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ANTIPSYCHOTIC, ANTIANXIETY,

ANTIDEPRESSANT

Noor Cahaya,S.Si.,M.Sc.,Apt. PS Farmasi FMIPA Universitas Lambung Mangkurat
Noor Cahaya,S.Si.,M.Sc.,Apt.
PS Farmasi FMIPA
Universitas Lambung Mangkurat
• DEFINISI obat yang bekerja pada atau mempengaruhi fungsi psikis, kelakuan atau pengalaman (Hari Sasangka,

DEFINISI

obat yang bekerja pada atau mempengaruhi fungsi

psikis, kelakuan atau pengalaman (Hari Sasangka,

2003: 63).

Menurut undang-undang nomor 5 tahun 1997

tentang Psikotropika, dalam pasal 1 butir 1 disebutkan, bahwa Psikotropika adalah zat atau obat baik alamiah maupun sintesis bukan narkotika yang

berkhasiat psikoaktif melalui pengaruh selektif pada

susunan saraf pusat yang menyebabkan perubahan khas pada aktivitas mental dan perilaku

ANTIPSIKOSIS

Obat yang menekan fungsi-fungsi psikis tertentu di SSP

Menghilangkan gejala psikosis (ex: schizophrenia):

halusinasi, delusi, ilusi, gangguan proses berpikir,

daya ingat, agresif, dll

Dosis tinggi tidak menyebabkan anestesia dan koma

Tidak menyebabkan ketergantungan obat

Menyebabkan gangguan extrapyramidal

Efek antipsikosis tidak berkaitan dengan efek sedasi

Antipsikosis ( neuroleptik, tranquilizer) Antidepresan Antiansietas Halusinogen (psikotogenik)

Antipsikosis ( neuroleptik, tranquilizer)

Antipsikosis ( neuroleptik, tranquilizer) Antidepresan Antiansietas Halusinogen (psikotogenik)

Antidepresan

Antipsikosis ( neuroleptik, tranquilizer) Antidepresan Antiansietas Halusinogen (psikotogenik)
Antipsikosis ( neuroleptik, tranquilizer) Antidepresan Antiansietas Halusinogen (psikotogenik)

Antiansietas

Antipsikosis ( neuroleptik, tranquilizer) Antidepresan Antiansietas Halusinogen (psikotogenik)
Antipsikosis ( neuroleptik, tranquilizer) Antidepresan Antiansietas Halusinogen (psikotogenik)

Halusinogen

(psikotogenik)

CLASSIFICATION OF ANTIPSYCHOTIC DRUGS

Main categories are:

Typical antipsychotics

Phenothiazines (chlorpromazine, perphenazine,

fluphenazine, thioridazine et al)

Thioxanthenes (flupenthixol, clopenthixol)

Butyrophenones (haloperidol, droperidol)

Atypical antipsychotics (e.g. clozapine, risperidone, sulpiride,

olanzapine)

CLASSIFICATION OF ANTIPSYCHOTIC DRUGS

Distinction between ‘typical’ and ‘atypical’ groups is not clearly defined, but rests on:

Incidence of extrapyramidal side-effects (less in ‘atypical’ group)

Efficacy in treatment-resistant group of patients

Efficacy against negative symptoms.

TYPICAL NEUROLEPTIC

Phenothiazines

Chlorpromazine (Thorazine ® )

Thioridazine (Mellaril ® )

Fluphenazine (Prolixin ® )

Thioxanthenes

Thiothixene (Navane® )

Chlorprotixen

Butyrophenones

Haloperidol (Haldol ® )

• Thioxanthenes • Thiothixene (Navane® ) • Chlorprotixen • Butyrophenones • Haloperidol (Haldol ® )
• Thioxanthenes • Thiothixene (Navane® ) • Chlorprotixen • Butyrophenones • Haloperidol (Haldol ® )

TYPICAL NEUROLEPTIC

Typical neuroleptics block the dopamine-2 receptor.

TYPICAL NEUROLEPTIC • Typical neuroleptics block the dopamine-2 receptor.

