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									                   Module II
The Basics of the Brain, the Body and Drug Actions

      Segment G
Psychotherapeutic Drugs




                    Kim Edward Light, Ph.D.
                    Professor, College of Pharmacy
                    University of Arkansas for
                    Medical Sciences
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                    Objectives
 Identify the different categories of drugs having
  therapeutic value in treating CNS disorders.
 Identify the spectrum of disorders of brain function
 For each category of drugs not previously discussed
    Identify therapeutic uses and indications
    Present pharmacological mechanisms
    Discuss specific features of drug action
    Present adverse reactions and side effects
    Identify contraindications and complications




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          Drug Categories

 Antipsychotics /    Stimulant Medications
   Neuroleptics       Antianxiety Medications
                      Hypnotics
 Antimanic
                      Narcotics - Opioid
 Antidepressants      Analgesics
 Alzheimer's         Addiction Treatment
 Antiparkinsonian     Medications
 Anticonvulsants


                                                 3
     Spectrum of Disorders1
 Attention Deficit Hyperactivity Disorder
  (ADHD, ADD)
 Autism Spectrum Disorders (Pervasive
  Developmental Disorders)
 Bipolar Disorder (Manic-Depressive Illness)
 Borderline Personality Disorder
 Depression
 Eating Disorders

                                                4
   Spectrum of Disorders2
 Generalized Anxiety Disorder
  Obsessive-Compulsive Disorder (OCD)
  Panic Disorder
  Post-Traumatic Stress Disorder (PTSD)
  Social Phobia (Social Anxiety Disorder)
 Schizophrenia
 Seizure Disorders



                                             5
Traditional Antipsychotic Drugs
   chlorpromazine Thorazine®, Largactil®
   fluphenazine Prolixin®, Permitil®
   haloperidol Haldol®
   loxapine Loxitane, Daxolin®
   mesoridazine Serentil®
   molindone Moban, Lindone®
   perphenazine Trilafon®, Etrafon®
   pimozide Orap®
   thioridazine Mellaril®
   thiothixene Navane®
   trifluoperazine Stelazine ®
                                            6
Atypical Antipsychotic Drugs
   aripiprazole Abilify®
   clozapine Clozaril®
   olanzapine Zyprexa®, Zyprexa®, Zydis®
   quetiapine Seroquel®
   risperidone Risperdal®
   ziprasidone Geodon®




                                            7
          Antipsychotic Drug
               Adverse Reactions
Tardive Dyskinesia
  Involuntary movements
  Long-term use and older patients
  Women > men

Neuroleptic Malignant Syndrome
    Blood pressure up and down
    Dazed and confused
    Difficulty breathing
    Muscle stiffness
    Rapid heart rate
    Sweating and shakiness
    Temperature above normal
                                      8
      Antipsychotic Drug
              Side Effects
 Blurred vision, Dry mouth
 Drowsiness, Slurred speech, Dizziness
 Muscle rigidity
 Nasal congestion, Lowered blood pressure
 Restlessness, Slowed heart rate
 Sensitivity to bright light
 Upset stomach, Constipation
 Weight gain

                                             9
      Bipolar Disorder Drugs
Lithium
  Carbonate - Eskalith®, Eskalith CR®, Lithane®,
     Lithobid®, Lithonate®, Lithotabs®
  Citrate - Cibalith®

Anticonvulsants

Neuroleptics – atypical
    olanzapine Zyprexa®, Zyprexa®, Zydis®
    quetiapine Seroquel®
    risperidone Risperdal®
    ziprasidone Geodon®

                                                    10
          Lithium Side Effects
   ataxia, fine hand tremor, hyperactive reflexes
   blurred vision, drowsiness, diarrhea, vomiting
   muscular weakness, dry mouth, polyuria,
   cardiac arrhythmia, hypotension,
   epileptiform seizures, coma
   large output of dilute urine

Regular monitoring of blood levels necessary



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        Antidepressant Drugs
                      Older
MAO Inhibitors              Tricyclics & Quarta-cyclics
isocarboxazid Marplan®      amitriptyline Elavil®
phenelzine Nardil®          amoxapine Asendin®
tranylcypromine Parnate®    clomipramine Anafranil®
                             desipramine Norpramin®
                             doxepin Sinequan®
                             imipramine Tofranil®
                             maprotiline Ludiomil®
                             nortriptyline Pamelor®
                             protriptyline Vivactil®
                                                     12
     Antidepressant Drugs
                    Newer
SSRIs                     SNRIs
 citalopram Celexa®       venlafaxine Effexor®,
 escitalopram Lexapro®     Effexor ER®
 fluoxetine Prozac®       nefazodone Serzone®
 fluvoxamine Luvox®       mirtazapine Remeron®
 paroxetine Paxil®
 sertraline Zoloft®      Others
                           bupropion Wellbutrin®
                           trazodone Desyrel®


                                                    13
       Antidepressant Drugs
           Adverse Reactions
MAO Inhibitors
 Foods containing tyramine at high levels

Serotonin Syndrome
 Produced by combination of products that act to
  increase serotonin
 Similar to Neuroleptic Malignant Syndrome
 Euphoria, drowsiness, exaggerated reflexes,
  sweating, hyperthermia, mental status changes


                                                    14
     Antidepressant Drugs
               Side Effects
Older agents
Dry mouth, dizziness, constipation, blurred vision,
cardiac arrhythmias
Orthostatic hypotension, sexual dysfunction, weight
gain
Newer agents
Headache, nausea, nervousness, agitation,
Sexual dysfunction, insomnia, weight gain
Seizure risk (bupropion)
Suicide or aggressive acts especially in adolescents
                                                        15
    Anti-Parkinsonian Drugs
DA Boosters
 L-DOPA
 L-DOPA / carbidopa Sinemet® or Atamet®
 entacapone Comtan®
MAO-B Inhibitor
 Selegiline Eldepryl® Atapryl® Carbex®
DA Agonists
 bromocriptine Parlodel®
 pergolide Permax®
 pramipexole Mirapex®
 ropinirole Requip®
 amantadine Symmetrel®, Symadine®
                                           16
    Anti-Parkinsonian Drugs
                   Adjuncts

Anticholinergics
 benztropine Cogentin®
 trihexyphenidyl Artane®




                              17
   Anti-Alzheimer's Drugs
 Donepezil Aricept®
 Galantamine Reminyl®
 Rivastigmine Exelon®
 Tacrine Cognex®
 Memantine Namenda®
Side Effects
 Dizziness, Confusion, Sleep problems
 Increased respiratory secretions, Urinary frequency
 Cardiovascular problems



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        Anticonvulsant Drugs
   carbamazepine Tegretol®
   divalproex sodium Depakote®,
   valproate Depacon®, Depakene®
   gabapentin Neurontin®
   lamotrigine Lamictal®
   levetiracetam Keppra®
   oxcarbazepine Trileptal®
   tiagabine Gabitril®
   topiramate Topamax®


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      Anticonvulsant Drugs
               Side Effects
 weight gain,
 memory and cognitive function disturbances,
 photosensitivity,
 dermatological sensitivity leading to rashes,
 sinus congestion,
 hair thinning,
 impaired absorption of B vitamins.


                                                  20
                          Summary
 Discussed the various major classes of
  drugs used to treat various mental disorders
  including:
    Antipsychotic drugs
    Bipolar disorder drugs
    Antidepressant drugs
    Anti-Parkinsonian drugs
    Anti-Alzheimer’s drugs
    Anticonvulsant drugs
Psychotherapeutic Medications Information
   http://www.nimh.nih.gov/healthinformation/index.cfm

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