KELOMPOK 5
EZAFADDILA
MAISARAH
NURNABIHAH
RIZQA RAZAQTANIA
ROICHAN M. FIRDAUS
PEMBIMBING
Dr. Prianto Djatmiko, spKJ
Definisi
Psikofarmaka = obat
psikotropik = Psikotropika
Obat yang bekerja scr
selektif pada susunan
sarap pusat (SSP) dan
mempunyai efek efek
utama terhadap aktifitas
mental dan perilaku,
digunakan untuk terapi
gangguan psikiatrik.
Jenis Obat
Gejala Sasaran
Antipsychotics
Psikosis
Antidepressants
Depresi
Mood-Stabilizers
Mania
Anxiolytics
Anxietas
Hypnotics/anti-insomnia
Insomnia
Anti panik
Panik
Mekanisme agonisantagonis
Antipsikotik (Neuroleptik)
Antipsychotics
Used to treat schizophrenia and
psychotic symptoms of other disorders
Schizophrenia is a severe chronic
disorder
Positive symptoms: hallucinations, and
delusions
Negative symptoms: amotivation,
poverty of speech, flat affect
Disorganized symptoms: speech,
thought, and behavior
Anti Psikotik
NEUROLEPT
ICS
MAJOR
TRANQULIZE
RS
Anti Psikotik
Anti Psikotik
Efek Samping :
- Sedasi dan Inhibisi
Psikomotor
- Gangguan Otonomik :
hipotensi
- Gangguan
Ekstrapiramidal
- Ggn Endokrin,
metabolik, hematologik,
Overview of Antipsychotics
Conventional Antipsychotics(TYPICAL)
Chem. Group
Generic Name
Trade Mark
CHLORPROMAZIN,
LARGACTIL,
PLEGOMAZIN,
MEGAPHEN,
THORAZIN
levomepromazine TISERCIN, NOZINAN
chlorpromazine
Phenothiazin
es
Thioxanthes
thioridazine
THIORIDAZIN,
MELLERIL
periciazine
NEULEPTIL
chlorprothixene
CHLORPROTHIXEN,
TRUXAL
clopenthixol
CISORDINOL,
CLOPIXOL
Dose (mg)
200-800
50-400
100-600
10-40
100-600
20-100
Overview of Antipsychotics
Conventional Antipsychotics
Chem. Group
Phenothiazine
s
Generic Name
Trade Mark
Dose (mg)
perfenazine
PERFENAZIN,
TRILAFON, PERATSIN
16-24
prochlorperazi
ne
flufenazine
PROCHLORPERAZIN,
STEMETIL
20-80
MODITEN
2-16
trifluoperazine
STELAZIN
10-50
FLUANXOL
6-18
Thioxanthenes flupenthixol
Butyrophenon
es
Diphenylbutyl
piperidines
Perathiepines
haloperidol
HALOPERIDOL,
HALDOL, APOHALOPERIDOL
2,5-10
melperone
BURONIL
50-300
pimozide
ORAP
2-10
fluspirilen
IMAP
2-10
penfluridol
SEMAP
2-60
oxyprothepin
MECLOPIN
5-20
Trade Mark
Dose (mg)
DOGMATIL, PROSULPIN
50-1200
amisulpride
SOLIAN, DENIBAN
50-1200
SDA
risperidone
4-8
Aripripazol
RISPERDAL, RISPEN,
RISPERDAL QUICKLET
ABILIFY
ziprasidone
ZELDOX
40-160
sertindole
SERDOLECT
12-20
15-30
MARTA
clozapine
LEPONEX
200-600
olanzapine
5-20
quetiapine
SEROQUEL
300-600
Depot Antipsychotics
Generic Name
Trade Mark
Mean Dose
(mg)
flufenazin
MODITEN DEPOT
25
oxyprothepin
MECLOPIN
25
haloperidol
HALDOL DEPOT
flupenthixol
FLUANXOL DEPOT
zuclopenthixol
CISORDINOL
DEPOT
IMAP
fluspirilen
risperidone
RISPERDAL
CONSTA
100
Interval
14-28
days
40
200
6
7 days !!
