ANTI-PSYCHOTICS.docx - LECTURE 6 DRUGS USED IN PSYCHOSIS Psychoses These are severe psychiatric illness with serious distortion of thought behavior


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LECTURE 6 DRUGS USED IN PSYCHOSIS Psychoses: These are severe psychiatric illness with serious distortion of thought, behavior, capacity to recognize reality and of perception. Patient is unable to meet ordinary demands of life ANTI-PSYCHOTIC DRUGS CLASSIFICATION 1) Phenothiazenes Aliphatic side chain: Chlorpromazine, Influpromazine Piperidine side chain: Thioridazine Piperazine side chain: Trifluoperazine, Fluphenazire 2) Butyrophenones : Haloperidol , Trifluperidol , perifluridol 3) Thioxanthenes : Flupenthixol 4) Other heterocyclics : Loxapine 5) Atypical Antipsychotics: Risperidone, Olanzapine , Ziprasidone Pharmacological Actions Pharmacology of Chlorpromazine (CPZ) is described as the prototype others as they only differs from it. a. Central Nervous System In a psychotic, CPZ reduces irrational behavior, agitation , aggressiveness, Disturbed thought is normalized gradually, anxiety is relieved. Hyperactivity, hallucinations, delusions are suppressed. All phenothiezine, thioxanthenes, butyrophenones have similar anti-psychotic efficacy but potency differs in equipotent dose. Mechanism Of Action All anti-psychotics (except Clozapinine-like atypical) have potent dopamine D 2 receptor blocking action Also block D1, D3,D4 receptor, bud there is correlation with anti-psychotic potency. Blockade of dopaminerigic projections to the temporal and prefrontal areas constituting the limbic system and in mesocortical areas is responsible for antipsychotic action b. Autonomic Nervous System :-Neuroleptics have varying degrees of alpha adrenergic blocking activity may be. Anti-cholinergic properties are weak. c. Cardiovascular System:- Produce postural hypotension, high dose of CPZ directly depress the heart of and produce ECG changers (Q-T prolongation and suppression of T- wave) d. Local Anaesthetic:- CPZ is a potent local anesthetic. However not used for this action because of its irritation action.
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e. Endocrine:- Neuroleptics consistently increase prolactin release by blocking the inhibitory action of Dopamine on pituitary lactotropes. This may result into galactorrhoea, and gynaecomastia. Decrease in ADH may result in increase urine volume.
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