from days to

weeks
 Anti-psychotics-MOA
• Neuroleptics

• Tend to block D2 receptors in

the dopamine pathways of the brain

• In addition atypical neuroleptics

also antagonize 5-HT  receptors

 Adverse Effects
• Parkinson’s syndrome • Weight gain

• Akathisisa • Hyper-prolactinemia in

• Acute dystonic women causing amenorrhea-

reactions galactorrhea syndrome &

infertility
• Tardive dyskinesia
• Loss of libido, impotence &
• Seizures
infertility in men
 BENZODIAZEPINES-MOA
•Act on GABA receptors

•Bind to benzodiazepine receptors, which

results in opening chloride channels leading to
increased chloride conductance
•causes a small hyper-polarization, inhibiting
formation of action potential
 ADVERSE EFFECTS
• Drowsiness and confusion: most
common side effects
• Ataxia at high doses

• Cognitive impairment, early morning

insomnia, daytime anxiety and
confusion
 Dementia
• Group of symptoms affecting
thinking & social abilities severely
enough to interfere with daily
functioning
 Dementia
• Reversible:
– D= Drugs, Delirium
– E=Emotions (such as depression) and Endocrine Disorders

– M=Metabolic Disturbances
– E=Eye and Ear Impairments
– N=Nutritional Disorders
– T=Tumors, Toxicity, Trauma to Head

– I=Infectious Disorders
– A=Alcohol, Arteriosclerosis
 Dementia
• Irreversible:

– Alzheimer’s
– Lewy Body Dementia
– Pick’s Disease (Fronto-temperal Dementia)
– Parkinson’s disease
– Heady Injury
– Huntington’s Disease
– Jacob-Cruzefeldt Disease
 Medicines used
Donepezil • Citalopram
•Used to delay or slow the • Used to reduce depression
symptoms of AD in mild, and anxiety

moderate and severe AD • May take 4 to 6 weeks

• Sometimes used to help to
• Loses its effect over time
sleep
• Does not prevent or cure AD
 Medicines used
Sodium Valproate Rivastigmine
• Used to delay or
• Used to treat severe
slow the
aggression
symptoms of AD
• Also used to treat
• Loses its effect
depression and anxiety
over time
 Medicines used
Memantine Galantamine
• Used to delay or slow •Used to prevent or slow
symptoms of AD the symptoms of AD
• Loses effect over time •Loses its effect over time
• Used for moderate to
•Used for mild to
severe AD
moderate AD
 Medicines used
Sertraline Oxcarbazepine
• Used to reduce depression
• Used to treat severe
and anxiety
• May take 4 to 6 weeks aggression
• Sometimes used to help • Also used to treat
people get to sleep
depression and
anxiety
 Depression-Etiology
• Serotonin-depletion

• Norepinephrine-abnormal usually
low
• Dopamine-reduced
• Psychosocial factors
 Mechanism of Action-TCA
• block reuptake of norepinephrine &
serotonin
• also change the densities of
monoamine receptors.
• do not block reuptake of dopamine.
 Adverse Effects
o produce sedation, degree of sedation is
highest with amitryptaline, doxepin, and
least with protryptaline.
o Blurring of vision, xerostomia, urinary
retention, constipation
 Mechanism Of Action-SSRI

