anti depresion

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ANALEPTIC (CNS STIMULANT AND

ANTI DEPRESSION

Alias bin MahmudKolej Pembantu Perubatan

Ulu Kinta



DEFINISI

ANALEPTIC

RESTORATIVE OR STIMULATING

A Medical used as a central Nervous Sys temStimulant

STIMULANT

Drugs that prom ote the act iv i ty of the bodysys tem or fun ct ion. CNS Stimu lant – increase

act iv i ty of the brain and spinal cord, produc ing

feel ings of alertness



BASIC PHAMARCOLOGY

Devided 3 major groups:

1. Psychomotor stimulants

•

create feelings of excitement• diminish feeling of tiredness and fatigue• increase motor activiti• ex: nicotine, caffeine, cocaine,

amphetamine, ect.

2. Convulsants and Respiratory stimulants

• Stimulate respiration after and overdoseof CNS Depressants (Barbiturate abuse)

• Ex: Doxapram and Nikethamide



BASIC PHAMARCOLOGI

3. Psycotomimetic stimulants

• Known as ‘ Hallucinogens’

• ex: 1. Tetrahydocannabinol (THC)

found in marijuana – produces feelingof euphoria, sleepiness, delusion,

increased appetite, etc

2. Lysergic acid diethylamide (LSD)

Induce hallicunations

3. Phencyclidine (PCP)Inhibits re-uptake of Neurotransmittersviolant, cramps, slurred speech, etc



CNS STIMULANTS



1. Amphetamines

Methamphetamin,

dexedrine,

ephedrine

Street names:

Black beauties,

crosses, hearts etc



1. Amphetamines

Mode of action

• Acts by releasing nor adrenaline stored in

nerve endings both the CNS and the periphery

• Become euphoric, confident, initiative, speedy

perfomance, anxiaty, nervous, tremours and

confusions (large doses)

• Symptomemetic effect on the heart:palpitations

• Increase peripheral oxygen, vasoconstriction,

restlesness



1. Amphetamines

Uses

• Narcolepsy : delays onset of REM sleep

•

Hyperactive children (ADHD)• Against fatigue

• Appetite supression-anorexigenic effect

Interaction• Severe HPT with MAOI’s and Beta-adrenocepotor

blocking drugs



1. Amphetamines

Side effects/Adverse reactions

• Restlessness, diziness, insomnia, generalised

overstimulation• Aggresion, confusion, delusion and hallusination

• Weigh loss, libido, impotence

• Palpitation, tachycardia, HPT

• Dry mouth, diarrhoea/constipation

• photophobia

• Ejaculatory failure



1. Amphetamines

Contraindication

• History of drugs abuse

• angle closure glaucoma• Cardiovascular disease: Hpt, Angina pectoris

• Diabetes Mellitus



1. Amphetamines

Dosage and route of Adminstration

1. Dextroamphetamine (dexedine, dexedrine, spansule)

•

Obesity : Adult – up to 30 mg/d immediate acting5 – 10 mg : 30-60 b4 meal

• ADHD : Children 3-5 yrs: 2.5 mg qid after meal6 – puberty : 5 mg bd/qid

• Narcolepsy: Adult – 5-6mg/d in divided dose

* SPANSULE : one-daily in morning



OTHER CNS STIMULANTS

AGENT CLINICAL USES DOSAGE

Caffeine

Caffeine

Citrate

Caffeine Sod.Benzoate

Psymotor Stimulant

Resp. stimulation inNewborn

Respiratorystimulant

Adult: 100-200 mg

Nasogastric 10mg/kg

Maintenance dose2.5 mg/kg/d

IM/IV Adult:500 mg

Doxapram Drug-inducedRespiratorydepression

Adult: 2mg/kg rpt 5”



ANTIDEPRESSANTS



ANTIDEPRESSANTS

Typical symptoms of Depression

• Apathy

• Sadness

• insomnia

• Hopelessness

• Guilt

• Fatigue

• Thoughts of death

•

Decrease lobido



ANTIDEPRESSANTS

1. TRYCYCLIC ANTI DEPRESSANTS

(prototype: IMIPRAMINE)

• INHABIT REUPTAKE OF

NEUROTRANSMITTER INTO NERVE

ENDING

• CAUSE SEDATION AFTER

ADMINSTRATION

• IMPROVE APPETITE



ANTIDEPRESSANTS



ANTIDEPRESSANTS

INDICATION

• Treat Depression

• PSYCHOTIC DISORDER (schizophrenia,

manic-depression illness)

• Organic mental syndrome

• Anxiety with alcoholism

• Preventive therapy for depression



ANTIDEPRESSANTS

Side Effects/Adverse Reactions

• CNS – Sedation, confusion, delirium

• Eye - Blurred vision, photophobia

• CVS - Hypotension, Arrythmias, Tachycardia

Palpitation

• G/I - Dry mouth, constipation

• Sweat Gland – Decrease sweating

• Genitourinary - Retention of urine, hesitancy



ANTIDEPRESSANTS

2. MONOAMINE OXIDASE INHABITORS

• Second major class of anti

depressions

• Available agents are:

• Isocarboxazid(MARPLAN)

• Phenelzine (NARDIL)

• Tranylcypromine(PARNATE)



ANTIDEPRESSANTS

Normal Nerve

MAO effects in

CNS

MAO effects in

Peripheral nerve



ANTIDEPRESSANTS

AGENT CLINICAL USES DOSAGE

Marplan

(Isocarboxazid)

Nardil(Phenelzine)

Parnate

(Tranylcypromine)

Depression -Refactory to

Tricyclic anti depression

And ECT Therapy

Refractory depression:neurotic(dysthymia)

Major Refractory

depression

Adult: Start with 30

mg/d in single doses

or divided doses.

Adult: Start with

15mg mg tds

Adult: start with 10

mg bd for 2 weeks

CLINICAL USES AND ADMINISTRATION



ANTIDEPRESSANTS

SIDE EFFECT CONTRA INDICATION

1. CNS HYPOMANIA

2. Eye Blurred vision

3. CVS

Hypotension

4. G/I Dry mouth,

Constipation

Schizophrenia

Hypotension

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