Stimulants
MACP 2113
Disediakan oleh:
Pn. Nirmala Devi Tailan
Pengajar U41
Kolej Pembantu Perubatan, Ulu Kinta
OBJEKTIF
Indication
• Psychotic disorders
Cara bertindak
• Blocks postsynaptic
dopamine receptor in the
brain.
• Depress those parts of the
brain involved with
wakefulness & emesis(the act
of vomiting)
Contoh ubat
• chlorpromazine HCl
(Largactil)
• haloperidol (Haldol)
• fluphenezine decanoate
(Modecate)
• quetiapine fumarate
(Seroquel)
• lithium carbonate (Lithobid)
1. Chlorpromazine
(Largactil 25mg, 100mg)
Category: B
Dose
• Adult:
– Permulaan: 25mg tds PO
– Max: 1g/day
• Peads < 5yr:
– 0.5mg/kg q 4-6 hr
– Max: 40mg/day
• Peads 6-12 yr:
– 1/3 or ½ of adult dose
– Max: 75mg/day
2. Chlorpromazine
(Largactil 25mg/ml in 2 ml inj)
Category: B
Dose
• Adult:
– 25-50mg IM q 6-8 hr
– Max: 1g/day
• Peads < 5yr:
– 0.5mg/kg q 6-8 hr
– Max: 40mg/day
• Peads 6-12 yr:
– 1/3 or ½ of adult dose
– Max: 75mg/day
3. haloperidol
(Serenace 1.5mg, 5mg)
Category: B
Dose
• Adult:
– 1.5-5mg bd-tds PO
– Max: 30mg/day
• Peads 3-12 yr:
– Initial 0.5mg/day PO
– Increase gradually 0.5mg q 5-
7days (divided dose)
– Max: 10mg/day
4. haloperidol
(Serenace 5mg/ml inj)
Category: B
Dose
• Adult:
– 2-10mg IM/ IV q 4-8 hr
– Max: 18mg/day
5. fluphenezine decanoate
(Modecate)
Category: B
Dose
• Adult:
– Initial: 12.5mg/day deep IM
(elderly 6.25mg/day)
– Then increase to 12.5-100mg
after 4-7 days
– May repeat at intervals of 14-
35days
• Peads 6-12 yr:
– Not Recommended
6. quetiapine fumarate
(Seroquel)
Category: A*
Indication
• Schizophrenia
• Psychotic disorders
Dose
• Adult:
– Initial: 25mg bd
– Increase by 25-50mg/day every
1-2 days to a target dose of
300-400mg/day
– Max: 800mg/day
Kesan Sampingan
• Drowsiness
• Sedation
• Hypotension
• Orthostatic hypotension
• Dry mouth
• Photophobia
• Headache
• Tardive dyskinesia
– Irreversible, involuntary
dyskinetik movement (tongue,
face, mouth, jaw & sometimes
extremities)
• Extrapyramidal effects
– Disturbance in extrapyramidal
portion of nervous system
– Causes abnormal muscle
movement
Contraindication
• Allergic to drugs
• Severe CNS depression
• Bone Marrow depression
• Blood dyscrasias
• Parkinson’s disease
• Liver damage
• CAD
• Severe hypotension
• Pregnancy & Lactation
Cautious
• Respiratory disorders
• Glaucoma
• Prostatic hypertrophy
• Epilepsy
• Peptic ulcer
• Impaired renal function
Interaction
• Alcohol
– Additive CNS depression
• Anticholinergics
– Reduce effects of
antipsychotics
7. lithium carbonate
(Lithobid)
Category: A
Dose
• Adult:
– 600mg PO tid or 900mg PO bid
(slow release)
– Long term: 300mg PO tid-qid
Kesan Sampingan
• Drowsiness
• Confusion
• Muscle weakness
• Blurred vision
• GI upset
• Fatigue
• Goitre
• Seizure
Contraindication
• Allergic to drugs
• Renal/ CV disease
• Patient on diuretics
• Pregnancy
• Lactation
Cautious
• Elderly
• Electrolyte imbalance
• Impaired renal function
• CAD
Interaction
• Other antipsychotics,
thiazide or loop diuretics
– Lithium clearence reduced &
causes litjium toxicity
• Antacids
– Reduce effects of lithium
Soalan
1. Berikan definisi Neuroleptics?
2. Terangkan cara tindakan
Neuroleptics?
3. Senaraikan ubat Neuroleptics?
4. Nyatakan kesan sampingan
serta kontraindikasi ubat
Neuroleptics?
CNS Stimulants
CNS Stimulants
Category: A
Dose
• Adult:
– Postanesthetic use: single inj
0.5 – 1mg/kg IV
– Do not exceed 1.5mg/kg
• Peads:
– Do not give children < 12 yrs
Kesan Sampingan
• Hyperactivity
• Headache
• Disorientation
• Tachycardia
• Hypertension
• Palpitation
Contraindication
• Allergic to drugs
• Newborn
• Epilepsy
• Head injury
• Stroke
• Pregnancy
• Lactation
Interaction
• MAOIs
– Hypertensive crisis
Amphetamines
• Ubat yang merangsang
sistem saraf pusat.
• Mempunyai potensi
ketagihan.
Cara Tindakan
• Meningkatkan pembebasan
norepinephrine dalam CNS.
• Menyebabkan peningkatan
tekanan darah, ‘wakefulness’
& ‘alertness’.
Indication
• Attention Deficit
Hyperactivity Disorders
(ADHD) difficulties
of inattention or hyperactivity and impulsiveness or a
combination of the two
Contoh ubat
• Methylphenidate HCl
(Ritalin)
1. Methylphenidate HCl
(Ritalin)
Category: A*
Dose
• Adult & Peads > 6 yr:
– 20mg once daily OM
– Increase to max dose:
60mg/day
Kesan Sampingan
• Insomnia
• Nervousness
• Tachycardia
• Anorexia
• Excitement
• Arrhythmias
• Blood dyscrasias
Contraindication
• Allergic to drugs
• Newborn
• Cardiac
arrhythmias
• Hyperthyroidism
Cautious
• Epilepsy
• Psychotic patient
• Hypertension
• Child < 6 yr
• Pregnancy
• Lactation
Interaction
• MAOIs
– Hypertensive crisis
– Intracranial hemorrhage
• TCAs
– Decrease the effects of
amphetamines
Anorexiants
• Short-term treatment of
exogenous obesity
• Only available by
prescription
Contoh ubat
Dose
• Adult:
– 5-15mg q PO (once daily)
• Peads:
– Do not give children < 12 yrs
Kesan Sampingan
• Excitement
• Insomnia
• Nervousness
• Tachycardia
• Headache
• Anorexia
Contraindication
• Allergic to drugs
• Newborn
• Epilepsy
• Head injury
• Stroke
• Pregnancy
Cautious
• Lactation
Interaction
• MAOIs
– Hypertensive crisis
– Intracranial hemorrhage
• TCAs
– Decrease the effects of
amphetamines
Soalan