1

M.A. R.N DAHAN SAGIT

-

:
- , ( , )
( ,SSRI, SNRI, NRI,)
- ()
()
( , , , ,)
.

ANTIPSYCHOTICS DRUGS
: - .

Basal
Ganglia

Frontal
cortex

Nucleus
accumbens

hypothalamus

Substantia
nigra

Tegmentum

Stahl S M, Essential
)Psychopharmacology (2000

Nigro-Striatal - Extrapyramidal Movements (EPS) .1

Mesolimbic (VTA-amygdala) - Positive Symptoms .2

.3

Mesocortical (VTA-frontal lobe) - Negative Symptoms

.4

Tubero-Infundibular - Inhibits PRL, Thermoregulation

( , , ).

10-7

20

Acute psychotic episodes in schizophrenia and schizoaffective

disorder
Maintenance treatment in schizophrenia and schizoaffective

disorders
Bipolar- Mania /Depression with psychotic symptoms

Delusional disorder
Borderline personality disorder
Substance-induced psychotic disorder
Delirium and dementia
Mental disorders due to a medical condition
Childhood schizophrenia
Pervasive developmental disorder
Tourette's syndrome
Huntington's disease

, , , ,
, -
: , , , ,
, , ,.
, , .
.)1PHENOTHIAZINES :

,Photosensitivity , ,

Taroctyl, Largactil

Chlorpromazine

' ,
, .

Thorazine

, ,
' , .
.

Stelazine

"

Melleril

Thiorodazine

"

Perphenan

Perphenazine

Sedizin, Terfluzine

Trifluoperazine

LONG ACTING

, , .

"

Modecate, Fludicate

Fluphenazine

.)2BUTYROPHENONES :

, , ,
' , , .
.

Halidol

Haloperidol

LONG ACTING

Halidol

Pericate

Haloperidol Decanoas

Halidol

Semap

Penfluridol

.)3THIOXANTINES :

Clopixol

Zuchlopenthixol

Fluanxol

Fluanxol

,Orthostatic Hypotention .. ,
) ,( E.P.S
.

INTERMIDIAN ACTING

Clopixol Aqufase

Zuchlopenthizol Aqufase

LONG ACTING

()MG
50-500

Clopixol Depote

Zuchlope Depot

: , , , , ,
, , ,

A - TYPICAL ANTIPSYCHOTIC
: .
-
.
.)1Benzisoxazoles :

) ,(QT ,,

Geodon

Ziprasidone HCl

,Orthostatic Hypotension ,

,E.P.S , , , ,

Risperidal

Risperidone

-
)

)(,

Orthostatic

,Hypotension , , , ,
,Photosensitivity ,
' - , , ,,
, . -
, , ,-
.
.

(.
Invega

Side effects: EPS, headache, dizziness, tachycardia

. orthostatic hypotension, dyspepsia, nausea
Uncommon: NMS, elevation in prolactin, Diabetes

Paliperidone

active metabolite of
Risperidone- D2 and

5HT2a antagonist

.Mellitus, weight gain, prolonged QT interval

.)2DIBENZOTHIAZEPINES :

, , ,Hypersalivacia ,

Leponex

Clozapine

," , ,
..,. - ) ,
( . .

LEPONEX -
, . : .
.16 . : ,
WBC , 3500 - .
,. , , , .
. , , ....
18 , .
. , ...
4 3 . ; <NEU <1..500 ;WBC
3..000:PLT <100..000 :
) :( . )( )(
. .
,ACE .
, , , , E.P.S ,

Zyprexa

, Orthostatic Hypotension , , ,

p.o, s.l, i.m

Olanzapine

, , , , ,
. :,
) (
. .
, , ,Orthostatic Hypotension ,

Seroquel

Quetiapine

, .
,Orthostatic Hypotension , )

Serdolect

,(QT RBC &WBC , , .

Sertindole

: , , ,,
. .

.)3SULPIRIDES :

, , EPS
.

Solian

Amisulpiride

*Aripiprazole (Abilify)- D2 partial agonist, D2 and 5HT2a antagonist Indications:

Schizophrenia (acute & chronicstage), Bipolar Disorder Side effects: EPS
(especially akathisia),dyslipidemia, ,constipation, nausea, vomiting, insomnia,
orthostatic hypotension, dizziness.Uncommon: NMS, convulsion, diabetes mellitus

NON-ATIPIC DIBENZOTHIAZEPINES
WITH MILD ANTIPSYCOTIC TREATMENT
CLOTIAPINE ETUMINE
: D . ,
. .
.
. ,
, . .
.

- , , ..
. .. ,
.

Etumine

Clotiapine

.
, ,
,

) - (potency .

) .(.
Low potency .
High potency .

)(

)Affinity( - .

,
.
,
.

11

.1

ACUTE DYSTONIA

: ,
, , .
) ,(Oculogyric Crisis

.:.

: ,
, . .
.
: , , . 10%-.
.
. .
.

PARKINSONIC SYNDROM .2
: : )( , ,
, , ,
, : ,
, ' . ,
. 5-90 . 15%-.
: 40 .

.:.

, ,
. . ,
.
.

AKATISIA .3
.
: ,
. :
.1

- .
. ,
.
, . ,
.

.3

Akatisia -

.2

11

.:.

.4

,
. .

.5

, ,
.
) B( .
.

TARDIVE DYSKINESIA .4
: ) 6-
( . ' .
, ,
. , .
. , ,
. : , , 50 .
.:.

,
: , ,
, .
" ,
, .

N.M.S .1
NEUROLEPTIC MALIGNANT SYNDROM
0.02%-2.4% -
Halidol . C.P.K.
. C.P.K. , C.P.K. -
- .
. . .20% -
: : , , , ,Tachipnea , ,
.
. , , .
, , 40 ,
. ,C.P.K. - ,
,Bilirubin-
, .