20-30
14 days
Relative
Antipsychotic
Potency
Sedation
Extrapyramidal
Anticholinergic
Hypotension
chlorpromazine
(Thorazine)
+++
+++
+++
thioridazine
(Mellaril)
+++
+++
+++
fluphenazine
(Prolixin)
+++
+++
++
haloperidol
(Haldol)
+++
+++
+/-
loxapine
(Loxitane)
++
++
+/-
molindone
(Moban)
++
++
clozapine
(Clozaril)
++
+++
+/-
+++
+++
risperidone
(Risperdal)
+++
++
Diabetes
Extrapyramid
al Symptoms
Elevated
Prolactin
QTc
Weight
Prolongation Gain
Aripiprazole
+/-
+/-
+/-
+/-
Clozapine*
++++
+/-
+/-
++++
Olanzapine
++++
+/-
++++
Quetiapine
++
+/-
+/-
+/-
+++
Risperidone
++
+++
+++
++
Ziprasidone
+/-
++
+/-
*Clozapine is also associated with myocarditis and agranulocytosis; the other secondgeneration antipsychotics are not.
No response
No response
No response
Antidepresan
Penggolongan
Antidepressan
Indication of Antidepressants
Depressive Disturbances
Affective Disorders
Obsessive-Compulsive
Disorders
Panic Disorders
Eating Disorders
Psychosomatic Disorders
Posttraumatic Stress Disorder
Alcohol and Drugs
Withdrawal Symptoms
Pain Syndromes
Enuresis
Narcolepsy
Antidepressants:
Monoamine Reuptake Inhibitors
1st Generation of Antidepressants (TCA, TeCA)
Generic Name
Trade Mark
Doses (mg)
amitriptyline
AMITRIPTYLIN
75-200
nortriptyline
NORTRILEN
50-150
imipramine
MELIPRAMIN
75-250
clomipramine ANAFRANIL,
HYDIPHEN
dosulepin
PROTHIADEN
75-225
100-300
dibenzepine
NOVERIL
240-720
maprotiline
LUDIOMIL,
MAPROTILINE
75-150
Mechanism of
Efficacy
Inhibition of
Serotonin
and/or
Norepinephrine
Reuptake
Followed by
Increase of
their
Concentrations
in Synaptic
Cleft
Trade Mark
Mean Doses
(mg)
Mechanism
SSRI
fluvoxamine
FEVARIN
fluoxetine
DEPREX, DEPRENON,
PROZAC, PORTAL,
FLOXET, FLUXONIL,
MAGRILAN
SEROPRAM, CITALEC,
CEROTER, PRAM
20-60
escitalopram
CIPRALEX
10-20
paroxetine
SEROXAT, PAROLEX,
APO-PAROX, REMOD
20-60
sertraline
ZOLOFT, SERLIFT,
ASENTRA, STIMULOTON
citalopram
100-300
20-60
50-200
Selective
Serotonin
Reuptake
Inhibition
Anxiety/Panic
Bulimia Nervosa
PMDD
OCD-Spectrum
Impulse Control
3rd Generation of
Antidepressants
Generic Name
Trade Mark
Mean Doses
(mg)
Mechanism
SARI
Antidepressants with Doubled Serotonergic Efficacy
trazodone
TRITTICO AC
4-8
Double Serotonergic
nefazodon SERZONE,
100-300
Efficacy
e
DUTONIN
NARI
reboxetine
EDRONAX
4-8
Norepinephrine
Reuptake Inhibition
tianeptine
COAXIL
75
Increasing of Serotonin
Reuptake
MAO Inhibitors
Non Selective and Irreversible: (IMAO A, IMAO B)
phenelzine
NARDIL
isocarboxazid
MARPLAN
nialamide
NIAMID, NUREDAL
tranylcypromine
PARNATE
MAO A
moclobemide
AURORIX
brofaromine
CONSONAR
toloxatone
MAO B
HUMORYL
Antiepileptics
of 3rd
gabapentine
Generation
topiramate
olanzapine
ZYPREXA
quetiapine
SEROQUEL
3 bulan
Mood Stabilizer
Digunakan utk mengendalikan mood pad
Bipolar atau Manik-Depresif to
Mood Stabilizer
Lithium carbonate mood stabilizer klasik.