o selectively inhibit the reuptake of

serotonin (5-Hydroxytryptamine).
o have relatively low incidence of
side effects.
 Adverse Effects
• nausea, anxiety, insomnia, tremors,
anorexia, seizures and sexual dysfunction.
o Serotonin syndrome (SSRI is used with
MAO inhibitor, characterized by
hyperthermia, muscle rigidity and rapid
changes in mental state and vital signs)
 Mechanism of Action-MAOIs
o Enzyme MAO is present in neuronal
terminals, liver and gut.
o MAO is responsible for the
degradation of NE, epinephrine, &
Serotonin.
oMAO inhibitors prevent the
degradation of monoamines
oincreases contact time of
monoamines from nerve
terminals
 Adverse Effects
o headache, excitement, disturbances
of sleep and exaggerated psychosis.
o Tremors, ataxia, twitching,
hyperthermia, weight gain, sexual
disturbances and convulsions
o can produce constipation, dryness of
mouth, difficulty in micturition,
blurring of vision and postural
hypotension
o Some agents can produce allergic
reactions & jaundice.
o sedation, drowsiness, dizziness,
headache, weight loss.
o nausea, sweating, sedation,
sexual disturbances, anxiety and
hypertension
 Anxiety Disorders
• Panic Disorder
• Obsessive-Compulsive Disorder
• Post-Traumatic Stress Disorder
• Phobias
• Generalized Anxiety Disorder
 Panic disorder
• Hyperthyroidism (overactive thryroid gland)

• Hypoglycemia (low blood sugar)

• Stimulant use (amphetamines, cocaine,

caffeine)

• Medication withdrawal
 Treatment
• Antidepressants. Patient have to take them

continuously, not just during a panic attack.

• can take between two to four weeks before they

become effective

• Many types of antidepressants  are recommended

to treat panic disorder

 Treatment
• selective serotonin reuptake inhibitors (SSRIs)

• Tricyclic antidepressants

• Benzodiazepines. act very quickly (usually within

30 minutes to an hour). Taking them during a

panic attack provides rapid relief of symptoms

 PTSD-Treatment
• Antidepressants. can help symptoms of

depression and anxiety, improve sleep

problems and concentration. SSRI

sertraline and paroxetine

 PTSD-Treatment
• Anti-anxiety medications. can improve

anxiety and stress for a short time to relieve

severe anxiety and related problems

• Prazosin.  include insomnia or recurrent

nightmares
 Barbiturates
• Barbiturates potentiate GABA action
in chloride entry into neuron by
prolonging the duration of chloride
channel opening
• can also block excitatory glutamate
 ADVERSE EFFECTS
• drowsiness, impaired concentration and
mental and physical sluggishness
• feeling of tiredness on wakening at
hypnotic dose leading to impaired ability
to normal functions for many hours
• Nausea and dizziness occasionally
 ZOLPIDEM
• No withdrawal symptoms, minimal rebound

insomnia, and little or no tolerance

• Rapidly absorbed from GIT & Rapid onset of action

• Adverse effects include nightmares, agitation,

headache, GIT upset, dizziness, and daytime

drowsiness
 BUSPIRONE
• Used in the generalized anxiety disorders

• Equally effective as benzodiazepines

• Seems to act through serotonin (5-HT1A)

receptors
• Causes hypothermia, increased
production of prolactin and growth hormone
 Post Partum Depression
• Loss of appetite

• Insomnia

• Intense irritability and anger

• Overwhelming fatigue

• Loss of libido
 Post Partum Depression

• Feelings of shame, guilt or inadequacy

• Severe mood swings
• Difficulty bonding with baby
• Withdrawal from family and friends
• Thoughts of harming baby or self
 Post Partum Depression
• Treatment and recovery depend on severity

of depression

• Baby blues usually fade on their own within

a few days to one to two weeks

• Rest, counselling, family help, thyroid

 Post Partum Depression
• Antidepressants

• Hormone therapy. Estrogen replacement

counteract the rapid drop in estrogen that
accompanies childbirth, may ease the signs and
symptoms in some women
 Post Partum Psychosis
• Requires immediate treatment, often in the

hospital.

• A combination of medications such as

antidepressants, antipsychotic medications and

mood stabilizers

• Sometimes ECT is recommended as well.

 Medications- Mania
• Lithium is effective at stabilizing mood

and preventing the extreme highs and

lows

• Anticonvulsants. valproic acid,

divalproex , lamotrigine.
 Medications
• Antipsychotics. aripiprazole, olanzapine,

risperidone and quetiapine, may help

people who don't benefit from

anticonvulsants.

