Biological Therapies
description
Transcript of Biological Therapies
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Biological Therapies
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SSRIs
FluoxetineFluvoxamineParoxetineCitalopramSertralineescitalopram
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SSRIs
Share no molecular featuresHalf life:20 hours&3daysHepatic metabolismSpecific activity in the inhibition of serotonin
reuptakeNo activity on other receptorsOccurring 90% of clinical response at the
starting dose
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SSRIsTherapeutic Indications
DepressionAnxiety dis.Eating dis.PMSPremature
ejaculation
ParaphiliasADHDAutistic dis.chronic pain
syndromes.Psychosomatic
conditions
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SSRIs Adverse Effects
Sexual dysfunctionGI effectsHeadacheCNS effectsAntichoinergic effectsHematologic effectsElectrolyte and glucose disturbancesEndocrine and allergic reactions
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Serotonin syndrome
HyperthermiashiveringDiarrheaAgitationHyperreflexia
MyoclonusSeizuresRigidityDeliriumcoma
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SSRI withdrawal
DizzinessWeaknessNauseaHeadacheRebound depressionAnxietyInsomniaPoor concentration
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SSRIs
Drug-drug interactions
Dosage and administration
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TCAs
Tertiary amines:
Imipramine
Amitriptyline
Trimipramine
Doxepine
Clomipramine
Secondary amines:
Desipramine
Nortriptyline
ProtriptylineTetracyclic drugs:
Maprotiline
Amoxapine
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TCAs:
Half life :10-70h(longer HL in Nortriptyline,Maprotiline)
Hepatic metabolismBlocking of reuptake of serotonin and NEAntagonism of muscarinic,H1,alfa1,2Type A antiarrhytmic effects40-fold difference in plasma concentrations in
different persons
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TCAsTherapeutic Indications
MDDPanic disorder with AgoraphobiaGADOCDEating dis.Pain dis.Sleep dis.
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TCAsAdverse Effects
Psychiatric effectsAnticholinergic effectsSedationAutonomic effectsCardiac effectsNeurological effectsAllergic and hematological effectsWeight gain
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TCAsDrug – Drug Interactions
AntihypertensivesAntipsychoticsCNS depressantsSympathomimeticsOCPsSSRIsLithiumPrimidonAscorbic Acid
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MAOIs
PhenelzineIsocarboxazidTranylcypromineSelegiline
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MAOIsTherapeutic Indications
Panic disorder with agoraphobiaSocial phobiaPTSDAtypical depressionEating dis.Pain dis.
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MAOIsAdverse Reactions
Or HTNInsomniaWeight gainEdemaSexual dysfunctionHypertensive crisisparesthesia.,myoclonus,muscle pain
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Tyramine-Rich Foods
CheeseFishSausagePatesMortadellabanana
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drugs to be avoided
AntiasthmaticsAntihypertensivesBuspironeLevodopaOpioidsSympathomimeticsSSRIsClomipramine
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Mood Stabilizers
LithiumSodium ValproateCarbamazepineLamotrigineTopiramateGabapentinCalcium Channel Inhibitors
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lithium
No binding to plasma proteinsNo metabolismSlow crossing BBBHalf- life : 20 hoursDecreasing of renal clearance in renal
insufficiency and puerperium / increasing during pregnancy
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Lithiumtherapeutic indications
Bipolar mood disorderSchizophrenia/schizoaffective disordersMDDAggressionPMSBulimiaBinge drinkingBPDOCDPTSDTrichotilomania
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Lithiummaintenance treatment
After the second episode of BMD1 After the first episode in :
1. Adolescents
2. High suicide risk
3. Poor support systems
4. No percipitating factors
5. Sudden onset
6. First episode of mania
7. FH of BMD1
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LITHIUMAdverse effects
Gastrointestinal effectsNeurological effectsRenal effectsCardiac effectsThyroid effectsDermatological effects
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Lithium toxicityCoarse tremorDysarthriaAtaxiaGI symptomsCardiovascular changesRenal dysfunctionFasciculationsMyoclonusSeizurescoma
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LITHIUMDrug interactions
DAsAnticonvulsantsThiazidsPotassium sparing
diureticsNSAIDsACEIsCalcium channel
inhibitors
Osmotic diureticsLoop diureticsXantinsCarbonic anhydrase
inhibitors
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LithiumClinical Guidelines
Initial medical work upDosageSerum concentrationsDiscontinuationPatient education
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Sodium valproate
Effects on GABA neurotransmitter system.Therapeutically effective at serum
concentrations above 50 -100 microgr/mlHalf-life : 8-17 hoursMaintaining effective plasma concentrations
with dosing 1 to 4 times a day
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Sodium ValproateTherapeutic Indications
Bipolar 1Disorder (acute – prophylaxis )Schizoaffective DisorderBehavioral dyscontrol syndromesDementiaOrganic brain diseasesTBIOther mental disorders
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Sodium Valproate Adverse Reactions
GI effectsSedationAtaxiaDysarthriaTremorWeight gainHair loss
Elevation of liver transaminases
ThrombocytopeniaPlatelet dysfunctionHyponatremiaHepatotoxicityPancratitisPCO
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Sodium ValproateDrug interactions
Lithium CarbamazepinAntidepressantsSDAsDAsPhenytoinPhenobarbitalBZDs
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Sodium ValproateAdministration
R/O liver and pancreatic diseaseDose on the first day : 250 mgplasma concentrations : 50-100 mg/mlDaily dose : 1200-1500mgMood-stabilizing effects appear between 5-15
days after initiation
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Carbamazepine
Steady-state levels in 2-4 days on a steady dosage
Half-life : 12-17 h after 1 month of administration
Metabolized in liverdecreasing synoptic transmission Reduction of currents through NMDA
channelsAntagonism of adenosine A1 receptors
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Carbamazepine Therapeutic Indications
Bipolar disorder (manic-depressive episodes)Schizophrenia and schizoaffective disorderImpulse-control dis.PTSDAlcohol and BZD withdrawal
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CarbamazepineAdverse Reactions
Blood DyscrasiasHepatitisExfoliative dermatitisGI EffectsCNS EffectsCardiac EffectsHyponatremia
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CarbamazepineDrug Interactions
SSRIsAnti psychoticsCimetidineErythromycinIsoniazideKetoconazoleVerapamilallopurinol
OCPTCAsNa-valproateBupropionMAOIsClomipraminePrimidonePhenytoin
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CarbamazepineTreatment
CBC,LFT,ECG,Serum ElectrolytesInitiate with 200mg to 600-1200mgAnticonvulsant Blood Concentration : 4-
12microgr/mlLaboratory
Monitoring :CBC ,Billirubin,LFT,CBZ Level
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CarbamazepineTreatment Discontinuation
WBC<3000/mm3Erythrocyte Count < 4000000/mm3PMN<1500/mm3HCT <32%HB<11gr/100mlReticulocyte Count<0.3 %Serum Iron Concentration,150mg/100ml