PHENOTHIAZINES

Pharmacologic effects and mechanism:

(1) CNS: a. neuroleptic effect---

D1, D5---D1-like receprtors

D2-4------D2-like receptors

Antipsychotic drugs probably owe their therapeutic

effects mainly to blockade of D2-receptors (lies in

midbrain-cortex and midbrain-limbic system ).

b. antiemetic effect--- inhibit chemoreceptor trigger

zone or directly depress the medullary vomiting center.

c. temperature-regulating effect--- produce

hypothermia

PHENOTHIAZINES

Pharmacologic effects:

(2) autonomic nervous system: block α-

adrenergic and M-Cholinergic receptors and

result in hypotension, dry mouth, constipation and blurred vision.

(3) Endocrine system: increase the release of prolactin and decrease corticotropin release and secretion of pituitary growth hormone.

THIOXANTHENES

Chlorprothixene: mild antipsychotic action, and

antianxiety and antidepressant action.

BUTYROPHENONES

Haloperidol: control psychomotor excitement.

Adverse effects: severe extrapyramidal

symptoms.

ADVERSE EFFECTS OF TYPICAL

NEUROLEPTICS

Anticholinergic (antimuscarinic) side effects: Dry mouth, blurred vision, tachycardia, constipation, urinary retention, impotence

(antimuscarinic) side effects: Dry mouth, blurred vision, tachycardia, constipation, urinary retention, impotence

LANJUTAN

Antiadrenergic (Alpha-1) side effects:

Orthostatic hypotension w/ reflex tachycardia

Sedation

LANJUTAN … • Antiadrenergic (Alpha-1) side effects: • Orthostatic hypotension w/ reflex tachycardia • Sedation

LANJUTAN

Antihistamine effect : sedation, weight gain

LANJUTAN … • Antihistamine effect : sedation, weight gain

LANJUTAN

Chlorpromazine and thioridazine produce

marked autonomic side effects and sedation; EPS tend to be weak (thioridazine) or

moderate (chlorpromazine).

Haloperidol, thiothixene and fluphenazine produce weak autonomic and sedative effects,

but EPS are marked.

ATYPICAL NEUROLEPTIC

Risperidone (Risperdal ® )

Clozapine (Clozaril ® )

Olanzapine (Zyprexa ® )

Quetiapine (Seroquel ® )

GENERAL CHARACTERISTICS OF ATYPICAL

NEUROLEPTICS

Effective antipsychotic agents with greatly reduced

or absent EPS, esp. reduced Parkinsonism and

tardive dyskinesia

All atypical neuroleptics block dopamine and

serotonin receptors; other neurochemical effects

differ

Are effective against positive and negative

symptoms of schizophrenia; and in patients

refractory to typical neuroleptics

PHARMACOLOGY OF CLOZAPINE (CLOZARIL ®) • be effective in treating some patients with psychosis unresponsive

PHARMACOLOGY OF

CLOZAPINE (CLOZARIL ®)

be effective in treating some patients with psychosis unresponsive to standard neuroleptic drug

blocks D4 receptor and have low affinity for D1 and D2 dopamine receptors.

lacks extrapyramidal side effects.

Also effective in bipolar disorder

must monitor the granulocyte counts weekly

• Blockade of alpha-1 adrenergic receptors • Blockade of muscarinic cholinergic receptors • Blockade of

Blockade of alpha-1 adrenergic receptors

Blockade of muscarinic cholinergic receptors

Blockade of histamine-1 receptors

Other adverse effects;

LANJUTAN

Weight gain

Increased salivation

Increased risk of seizures

Risk of agranulocytosis requires continual monitoring

PHARMACOLOGY OF

OLANZAPINE (ZYPREXA ® )

Olanzapine is clozapine without the agranulocytosis.

Same therapeutic effectiveness

Same side effect profile

Olanzapine is clozapine without the agranulocytosis. • Same therapeutic effectiveness • Same side effect profile

PHARMACOLOGY OF QUETIAPINE

(SEROQUEL ®)

Quetiapine is olanzapine without the anticholinergic effects.