• Antidepressants- trigger manic episodes,

 Medications
• Symbyax-combines the antidepressant fluoxetine

and the antipsychotic olanzapine. It works as a

depression treatment and a mood stabilizer

• Benzodiazepines.-may help with anxiety and

improve sleep. Examples include clonazepam,

lorazepam , diazepam, chlordiazepoxide

 Lithium
• Regular serum levels and should monitor thyroid and
kidney function

• Dehydration, compounded by heat, can result in

increasing lithium levels

• Due to lithium inhibition of antidiuretic hormone, an

inability to concentrate urine, leading to consequent loss
of body water and thirst
 ADVERSE EFFECTS
– Tremors
• Nephrotoxicity
– Motor hyperactivity
• Edema
– Ataxia

– Dysarthria • Leukocytosis
– Decreased thyroid • Polyuria
function
• Polydipsia
 VALPROIC ACID

• An anti-epileptic drug, also shown to

have anti manic effect
• Effective in some patients unresponsive
to lithium
• Can be nauseating for some patients
 CARBAMAZEPINE
• Useful in acute mania and in prophylactic therapy
• Can be used alone or combined with lithium or
valporate
• Mode of action unclear, may reduce sensitization
of the brain to repeated episodes of mood swing
 LAMOTRIGINE
• Like phenytoin it inhibits sodium channels.

• It also blocks calcium channels, and also

decreases synaptic release of glutamate.

• Dizziness, headache, diplopia, nausea, are

main side effects of the drug
• Other anticonvulsants used for bipolar
disorder include gabapentin, and topiramate
• Anticonvulsant effectiveness is stronger for
acute mania than for long-term maintenance
of bipolar disorder
• Particular efficacy of lamotrigine in bipolar
depression
 Prescription drugs-Sleep disorders

• Anti-Parkinsonian drugs (dopamine agonists), may

be used to treat restless legs
syndrome and periodic limb movement disorder 

• Benzodiazepines, may be used to treat

parasomnias, also used to treat bruxism (teeth
grinding) and short-term insomnia
 Prescription drugs

• Non-benzodiazepine hypnotics, are

used to treat short-term insomnia.

• Melatonin receptor stimulator, used

to treat insomnia.
 Prescription drugs
• Opiates, may be used to treat restless legs
syndrome that won't respond to treatment or is
present in pregnancy.

• Anticonvulsants, may be used to treat nocturnal

eating syndrome, restless legs syndrome, periodic
limb movement disorder and insomnia related to
bipolar disorder.
 Prescription drugs

• Anti-narcoleptics, can be used to improve

daytime wakefulness in those who are
shift workers or suffer from narcolepsy or
sleep apnea.
 TYPES OF PARKINSONISM
• NATURALLY OCCURRING

• DRUG INDUCED
• BUTYROPHENONS
• PHENOTHIAZINE
• RESERPINE
 Drug induced parkinsonism
• blockade of D2 receptors

• All anti-psychotics can cause these

symptoms, Newer atypical antipsychotics
are less likely to cause these symptoms
• Can be treated with anticholinergic
agents
 Acute dystonia
• Brief or prolonged contraction of
muscles
• Tongue protrusion, trismus, dysarthria,
dysphagia, irregular postures
• Can occur with any anti-psychotic
 Acute dystonia
• More common with high potency one

• Mechanism of action is thought to be

dopaminergic hyperactivity
• Prophylaxis & treatment with
anticholinergic or antihistamines
 Acute akathisia

• Feeling & objective signs of

restlessness
• Anxiety, inability to relax, jitteriness,
pacing, rocking motion while sitting,
rapid alteration of sitting & standing
 Tardive dyskinesia
• A delayed effect of antipsychotics

• Rarely occurs until after 6 months of

treatment
• Abnormal involuntary movements of head,
limbs & trunks
• Inc. by stress & disappear during sleep
 Epilepsy-DIAGNOSIS
• Magnetic resonance imaging (MRI). 

• Functional MRI (fMRI). 

• Positron emission tomography (PET). 