Pengobatan:
APA Practice Guidelines 2002
Manik gjl akut/tipe campuran:
1st line: lithium or valproate or antipsychotic*
1st line severe: lithium or valproate +
antipsychotic*
Depresi akut:
1st line: lithium or lamotrigine
1st line severe: lithium + antidepressant
Maintenance
lithium or valproate:
Alternatif: lamotrigine, carbamazepine,
oxycarbazepine
Atipikal antipsikotik dapt diberikan
Mood Stabilizers:
Lithium
kelebihan:
(FDA-approved 1970)
Efektif pd manik dan hipomanik
Tidak mahal
Menurunkan kdr bunuh diri
kekurangan:
Onset lmbat ~14 hari
Indeks terapeutik redah
Tdk berespon pd > 50% (pd subtipe
bipolar)
ES (polyuria, tremor, GI s) and noncompliance
Kejadian Relaps meningkat krn berhenti
Mood Stabilizers:
Divalproex
Kelebihan:
(FDA-approved utk epilepsy 1983; utk
bipolar episode mania 1995)
Onset cepat (1-4 hari)
77% menunjukkan respon
Efektif pada subtipe Bipolar
Efektif utk gejala psikotiktif
Efek samping Gangguan kognitif
kurang dari lithium
Mood Stabilizer:
Divalproex
Kekurangan:
-Efek sedasi
-Rambut rontok
-Peningkatan BB
-tremor
-Gangguan GI
-thrombositopenia
-Hepatoksisitas ,pancreatitis (jarang)
-Polycystic Ovarian Syndrome
-Harus monitor kadar obat dlm plasma
Mood Stabilizers:
Lamictal
FDA-approved utk terapi rumatan
Gangg Bipolar I
Hati hati dgn efek timbulnya kelainan
kulit spt ruam (itermasuk StevensJohnson Syndrome dan Toxic epidermal
necrolysis)
Interaksi obat dgn AED(tu valproic acid
and carbamazepine)
ANXIOLYTICS/
ANTI CEMAS/
ANTI ANSIETAS
5-HT1Areceptoragonists:
Azaspirodecanedion- Buspirone
Barbiturat : fenobarbital,teopental
-Blockers
: Propranolol
2-AR partial agonist : Clonidine
Antidepressants : TCAs, SSRIs
Antihistaminicdrugs
Diphenhydramine
BENZODIAZEPIN
Cara kerja:
Me >>transmisi GABAergik
Benzodiazepin
Efek:
Menurunkan ansietas
Hipnotik sedatif
Anti konvulsif
Pelemas otot
Pharmacodynamics of Benzodiazepines
Benzodiazepin
Gangguan anxietas
Gangguan kekakuan otot
Gangguan tidur
Kejang
Efek samping
Depresi nafas ,gangg SSP
pusing,sedasi, mual ,muntah,konfusi dan
gangg memori
Toleransi obat
BARBITURAT
Efek samping
Depresi SSP dan pernafasan
Kegunaan klinis
Anestesia,antikonvulsan
Anxietas telah digantikan dg benzodiazepin
BUSPIRONE
Obat antiansietas agonis parsial pd
reseptor 5-HT1A receptor menghambat
pelepasan serotonin dan mempunyai
afinitas pd reseptor D2 dopamine pd otak
yg dpt bertindak sbg antagonist dan
agonist.
Pengobatan simptomatik kerja cepat pd
pasien gangg cemas menyeluruh
BUSPIRONE
Tidak ada efek sedatif dan tidak menekan
SSP
margin of safety tinggi
tdk menimbulkan ketergantungan.
Efek samping:
Dpt menimbulkan takikardia, palpitasi,
cemas, gangg GI dan parestesia.
Menyebabkan konstriksi pupil-trgntung
dosis
TERIMA KASIH...