Same therapeutic effectiveness

Same side effect profile

PHARMACOLOGY OF

RISPERIDONE

Highly effective against positive and negative

symptoms

Adverse effects:

EPS incidence is dose-related

Alpha-1 receptor blockade

Little or no anticholinergic or antihistamine

effects

Weight gain

is dose-related • Alpha-1 receptor blockade • Little or no anticholinergic or antihistamine effects • Weight

ANTIANXIETY

Generalized anxiety disorder (GAD)

Phobic disorders

Anxiety disorder due to general medical condition

Panic disorder

Obsessive-compulsive disorder (OCD)

Posttraumatic stress disorder (PTSD)

Sleep disorders (dyssomnias; parasomnias)

disorder (OCD) • Posttraumatic stress disorder (PTSD) • Sleep disorders (dyssomnias; parasomnias)

WHAT IS ANXIETY ?

Physical and emotional distress which interfere with normal life.

WHAT IS ANXIETY ? Physical and emotional distress which interfere with normal life.
Stress
Stress
Frighten
Frighten
Restless
Restless
Worry
Worry

Types of anxiety

1. Generalized anxiety disorder

2. Post-traumatic stress disorder (PTSD).

3. Obsessive-compulsive disorder (OCD).

4. Panic disorder

5. Phobia

TREATMENT OF ANXIETY

Psychotherapy (cognitive behavioral therapy).

TREATMENT OF ANXIETY • Psychotherapy (cognitive behavioral therapy). • Anxiolytics

Anxiolytics

TREATMENT OF ANXIETY • Psychotherapy (cognitive behavioral therapy). • Anxiolytics

Classification of anxiolytic drugs:

1.

Benzodiazepines ( BDZ ).

2.

5HT 1A agonists.

3.

5HT reuptake inhibitors.

4.

Antidepressants

5.

beta-adrenergic blockers

6.

MAO inhibitors

ANTIANXIETY AGENTS

Class/Trade Name

Generic Name

Usual Daily Dosage (mg/d)

BZDs

   

Librium, others

Chlordiazepoxide

10-100

Valium, others

Diazepam

2-40

Serax, others

Oxazepam

30-120

Tranxene, others

Chlorazepate

15-60

Ativan

Lorazepam

1-10

Centrax

Prazepam

20-60

Paxipam

Halazepam

60-160

Xanax

Alprazolam

0.75-4

Serotonergic agents

   

Sertraline, others

SSRIs

25-250

Buspar

Buspirone

15-60

Desyrel

Trazodone*

50-100

Noradrenergic agents

   

Inderal

Propranolol*

30-120

Catapres

Clonidine*

0.1-0.5

Classifications of Benzodiazepines

- Short acting: (3-5 hours): triazolam

- Intermediate: (6-24 hours)

Alprazolam

Lorazepam

Oxazepam

Estazolam

Temazepam

Classifications of Benzodiazepines

- Long acting: ( 24-72 hours) Clonazepam

Chlordiazepoxide

Diazepam

Flurazepam

Mechanism of Action

Benzodiazepines act by binding to BZ receptors

in the brain enhance GABA action on brain

chloride influx to the

chloride channels opening

cell hyper- polarization inhibition of brain.

GABA (γ-aminobutyric acid):

is an inhibitory neurotransmitter

5HT 1A agonists Buspirone

acts as agonist at brain 5HT 1A receptors

rapidly absorbed orally.

Slow onset of action (delayed effect)

T½ :

liver dysfunction its clearance.

Drug Interactions with CYT P450 inducers

(2 4 h).

and inhibitors.

Buspirone

Only anxiolytic

No hypnotic effect.

Not muscle relaxant.

Not anticonvulsant.

No potentiation of other CNS depressants.

Minimal psychomotor and cognitive dysfunctions.

Does not affect driving skills.

Minimal risk of dependence.

No withdrawal signs.

Uses of buspirone

As anxiolytic in mild anxiety & generalized anxiety disorders.

Not effective in severe anxiety/panic disorder.

Beta Blockers

Propranolol atenolol

act by blocking peripheral sympathetic system.

Reduce somatic symptoms of anxiety.

Decrease BP & slow HR.

Used in social phobia.

are less effective for other forms of anxiety

Tricyclic Antidepressants

Doxepin- imipramine

act by reducing uptake of 5HT & NA.