• Single-photon emission computerized

tomography (SPECT). 
 PHENYTOIN SODIUM
• oldest antiepileptic agent.

• Effective in partial and grand mal

ineffective in petit mal epilepsy.
• Blocks sodium channels & Inhibits spread
of abnormal impulses
 SIDE EFFECTS
• Ataxia, diplopia, nystagmus, nausea, &
vomiting.
• Gingival hyperplasia & bleeding gums in
children.
• folic acid deficiency & megaloblastic anemia.
• Drowsiness, hallucinations, confusion
• Can produce hyperglycemia, glycosuria.
 CARBAMAZEPINE
• Chemically related to tricyclic
antidepressant imipramine
• Drug of choice for the treatment of partial

seizures & effective in grand mal epilepsy.

• Blocks voltage dependent sodium channels.

 SIDE EFFECTS
• Diplopia, blurred vision, ataxia,
drowsiness, vertigo, nausea and vomiting.
• May produce aplastic anemia.
• Chronic therapy may result in water
retention and dilutional hyponatremia.
 VALPROIC ACID
• Affects the sodium currents in repetitively firing

neurons.

• Increases the GABA levels in brain probably by

decreasing the degradation of GABA by GABA–

aminotransferase.

• At the higher concentration also affect K+

conductance and produces hyperpolarization.

 SIDE EFFECTS
• GIT Upset
• Hepatotoxicity
• Increased appetite
• Weight gain
• Hair loss
• Muscular tremors
 Down’s syndrome-Causes
• Down syndrome results if the extra
chromosome is number 21

• an extra chromosome 21 in each of the

body’s cells.

• also referred to as Trisomy 21

 Prenatal Diagnosis
• Alpha fetoprotein (AFP) blood test, a screening
test, can be done around the 16th week of
pregnancy.
• Amniocentesis or chorionic villus sampling are the
most reliable tests used, but should be used
cautiously due to the risks associated with them.
 Drug Therapy
• not currently a component of the standard care
for Down syndrome
• indicated only for symptomatic treatment of pain

• Diuretics and digoxin should be used to manage

congestive heart failure secondary to congenital
heart defect
 ADHD-Misdiagnosis
• Learning or language • Vision or hearing
problems problems

• Mood disorders (such • Tourette syndrome

as depression) • Sleep disorders

• Thyroid medication
• Anxiety disorders
• Substance abuse
• Seizure disorders
• Brain injury
 Treatment
• Stimulant medications
appear to boost and balance levels of
brain neurotransmitters
• help improve the signs and
symptoms of inattention and
hyperactivity
 Treatment-Stimulants
• Believed to work by increasing dopamine

levels in the brain

• For many with ADD or ADHD, stimulant

medications boost concentration and focus

while reducing hyperactive and impulsive

 Stimulants-Side effects
• Feeling restless and • Irritability, mood
jittery swings
• Difficulty sleeping • Depression
• Loss of appetite • Dizziness
• Headaches • Racing heartbeat
• Upset stomach • Tics
 Safety Concerns
• Effect on the developing brain —use of
drugs in children/teens might interfere
with normal brain development.
• Heart-related problems — found to cause
sudden death in children and adults with
heart conditions.
 Safety Concerns
• Psychiatric problems —can trigger or
exacerbate symptoms of hostility,
aggression, anxiety, depression, and
paranoia
• Potential for abuse —College students take
them for a boost when cramming for exams
 Non-stimulant Medications

• Strattera boosts the levels of norepinephrine

• longer-acting than the stimulant drugs

• Can cause Sleepiness, Headache, Abdominal

pain or upset stomach, Nausea and vomiting

 Other Medication options
• High blood pressure medication include

clonidine and guanfacine

• Antidepressants for ADD/ADHD –bupropion, is

most widely used, targets both norepinephrine

and dopamine. Another option is the use of

tricyclic antidepressants.
 Medications-AN
• Antidepressants. 

