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Psychopharmacology PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "Psychopharmacology" by Dr.Sujit Kumar Kar, MD. Know about Psychopharmacology, the study of the effects of drugs on affect, cognition, and behavior. Psychopharmacology is the scientific study of how drugs affect mood, behavior, and mental processes. It involves the use of drugs to treat psychiatric disorders such as depression, anxiety, schizophrenia, bipolar disorder, and ADHD.

Tags : Psychopharmacology, drugs, mental processes, psychiatric disorders, depression, anxiety, schizophrenia, bipolar disorder, ADHD

Published on : Mar 15, 2023 | Views : 1099 | Downloads : 1

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Dr.Sujit Kumar Kar, MD Lecturer Department of Psychiatry King George’s Medical University Lucknow, U.P
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Psychopharmacology Psychopharmacology is the study of the effects of drugs on affect, cognition, and behavior The term drug has many meanings: Medication to treat a disease A chemical that is likely to be abused An “exogenous” chemical that significantly alters the function of certain bodily cells when taken in relatively low doses (chemical is not required for normal cellular functioning)
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Pharmacokinetics Drug molecules interact with target sites to effect the nervous system The drug must be absorbed into the bloodstream and then carried to the target site(s) Pharmacokinetics is the study of drug absorption, distribution within body, and drug elimination Absorption depends on the route of administration Drug distribution depends on how soluble the drug molecule is in fat (to pass through membranes) and on the extent to which the drug binds to blood proteins (albumin) Drug elimination is accomplished by excretion into urine and/or by inactivation by enzymes in the liver
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Drug Effectiveness Dose-response (DR) curve: Depicts the relation between drug dose and magnitude of drug effect Drugs can have more than one effect Drugs vary in effectiveness Different sites of action Different affinities for receptors The effectiveness of a drug is considered relative to its safety (therapeutic index)
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Routes of Drug Administration Routes of drug administration into the body Intravenous (IV): into a vein (rapid absorption) Intraperitoneal (IP): into the gut (used in lab animals) Subcutaneous (SC): under the skin Intramuscular (IM): into a muscle Inhalation of the drug into the lungs Topical: absorbed through the skin Oral (PO): via the mouth
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Tolerance and Sensitization Repeated administration of a drug can alter its subsequent effectiveness Tolerance: Repeated drug administration results in diminished drug effect (or requires increased dosage to maintain constant effect) Withdrawal effects are often the opposite of the drug effect and often accompanies tolerance Tolerance can reflect decreased drug-receptor binding or reduced postsynaptic action of the drug Sensitization: Repeated drug administration results in heightened drug effectiveness
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Synaptic Transmission Transmitter substances are Synthesized, stored, released, and terminated Susceptible to drug manipulation Definitions: Direct agonist: a drug that binds to and activates a receptor Antagonist: a drug that binds to but does not activate a receptor Indirect antagonists are drugs that interfere with the normal action of a neurotransmitter without binding to its receptor site
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Drug Action on Synaptic Transmission Agonist Antagonists
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Presynaptic Drug Actions Presynaptic autoreceptors regulate the amount of NT released from the axon terminal Drugs that activate presynaptic autoreceptors reduce the amount of NT released, an antagonistic action Drugs that inactivate presynaptic autoreceptors increase the amount of NT released, an agonistic action Presynaptic heteroreceptors are sensitive to NT released by another neuron, can be inhibitory or facilitatory
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Neuromodulators Neurotransmitter binding to receptors produces either EPSPs or IPSPs Glutamate produces EPSPs GABA produces IPSPs Neuromodulators alter the action of systems of neurons that transmit information using either glutamate or GABA
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Objectives Classification of psychotropic medications. Mechanism of action of psychotropic medications. Choose a psychotropic medication rationally. Know common & dangerous adverse effects. Manage failure of response to a therapeutic trial.
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Why Medications ? Dopaminergic theory of Schizophrenia Monoaminergic theory of Mood Disorders