Used for anxiety especially associated with depression.

Effective for panic attacks.

Delayed onset of action (weeks).

dry mouth, postural hypotension, sexual

dysfunction, weight gain.

Selective serotonin reuptake inhibitors (SSRIs)

Fluoxetine

acts by blocking uptake of 5HT

Orally

Delayed onset of action (weeks).

Used for panic disorder OCD depression-

Generalized anxiety disorders - phobia. Side Effects:

Weight gain, sexual dysfunction, dry mouth

MONOAMINE OXIDASE INHIBITORS

Phenelzine

Acts by blocking the action of MAO enzymes.

Used for panic attacks and phobia.

Require dietary restriction

Avoid wine, beer, fermented foods as old cheese that

contain tyramine.

Side effects

Dry mouth, constipation, diarrhea, restlessness,

dizziness.

Conclusion of anxiolytics

CLASSES OF ANXIOLYTICS

USES

Benzodiazepines

Generalized anxiety disorders, OCD, phobia, panic attack

SSRIs

Generalized anxiety disorders, OCD, phobia, panic attack

(Fluoxetine)

Tricyclic antidepressants (doxepin, imipramine )

anxiety with depression. panic attacks

5HT1A agonists

Mild anxiety

(Buspirone)

Not effective in panic attack

Beta blockers (propranolol, atenolol)

Phobia (social Phobia)

MAO inhibitors Phenelzine

Panic attack, phobia

Conclusion of anxiolytics

CLASSES OF ANXIOLYTICS

Adverse effects

Benzodiazepines

Ataxia, confusion, dependence,

tolerance, withdrawal symptoms,

SSRIs

(Fluoxetine)

weight gain, sexual dysfunction Dry mouth

Tricyclic antidepressants (doxepin, imipramine )

weight gain, sexual dysfunction, atropine like actions

5HT1A agonists (Buspirone)

Minimal adverse effects

Beta blockers (propranolol, atenolol)

Hypotension

ANTIDEPRESSANT

INDICATIONS

Mood disorders

Major depressive disorder

Single or recurrent

With or without melancholia

Seasonal pattern

Bipolar disorder

Depressed

Mixed

Cyclothymic disorder

Dysthymic disorder

ANTIDEPRESSANTS AGENTS

Class/Generic Name

Trade Name

Usual Daily Dosage (mg/d)

SSRI

   

Citalopram

Celexa

20-40

Escitalopram

Lexapro

1-20

Fluoxetine

Prozac

10-60

Fluvoxamine a

Luvox

100-300

Paroxetine

Paxil

10-50

Sertraline

Zoloft

50-200

SNRI

   

Atomoxetine a

Strattera

60-120

DSNRI

   

Duloxetine

Cymbalta

30-60

Milnacipran b

 

100-200

Venlafaxine

Effexor

75-375

Aminoketone

   

Bupropion

Wellbutrin

150-450

Triazolopyridine

   

Nefazodone

Serzone c

100-600

Trazodone

Desyrel

150-600

SSRI, Selective serotonin reputake inhibitor; SSRI, selective norepinephrine, DSNI, dual norepinphrine reputae inhibitor; TCA, Tricyclic antidepressant; MAOI, monoamine oxidase inhibitor.

a Not approved by the FDA for depression. b Not available in the United States. c Serzone no longer available. d Transdermal system approved for depression.

ANTIDEPRESSANTS AGENTS

Class/Generic Name

Trade Name

Usual Daily Dosage (mg/d)

Tetracyclic

   

Amoxapine

Ascendin

200-600

Maprotiline

Ludiomil

75-225

Mirtazapine

Remeron

15-45

TCA

   

Amitriptyline

Elavil

75-300

Clomipramine

Anafranil

100-250

Desipramine

Norpramine

75-300

Doxepin

Sinequan

75-300

Imipramine

Tofranil

75-300

Nortriptyline

Pamelor

75-300

Protriptyline

Vivactil

20-60

Trimipramine

Surmontil

75-300

MAOI

   

Isocarboxazid

Marplan

40-60

Phenelzine

Nardil

30-90

Tranylcypromine

Parnate

30-60

Selegiline d

Emsam

20mg/20 cm 2 patch

SSRI, Selective serotonin reputake inhibitor; SSRI, selective norepinephrine, DSNI, dual norepinphrine reputae inhibitor; TCA, Tricyclic antidepressant; MAOI, monoamine oxidase inhibitor.

a Not approved by the FDA for depression. b Not available in the United States. c Serzone no longer available. d Transdermal system approved for depression.