• Amitriptyline and fluoxetine

• Fluoxetine did decrease both depression

and anxiety in anorectic patients
 Medications-AN
• Cyproheptadine

• a potent histamine & serotonin antagonist,

used to treat migraines has shown to be an
effective appetite stimulant
• significantly reduced the number of days to
reach normal weight in anorectic patients
 Medications-AN
• Olanzapine –an atypical antipsychotic

• an attempt to use olanzapine’s weight gain

side effect to clinical advantage
• Improved on depression and anxiety scales
& obsessive symptoms
 Medications-BN/BED
• SSRIs, Fluoxetine for bulimia;

• studies have endorsed the effectiveness of fluvoxamine

• for binge eating disorder (BED), including fluoxetine,

citalopram and sertraline

• Escitalopram was the only SSRI that was not associated

with reduced binge-eating episodes

 Medications-BN/BED
• Tricyclics

• Imipramine & desipramine effective for BN

• Amytriptilline can also be used

• Topiramate

• for both BN and BED

• most common side effects were parasthesias, taste

perversion, and difficulty with concentration/ attention

 Medications-BN/BED
• Naltrexone 

• an opiate antagonist used to treat alcoholism, may also be

effective for BN

• Sibutramine

• an FDA-approved weight loss agent, appears to be effective

for the treatment of BED

• Dry mouth, constipation, anorexia, insomnia

 Obesity
• Likely when an individual's body mass index (BMI) is 30 or
higher(calculated by dividing weight in kilograms (kg) by height in meters
(m) squared.

• Below 18.5 Underweight

• 18.5-24.9 Normal

• 25.0-29.9 Overweight

• 30.0-34.9Obese (Class I)

• 35.0-39.9Obese (Class II)

• 40.0 and higher Extreme obesity (Class III)

 Drug Treatment
• Orlistat . a weight-loss medication for long-term use in

adults and children 12 and older

• blocks the digestion and absorption of fat in stomach

and intestines. Unabsorbed fat is eliminated in the stool

• Side effects include oily and frequent bowel movements,

bowel urgency, and gas

 Drug Treatment
• Lorcaserin a long-term weight-loss drug for adults

• works by affecting chemicals in brain that help decrease

appetite and make feel full
• Side effects include headaches, dizziness and nausea.
Rare but serious side effects include a chemical imbalance
(serotonin syndrome), suicidal thoughts, psychiatric
problems, and problems with memory or comprehension
 Drug Treatment
• Phentermine-topiramate. a combination drug for long-
term use in adults
• combines phentermine, a weight-loss drug prescribed
for short-term use, with topiramate
• Side effects include increased heart rate, tingling of
hands and feet, dry mouth, and constipation. Serious
but rare side effects include suicidal thoughts, problems
with memory or comprehension, sleep disorders, and
 Drug Treatment
• Phentermine a weight-loss medication approved for short-
term use (three months) in adults
• Weight-loss surgery
• Gastric bypass surgery. a small pouch at the top of
stomach. small intestine is cut a short distance below the
main stomach and connected to the new pouch. Food and
liquid flow directly from the pouch into intestine, bypassing
most of stomach
 Drug Treatment
•Laparoscopic adjustable gastric banding

(LAGB). stomach is separated into two pouches with

an inflatable band. Pulling the band tight, like a belt,

the surgeon creates a tiny channel between the two

pouches. The band keeps the opening from expanding

and is generally designed to stay in place permanently

 Autism-Pre-Natal Diagnosis
• Children with ASD may have more rapidly growing
brains and bodies at the beginning of the second
trimester than children without the disorder

• A small study looking at ultrasound scans that checked

for fetal defects showed that children who went on to
develop ASD had greater head and abdominal sizes at
around 20 weeks' in the womb than did their healthy
peers.
 RELATED DRUGS
• Selective serotonin reuptake inhibitors

• used to treat symptoms of autism that can

be administered to children above the age
of seven include fluoxetine , fluvoxamine ,
sertraline , and clomipramine.
 