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Synthesis Storage Enzymatic destruction if not stored Exocytosis Termination of release via binding with autorecptors Binding to receptors Inactivated Drugs are developed that address these actions as an AGONIST (mimic the NT ) or ANTAGONIST (block the NT) Neurotransmitters Go through 7 steps
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Psychopharmacologic DrugsWork over A Spectrum
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General principles about adverse effects Psychopharmacological agents affect the whole body. Remember the common and dangerous side effects. They indicate the drug is working.
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Antipsychotics
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Antipsychotics Treat psychotic symptoms. Divided into: Typical/1st generation = D2 receptor antagonist Effective against +ve > -ve Atypicals/2nd generation = Serotonin-dopamine antagonists Effective against both +ve & -ve sx Requires ~ one month for significant antipsychotic effect
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AntipsychoticsAverage Daily Doses in mg Typicals Haloperidol (5-15) Thioridazine(100-300) Chlorpormazine (50-400) Atypicals Risperidone (4-8) Olanzapine (10-20) Quetiapine (600-1200) Clozapine (100-600) Lower numbers indicate higher potency
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Antidepressants Used in many psychiatric disorders other than Depression. Full clinical response in 6-8 weeks in major depression, up to 6/12 in obsessive compulsive disorder. Examples: Fluoxetine & Paroxetine (20-60 mg/d) Fluovoxamine & Sertraline (50-200 mg/d) Imipramine(200-300 mg/d)
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THREE PHASES OF TREATMENT Time Symptom Severity Normal Acute Phase (3 months+) Continuation Phase (6-12 months) Maintenance Phase (years) Response Remission Relapse Relapse Recurrence > 50% STOP Rx 65 to 70% STOP Rx Recovery
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Potential Adverse Effects ofAntidepressant Therapy 16-Mar-23 36 Cardiac Orthostasis hypertension heart block,tachycardia Urogenital Erectile dysfunction, ejaculation disorder, anorgasmia, priapism Central Nervous System Dizziness, cognitive impairment, sedation, light-headedness, somnolence, nervousness, insomnia, headache, tremor,changes in satiety and appetite Gastrointestinal Nausea, constipation, vomiting, dyspepsia, diarrhea Autonomic Nervous System Dry mouth, urinary retention, blurred vision, sweating
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Antidepressants and the Cytochrome P450 System Antidepressants and mood stabilizers may be inhibitors, inducers or substrates of one or more cytochrome P450 isoenzymes Knowledge of their P450 profile is useful in predicting drug-drug interactions When some isoenzymes are absent of inhibited, others may offer a secondary metabolic pathway P450 1A2, 2C (subfamily), 2D6 and 3A4 are especially important to antidepressant metabolism and drug-drug interactions
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Mood Stabilizers Lithium, Valproic acid, Carbamazepine, Lamotrigine, Gabapentine, Topiramate. Used in the treatment of Bipolar affective disorder and similar conditions associated with impulsivity. Drug level measurements are available for many of them. Mechanism of action is not clearly understod.
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Common Mood Stabilizers
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Anxiolytics/sedatives Benzodiazepines, Trazodone, Zolpidem and others Alprazolam, clonazepam, lorazepam, diazepam. Risk of dependence & withdrawal.
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Other pharmacological agents Cholinesterase inhibitors: Donepezil, Rivastigmine, Galantamine, (Tacrine has been withdrawn) Sympathomimetics: Methylphenidate, Dextroamphetamine. Anticholinergic agents: Procyclidine, Benztropine
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Dangerous Side Effects Hypertensive crisis Associated with MAOIs. Neuroleptic malignant syndrome Autonomic instability, severe EPS, delirium, ↑CK, ARF, myoglobulinuria Serotonin syndrome Restlessness, myoclonus, ↑reflexes, tremors, confusion. Due to combination of serotenergic agents Agranulocytosis ( Clozapine, carbamazepine).
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Prescribing a Psychotropic AgentAfter Diagnostic Assessment Choose a medication based on FDA approval Family or personal hx of response Adverse effects vs. key symptoms Starting dose Monitor side effects & clinical response Adjust dose if needed
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Failure of ResponseWhat to do? Check Compliance & availability Review the diagnosis Is the dose appropriate? Is the duration of treatment long enough? Any ongoing substance abuse? Other drugs/preparation causing drug-drug Interaction? Individual Variation?
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Thank you