TRICYCLIC ANTIDEPRESSANTS (TCAS)

 

/ CH 3

/

H

N

N

 

\ CH 3

\

CH 3

tertiary amine

3 o => 2 o

secondary amine

LANJUTAN

3°Amines: Imipramine, Amitriptyline

2°Amines: Desipramine, Nortriptyline

Selectivity 2 o Amines -- NE > 5-HT 3 o Amines -- 5-HT > NE

Mechanism of Action:

LANJUTAN

- Inhibition of NT reuptake.

- Immediate action = >NE and 5-HT in synapse.

- After chronic treatment (2 - 4 weeks) = >

  NE-R and 5-HT 2 R.

NE release and turnover.

NE-stimulated cAMP in brain.

Sensitization of 5-HT receptors.

* Adaptive Responses *

- Takes up to 4 weeks for all TCA antidepressants to have an effect.

MAO INHIBITORS

Mechanism of action:

Inhibit MAO enzymes (non-selective):

1) Irreversible MAO inhibitors

Phenelzine and isocarboxazid => hydrazides.

2) Reversible MAO Inhibitors.

Tranylcypromine => non-hydrazide, prolonged blockade, but reversible within 4hr.

SSRIS

Mechanism of action:

Specific serotonin uptake inhibitors increase 5-

HT by inhibiting reuptake.

Serotonin Syndrome”:

hyperthermia, muscle rigidity, rapid changes in mental status and vital

signs.

Thus it is important to wait up to 6 weeks after medication is stopped, before starting with another drug.

OTHERS (HETEROCYCLICS)

Mechanism of Action:

1) NT reuptake inhibition.

maprotiline.

2) 5-HT receptor antagonism (for 5-HT 2A or 2C receptors).

nefazodone, mirtazapine, and

3) Alteration of NE Output.

trazodone

bupropion, amoxapine, and trazodone.

OTHERS (HETEROCYCLICS)

Amoxapine. Metabolite of Loxapine (an anti- psychotic) -- retains some antipsychotic activity

and DA receptor antagonism => parkinson's-like

symptoms. May be useful if psychosis is present. NE output.

Maprotiline. A tetracyclic drug, resembles desipramine with less sedative and antimuscarinic

side effects. Evokes seizures at high doses.

Blocks NT reuptake.

OTHERS (HETEROCYCLICS)

Trazodone. Antagonist of 5-HT 2A or 2C receptors. Unpredictable

efficacy. Highly sedative (hypnotic), but minimal antimuscarinic action.

Bupropion. Resembles amphetamine. Blocks DA reuptake (not important in depression). Causes CNS stimulation. Inhibits appetite. Aggravates psychosis. NE output.

OTHERS (HETEROCYCLICS)

Mirtazapine. A derivative of mianserin. Antagonist of 5-HT 2A

or 5-HT

receptors, thus increasing NE and 5-HT release. Very

sedating.

receptors. Also antagonizes -adrenergic

2

2C

Venlafaxine. Short plasma half-live, thus needs to be given

in divided doses. Potent inhibitor of 5-HT uptake and

weaker at NE reuptake (at low concentrations it acts like

an SSRI).

Nefazodone. Antagonist of 5-HT

or 5-HT

receptors.