 RELATED DRUGS
• Anti psychotic (old)

• Haloperidol, Chlorpromazine, Thioridazine, and

Fluphenazine help in the treatment by
controlling the intensity of symptoms by
regulating dopamine in the brain.
• known to have side effects like sedation, muscle
stiffness, and abnormal movements.
 RELATED DRUGS
• Anti psychotic (new) – Risperidone

• proven effective in the treatment of

aggression and self-injury  with fewer side
effects.
• Risperidone can cause increased appetite
and weight gain
 RELATED DRUGS
• Anti-convulsants

• Drugs such as carbamazepine, lamotrigine,

topiramate, or valproic acid are some of the
most used anti-convulsants.
• drugs can only reduce the frequency of seizures,
not eliminate their occurrence completely.
 RELATED DRUGS
• Stimulants

• used to control and treat the autistic tendencies

of inattention and hyperactivity
• Drugs such as methylphenidate are prescribed
for ADHD and have proven sufficiently
competent in treating the similar symptoms of
autism.
 CP-Risk Factors
• Maternal health:
• German measles (rubella), a viral infection
• Chickenpox (varicella), a viral infection

• Cytomegalovirus, a very common virus that causes flu-like

symptoms
• Toxoplasmosis, a parasitic infection caused by a parasite found in
soil and the feces of infected cats
• Syphilis, a sexually transmitted bacterial infection
• Exposure to toxins, such as methyl mercury
 Risk Factors
• Infant illness
Bacterial meningitis, a bacterial infection that
causes inflammation in the membranes that
surround the brain and spinal cord
Viral encephalitis, a viral infection that causes
inflammation of the brain
 Risk Factors
• Severe or untreated jaundice

• Premature birth. 
• Low birth weight

• Breech births
• Multiple babies
 Treatment
• Medications

• Botulinum toxin A (Botox)

• Diazepam, tizanidine , dantrolene , and

baclofen

• for spasticity/rigidity
 Treatment
• Haloperidol or Reserpine- for choreoathetosis

• Propranolol- for essential tremor

• Clonazepam- for “rubral tremors”-(coarse tremor

exacerbated by posture adjustment)

• Valproic acid or clonazepam for action myoclonus-

(large jerks with intentional movements)

 Amnesia
• a deficit in memory caused by brain damage,
disease, or psychological trauma and some
drugs
• Essentially, amnesia is loss of memory, either
wholly or partially due to the extent of
damage that was caused
 Causes
• Concussion
• Migraines
• Hypoglycemia
• Epilepsy
 Causes
• Specific brain lesions (i.e. surgical
removal)
• Ischemic events

• Drugs

• Psychological

• Nutritional deficiency
 Causes
• Long-term alcohol abuse leading to
thiamin (vitamin B-1) deficiency
(Wernicke-Korsakoff syndrome)
• Tumors in areas of the brain that
control memory
 Drug induced amnesia
•
Antianxiety drugs (Benzodiazepines)
• dampen activity in key parts of the brain, including

those involved in the transfer of events from short-

term to long-term memory.

• Midazolam has particularly marked amnesic

properties.
 Drug induced amnesia
• Cholesterol-lowering drugs
• by depleting brain levels of cholesterol as well

• these lipids are vital to the formation of connections

between nerve cells — the links underlying memory and

learning

• Antiseizure drugs
• limit seizures by dampening flow of signals within the CNS
 Drug induced amnesia
• Antidepressant drugs (Tricyclic antidepressants)

• are thought to cause memory problems by blocking the

action of serotonin and norepinephrine — two of the

brain’s key chemical messengers.

