Drugs acting on the CNSI Unit 8 Week 5 Dr.Mohammed Hassan Drugs acting on the CNSI Al-Hamadi , Drugs acting on the CNSI. 4medstudents.com 2003

Drugs acting on the CNS 1 The psychotic disorders are classified into 3 major groups: Anxiety disorders (phobia and sleeping disorders). Effective/mood disorders (depression) Personality disorders (Schizophrenia)

Drugs acting on the CNS 1 Anxiolytic Drugs: Antidepressant Drugs: Benzodiazepines(BDZ) Barbiturate. Buspirone Antidepressant Drugs: Tricyclic/Plycyclic Monoamine oxidase inhibitors Selective serotonin-reuptake inhibitors (SSRI) Neurolytic Drugs: Phenothiazin Buteopheanol

Anxiety and Anxiolytic Drugs: Definition: Unpleasant state of tension or a fear that seems to arise from an unknown source. Symptoms: Tachycardia Sweating Palpitations Sympathetic activation

Anxiolytic Drugs (Benzodiazapine) Diazepam,Lurazepam, Midazolam Mode of action: Binding of GABA to its receptor trigger an opening of chloride conductance. The influx of chloride ions causes hyperpolarization that moves the post synaptic potential away from its firing threshold and thus inhibits the formation of action potential and neural firing> Actions: Reduction of anxiety( at low doses) Sedative and hypotonic actions (at higher doses) Anticonvulsant Muscle relaxant

Benzodiazapine Therapeutic uses: Pharmacokinetics: Anxiety disorders (Muscular disorders Seizures Sleep disorders Pharmacokinetics: Absorption and distribution: Lipophilic Rapidly absorbed

Benzodiazapine Pharmacokinetics: Dependence: Duration of action: Fate: Short, intermediate and long acting. Fate: Metabolized by the hepatic microsomal metabolism system. Dependence: At high doses Results in withdrawal symptoms: Confusion, anxiety, restlessness and tension.

Benzodiazapine Adverse effects: Precautions: Drowsiness and confusion. Cautiously in treating patients with liver disease. Goodbye BDZ

Welcome (Barbiturate) Phenobarbiturate, amobarbiturate Mode of action: Interfere with sodium and potassium transport across cell membranes. Actions: Depression of CNS (at low doses) Hypnosis and anesthesia ( at high doses) Respiratory depression. Enzyme induction (P-450 microsomal enzyme in liver)

Barbiturate Therapeutic uses: Pharmacokinetics: Anesthesia Anticonvulsant Anxiety Pharmacokinetics: Metabolized by the liver Distributed to: Splanchnic area Skeletal muscles Adipose tissue

Barbiturate Adverse effects: CNS: Drug hangover Addiction: Poisoning: Drowsiness, impaired concentration and mental sluggishness Drug hangover Tiredness, nausea and dizziness Addiction: Tremor, anxiety, tiredness, restlessness, nausea and vomiting Poisoning: death Goodbye Barbiturate

Goodbye all Anxiolytic Drugs Welcome Buspirone Useful in the treatment of generalized anxiety disorders. Action: The action is mediated by serotonin receptors. Adverse effects: Dizziness Nervousness ligthheadness The action is mediated by serotonin receptors Goodbye all Anxiolytic Drugs

Depression and Antidepressant drugs: Definition: Pervasive mood altering illness affecting energy, sleep, appetite and the ability to function. Symptoms: Depression Sadness Hopelessness Inability to experience pleasure in usual activity

Antidepressant Drugs (Tricyclic/Polycyclic) Amitriptyline, Imipramine Mode of action: Inhibit the neuronal reuptake of norepinephrine and serotonin into presynaptic nerve terminals which leads to increased concentration of monoamine in the synaptic clef. Blocking serotonergic,a-adrenergic, histamine and muscurinic receptors. Actions: Elevate moods Improve mental alertness Increase physical activity

Tricyclic/Polycyclic Therapeutic uses: Depression Panic disorder Bed-wetting in children Pharmacokinetics: Absorption and distribution: Lipophilic Low bioavailability Metabolized by hepatic microsomal system

Tricyclic/Polycyclic antidepressant Adverse effects: Anti muscarinic effects: Blurred vision, dry mouth, urinary retention and constipation Increase cardiovascular stimulation Sedation Orthostatic hypotension: By blocking a-adrenergic receptors. Goodbye tricyclic/polycyclic

Welcome (monoamine oxidase inhibitors) Hydralazine, phenelzine Mode of action: Reverrsibly or irreversibly inactivate the enzyme, this result in increased norepinephrine, serotonin and dopamine with in the neuron.

monoamine oxidase inhibitors Therapeutic uses: Depression Phobic states Pharmacokinetics: Effect require 2 to 4 weeks

monoamine oxidase inhibitors Adverse effects: Inability to degraded tyramine obtained from the gut Cheese Chicken liver Tyramine causes the release of large amounts of stored catecholamines from verve terminals resulting in: Headache Tachycardia Nausea hypertension Goodbye MAO Inhibitors

Welcome (Selective Serotonin-Reuptake Inhibitors) Fluoxetine Actions: Inhibit serotonin reuptake ( selective for serotonin) Therapeutic uses: Depression Panic disorders Pre menstrual syndrome

Selective Serotonin-Reuptake Inhibitors Pharmacokinetics: Slowly cleared from the body Potent inhibitor of a hepatic cytochrome P-450. Adverse effects: Nausea Anxiety Insomnia Sexual dysfunction Weight loss tremors Goodbye SSRI

Personality disorders and antipsycotic (neuroleptic) Drugs: schizophrenia Definition: Mental disorder caused by some inherited dysfunction of the brain. Symptoms: Delusions Hallucination Thinking or speech disturbance

(neuroleptic drugs) Five important classes. Most important classes are: Phenothiazines Fluphenazine Promethazine Butyrophenones Haloperidol Doroperidol Mode of action: Block dopamine and serotonin receptor in the brain Many of these drugs also block cholinergic, adrenergic and histamine receptors

neuroleptic drugs Actions: Antipsychotic actions: Reduce hallucinations by blocking dopamine receptors. Extrapyramidal effects: Parkinson syndrome by blocking the dopamine receptors in the nigrostriatal pathway. Antiemetic effects: By blocking dopaminergic receptors. Antimuscarinic effects: Blurred vision, dry mouth, sedation and confusion. Other effects: Hypotension and lightheadedness by blocking a-adrenergic receptors

Goodbye Neuroleptic Drugs Therapeutic uses: Schizophrenia Prevention of severe nausea Treatment of severe pain Adverse effects: Tremors Postural hypotension Constipation Urinary retention Confusion Sexual dysfunction Goodbye Neuroleptic Drugs

Thank You Team