2A

2C

Moderately sedating. Potent inhibitor of CYP3A4, so

cannot be given with cisapride

OTHERS (HETEROCYCLICS)

2nd Generation heterocyclics

• Amoxapine

Amoxapine

• Maprotiline

Maprotiline

• Trazodone

Trazodone

• Amoxapine • Maprotiline • Trazodone • Bupropion Third Generation heterocyclics •

Bupropion

Third Generation heterocyclics

• Trazodone • Bupropion Third Generation heterocyclics • Mirtazapine • Venlafaxine • Nefazodone
• Mirtazapine
• Mirtazapine

Mirtazapine

Venlafaxine

Nefazodone

Similar to TCAs• Mirtazapine • Venlafaxine • Nefazodone  NE output  2-AR antagonist 5-HT antagonists

NE output NE output

2-AR antagonist 2-AR antagonist

5-HT antagonists SSRI-like
5-HT antagonists SSRI-like SSRI-like

OTHERS (LITHIUM)

Lithium (Li + ) remains the drug of choice for the treatment and prophylaxis of mania.

Acute manic episodes are managed with lithium salts (carbonate or citrate) alone, or in combination with:

1) Antipsychotics (carbamazepine, similar in structure to TCAs but not effective in depression).

2) Valproic acid

3) Calcium-channel blockers (nifendipine, diltiazem,

verapamil).

OTHERS (LITHIUM)

Useful in refractory depression when added to SSRIs or TCAs, but not a good antidepressant alone.

ADVERSE EFFECTS: ANTIDEPRESSANTS

Cardiac
Cardiac

Orthostasis, hypertension, heart block, tachycardia

Urogenital
Urogenital

Erectile dysfunction, ejaculation disorder,

anorgasmia, priapism

Central Nervous System
Central Nervous System
disorder, anorgasmia, priapism Central Nervous System Dizziness, cognitive impairment, sedation, light-headedness,

Dizziness, cognitive impairment, sedation, light-headedness, somnolence, nervousness, insomnia, headache, tremor, changes in satiety and appetite

Gastrointestinal
Gastrointestinal

Nausea, constipation, vomiting, dyspepsia, diarrhea

Autonomic Nervous System
Autonomic Nervous System

Dry mouth, urinary retention, blurred vision, sweating

Adverse Effects: Antidepressants

Drugs

Sedation

Anticholinergics

Orthostatic Hypotension

Cardiac Effects

SSRIs

       

Citalopram

Low

None

None

None

Escitalopram

Low

None

None

None

Fluoxetine

Low

None

None

None

Fluvoxamine

Low

None

None

None

Paroxetine

Low

Low

None

None

Sertraline

Low

None

None

None

SNRIs

       

Atomoxetine*

Low

Low

Low

Low

DSNRIs

       

Duloxetine

Low

Low

Low

Low

Milnacipran

Low

Low

Low

Low

Venlafaxine

Low

Low

Low

Low

Aminoketones

       

Bupropion

Low

Very low

Very low - none

Low

Triazolopyridines

       

Nefazodone

Low

Low

Low

Low

Trazodone

High

Low

Moderate

Low

SSRI, Selective serotonin reputake inhibitor; SSRI, selective norepinephrine, DSNI, dual norepinphrine reputae inhibitor; TCA, Tricyclic antidepressant; MAOI, monoamine oxidase inhibitor. Adapted from Ward M. Appendix B. In: Flaherty J, Davis JM, Janicak PG, eds. Psychiatry: Diagnosis and Therapy. 2 nd ed. Norwalk, Conn: Appleton & Lange, 1995:493- 494. a Amoxapine is the only antidepressant with a clinically meaningful potency for blocking D2 receptors with the potential to cause acute and tardive extrapyramidal effects. * Not FDA approved for depression.

CONT…

Drugs

Sedation

Anticholinergics

Orthostatic Hypotension

Cardiac Effects

Tetracyclics

       

Amoxapine a

Low

Moderate

Low

None

Maprotiline

Moderate

Moderate

Low

Moderate

Mirtazapine

Moderate

Low

Low

Low

TCAs

       

Amitriptyline

High

High

Moderate

High

Clomipramine

High

High

Low

Moderate

Desipramine

Low

Low

Low

Moderate

Doxepin

High

Moderate

Moderate

Moderate

Imipramine

Moderate

Moderate

High

High

Nortriptyline

Moderate

Moderate

Low

Moderate

Protriptyline

Low

Moderate

Low

Moderate

Trimipramine

High

High

Moderate

High

MAOIs

       