• Narcotic painkillers, work by stemming the flow of pain

signals within the central nervous system and by blunting

one’s emotional reaction to pain

 Promising drug
• Xanthinol nicotinate

• improved sensory register, short-term memory

and long-term memory
• treatment effects of xanthinol nicotinate were
predominantly found in the old
• acts inside the cell, enhancing cell metabolism
and oxygen supply in the brain.
 Transient Global Amnesia

• a sudden, temporary episode of

memory loss that can't be attributed
to a more common neurological
condition, such as epilepsy or stroke.
 PS-Alcohol
• Acute intoxication:
– euphoria, flushed face, ataxia, slowed reaction
time, impaired motor performance, slurred
speech, poor concentration; in higher doses
behavioural changes – disinhibition of sexual
and aggressive impulses, increased suicidal
and homicidal behaviour
 Alcohol
Pathological intoxication:
– sudden change of consciousness with aggressive
behaviour and amnesia
– physical complications – hypertension,
arteriosclerosis, heart infarction, cardiomyopathy,
brain stroke, liver cirrhosis, fatty liver, gastritis, etc.
– psychic complications - depression
 Alcohol
• Dependence syndrome:
– increased tolerance to alcohol, morning drinking,
blackouts, deterioration in occupational and marital
life, behavioural changes, withdrawal symptoms

• Withdrawal state:
– tremor, anxiety, easy getting startled, agitation,
insomnia, nausea, sweating, epileptic seizures and
delirium tremens
 Alcohol
• Delirium tremens:
– usually starts in evening hours – growing
tremulousness, severe agitation, anxiety and
perceptual distortion
– a state seriously endangering patient's life
– recovery after several days, retrograde
amnesia
 Alcohol
• Treatment of alcoholism

– Withdrawal from alcohol, benzodiazepines,

clomethiazol
– Aversion therapy
– Alcohol-disulfiram Reaction (AAR)

– Psychotherapy
 Treatment
• Disulfiram may help to prevent from drinking

• drug produces a physical reaction including flushing,

nausea, vomiting and headaches

• Naltrexone blocks the good feelings alcohol causes, may

prevent heavy drinking and reduce the urge to drink

• Acamprosate may help combat alcohol cravings

•  Naltrexone, injected once a month

 ACAMPROSATE 
• possesses effects on GABA, glutamate,
serotonin, noradrenalin and dopamine
• Reduces relapse rate when combined with
psychotherapy
• Adverse effects include nausea, vomiting
diarrhea and rash
 Opioids
– withdrawal symptoms extremely unpleasant
– needle-sharing poses a serious risk of
transmission of HIV , hepatitis B & C viruses
– treatment of the withdrawal state –
buprenorphine, benzodiazepines, spasmolytics;
in serious cases of dependence heroin is
replaced by methadone
 Cannabinoids
• Marijuana a term for dried leaves and flowers of
cannabis plant (Cannabis sativa L.)
– acute: anxiety, panic, impaired attention,
memory, reaction time, psychomotor
performance and coordination, increased risk
of road accident, and increased risk of
psychotic symptoms in vulnerable persons
 Cannabinoids
–chronic: chronic bronchitis, a cannabis
dependence syndrome, subtle
impairments of attention, short-term
memory and ability to organize and
integrate complex information
 Cannabinoids
• May exacerbate schizophrenia & may
increase depressive symptoms among some
users
• impair executive function in the brain

• Abuse & dependence highly associated with

increased risks of other substance
 Stimulants
• Cocaine, amphetamine,
metamphetamine, phenmetrazine,
methyphenidate, MDMA (ecstasy,
methylenedioxymetamphetamine)
 Stimulants
• Positive mood, activity, planning,
diminished need of sleep
• Tachycardia, arrhythmia,
hypertension, hyperthermia, intra-
cerebral hemorrhage
 Stimulants
• Withdrawal symptoms: severe craving,
depression, decreased energy, fatigue, sleep
disturbance
• Prolonged use can trigger paranoid
psychoses, impulsivity, aggression,
irritability, suspiciousness and anxiety states
 Hallucinogens
• Lysergid acid diethylamide (LSD), psilocybin,
mescaline, phencyclidine
• Acute intoxication: distorted perception (optic
hallucinations and illusions); unpredictable
and dangerous behaviour
• Withdrawal syndrome not described
Best of luck for your exams