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ANALEPTIC (CNS STIMULANT AND
ANTI DEPRESSION
Alias bin MahmudKolej Pembantu Perubatan
Ulu Kinta
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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
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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
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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
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CNS STIMULANTS
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1. Amphetamines
Methamphetamin,
dexedrine,
ephedrine
Street names:
Black beauties,
crosses, hearts etc
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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
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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
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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
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1. Amphetamines
Contraindication
• History of drugs abuse
• angle closure glaucoma• Cardiovascular disease: Hpt, Angina pectoris
• Diabetes Mellitus
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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
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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”
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ANTIDEPRESSANTS
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ANTIDEPRESSANTS
Typical symptoms of Depression
• Apathy
• Sadness
• insomnia
• Hopelessness
• Guilt
• Fatigue
• Thoughts of death
•
Decrease lobido
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ANTIDEPRESSANTS
1. TRYCYCLIC ANTI DEPRESSANTS
(prototype: IMIPRAMINE)
• INHABIT REUPTAKE OF
NEUROTRANSMITTER INTO NERVE
ENDING
• CAUSE SEDATION AFTER
ADMINSTRATION
• IMPROVE APPETITE
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ANTIDEPRESSANTS
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ANTIDEPRESSANTS
INDICATION
• Treat Depression
• PSYCHOTIC DISORDER (schizophrenia,
manic-depression illness)
• Organic mental syndrome
• Anxiety with alcoholism
• Preventive therapy for depression
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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
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ANTIDEPRESSANTS
2. MONOAMINE OXIDASE INHABITORS
• Second major class of anti
depressions
• Available agents are:
• Isocarboxazid(MARPLAN)
• Phenelzine (NARDIL)
• Tranylcypromine(PARNATE)
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ANTIDEPRESSANTS
Normal Nerve
MAO effects in
CNS
MAO effects in
Peripheral nerve
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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
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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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