Isocarboxazid

Low

None

High

None

Phenelzine

Low

Low

High

None

Tranylcypromine

High

Very low

Very low

None

Selegiline TS

Low

Low

High

High (high doses)

SSRI, Selective serotonin reputake inhibitor; SSRI, selective norepinephrine, DSNI, dual norepinphrine reputae inhibitor; TCA, Tricyclic antidepressant; MAOI, monoamine oxidase inhibitor. Adapted from Ward M. Appendix B. In: Flaherty J, Davis JM, Janicak PG, eds. Psychiatry: Diagnosis and Therapy. 2 nd ed. Norwalk, Conn: Appleton & Lange, 1995:493- 494. a Amoxapine is the only antidepressant with a clinically meaningful potency for blocking D2 receptors with the potential to cause acute and tardive extrapyramidal effects. * Not FDA approved for depression.

ANTIDEPRESSANTS:

DRUG INTERACTIONS

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

MINIMIZING THE RISK OF DRUG

INTERACTIONS ASSOCIATED WITH

ANTIDEPRESSANTS

When adding an antidepressant with a potential for

pharmacokinetic interaction to another drug, clinicians could:

Reduce the dose of the current drug

Begin with a low dose of the antidepressant

Use therapeutic drug monitoring where appropriate

Monitor therapeutic and adverse effects

Choose an antidepressant with a favorable profile for that

interaction

• Hallucinogens or psychedelics are drugs which alter mood, thought and senses

Hallucinogens or psychedelics are drugs

which alter mood, thought and senses

• Hallucinogens or psychedelics are drugs which alter mood, thought and senses
• Hallucinogens or psychedelics are drugs which alter mood, thought and senses
• Halusinogen adalah obat-obatan yang dapat menimbulkan daya khayal (halusinasi) yang kuat, yang menyebabkan satu

Halusinogen adalah obat-obatan yang dapat

menimbulkan daya khayal (halusinasi) yang kuat, yang

menyebabkan satu persepsi tentang lingkungan dan

dirinya sendiri;

•Halusiogen dalam medik didefinisikan sebagai zat yang menimbulkan gejala halusinasi, bekerja terhadap

sistem neurotransmisi serotonin di otak.

•Jenis halusinogen yang umum adalah LSD

LSD

(Lyesergic acid Diethylamide)

Dibuat pertama kali oleh Dr. Albert Hoffman dari Basel Swiss di Laboratorium Kimia Sandoz;

Dipergunakan untuk recreational drug pada tahun 1960 di Eropa dan AS;

Pengguna LSD adalah golongan kelas atas sedangakan marijuana untuk golongan kelas bawah

REAKSI PENGGUNAAN LSD • Mengalami vertigo dan melihat warna-warna yang indah; • ½sampai 1 jam

REAKSI PENGGUNAAN LSD

Mengalami vertigo dan melihat warna-warna yang indah;

½sampai 1 jam pertama akan mengalami flydan mencapai

puncaknya dalam waktu 2 6 jam setelah pemakaian dan menghilang setelah 12 jam

Belum ada bukti yang cukup kuat akan ketergantungan fisik, akan tetapi ketergantungan psikis sangat besar

REAKSI FISIK

REAKSI FISIK • Pupil mengecil; • • Temperatur turun; • • Mual atau muntah; • •Kadar

Pupil mengecil;

Temperatur turun;

Mual atau muntah;

•Kadar gula bertambah;

Detak jantung bertambah cepat.

EFEK PEMAKAIAN JANGKA PANJANG

Tanda-tanda fisiologis:

Dilatasi pupil;

Palpitasi;

Tekanan darah meningkat;

Suhu badan fluktuasi;

Mual, pusing penglihatan kabur;

Kelemahan dan gangguan koordinasi

TANDA-TANDA PSIKOLOGIS

Moody;

Gangguan persepsi;

Gangguan proses berfikir;

Gangguan perilaku;

Euforia;

Keras kepala;

Mudah panik;

Disorientasi waktu dan tempat.

berfikir; • Gangguan perilaku; • Euforia; • Keras kepala; • Mudah panik; • Disorientasi waktu dan