12

.:.

, :

Dantrolene .Parlodel
,
, .
.
, ,
. .
. .

.2 :
. .. :. ,
, .
. , .. :. ) ,
( .
.
.
. .. :. : , .
.
, 500 -" .
. . , .
. :. , .
. .
.
.
.3 .. .,
.
, , .
.4 -Hypersalivacia LEPONEX. :.
, .
.5 ( -)Photosensitivity
. , .. :.
,
.

.6 - , .

13

.7 . :. ,
,-.
.8 . :. ,
.
.9 " , .
, ) ( . .

.10 .
: ) ,(Galacturia .
Dysmenorea : ,
Amenorea . .
. :. .
, .
) .(Impotention . .
)(.

.1 , .
. , ,
.
.2 )( .
. , .

14

- : - . -
.
:
.1 .
.2 .

ANTICHOLINERGIC DRUGS .)1

, , , ,
, , .

.

Kemadrin

Procyclidine

"

Artane

Trihexyphenidyl

partane
"

Dekinet

Biperiden

, , .
\ \

. : , , .
, ,.
: , , , ,
, , , .
.:.

. . , ,
. .Neostigmine
.

15

DOPAMINE AGONISTS )2

Symmetrel

Amantadine

AMANTADINE .
: , , , , , , ,,
,

BETA BLOCKERS
: Beta
. ,
.Akathisia

.. ,. ,

Deralin

Propranolol

.Rebound
"

Normiten

Athenolol

BETA BLOCKERS
Rebound , ,
, .. :.
, , . .
H1 BLOCKERS
PHENERGAN

PROTHEASINE

.
. H1 .
. ,
.Hypersalivacia , ,
. ,
.

, : , , , .
, .

16

3 : , , )
( . .

)5HT1A(-

5-HT

)1(+

N.E.
-

)5HT1D(-

)2(-
)2(-

reuptake

reuptake

5-HT1A

5-HT4,5,6

5-HT2A,C

PK -
cAMP, Ad. Cyc., Ca+2

* Brain-drived
Neurotropic Factor

)5HT1A(-

5-HT

-

()

)1(+

N.E.

Downreg.

)5HT1D(-

)2(-
)2(-

Upreg.

Upreg.

5-HT4,5,6

5-HT1A
5-HT2A,C
() Upreg.

) (
Upreg.

PK

)1 (
Downreg.

:
*
-
*

17

TRYCICLE\TETRACYCLIC ANTIDEPRESSANTS
:
. , 3 - . ,
") . "( . Major -
,O.C.D ,Depression , .
. . :
) ( , , ,
, .

Cardiac

Orthostatic

Anti

Hypotension

Cholinergic

Sedative
Tricyclic

effects.
++++

++++

++++

++++

75-200

Eletrol, Elatrolet

Amitriptyline

+++

+++

++

30-100

,Nortyline

Notriptyline

+++

++

+++

75-200

Anafranil

Clomipramine

++++

++++

++

+++

75-200

Tofranil, Primonil

Imipramine

++

++

++

75-200

Deprexane

Desipramine

+++

++

++++

++++

30-200

Gilex

Doxepin

++

++

+++

+++

50-150

Oprimil, Insidon

Opipramol

++

50-150

Ludiomil, Melodil

Maprotiline

Remeron

Mirtazapine

Tetracyclic

NASSA

)+( : )++( , )+++( ,)++++( , .

NASSA-Noradrenergic and Specific Serotonergic Antidepressant

-Remeron : , , , , ,,
, , , , )(
, , , , ,
) ( , -
,- Q-10 .

. : , , , ...

18

SELECTIVE SEROTONIN REAPTAKE INHIBITOR

S. S. R. I.
: . -
.: , , ,
- , ,ADHD , .

++++

+++

++

+++

++

Prozak, Prisma

Fluoxetine

++

++

++

+++

Favoxil

Fluvoxamine

+++

++

++

++

+++

Seroxat

Paroxetine

++

+++

++

++

Cipramil, cipralex

Citalopram

Escitalopram

++

Lustral

Sertraline

)+( : )++( , )+++( ,)++++( , ..

.1 - ,
, , , , , , , - .
. :. , , .
.
.2 - ,
,.
.3 , . :. .
, .
.
.4- .
,
- , .
. , , , . .

19

Serotonin syndrome
. : ,
MAO . : , , ,
, , , , . : ,
. : .

S. N. R. I. - SEROTONIN AND NOREPINEPHRINE REAPTAKE INHIBITOR

:
. .
: .

, , , ,,
, , , .

75-150

Effexor

Venlafaxaine

30-60

Cymbalta

Duloxetine

25-50

Ixel

Milnacipran

Effexor .
.

N. R. I - Norepinephrine Reaptake Inhibitor .

) Reboxetine - (Edronax : . : , , ,
, , , , .
NDRI - Norepinephrine Dopamine Reuptake Inhibitors
) - Bupropion (zyban, wellbutrin - .
. : , .ADHD
, , , ) ( , ,-
, , , , , .
: , ) ( , .MAO
SARI - Serotonin Antagonist and Reuptake Inhibitors
)Indications: Major depressive disorder, insomnia, -Trazodone (Desyrel, Trazodil
anxiety disorders
Side effects: constipation, dry mouth, nausea, sedation
vomiting, headache, tremor, hypotension, syncope,
bradycardia, dizziness, fatigue
Uncommon: seizures, hypomania, priapism

21

MAO-I
: , .
: - . . , , , , .
- Aurorix , . : .

14

Nardil,

Phenelzine

Phenelzine

Parnate

Tranylcypromine

Marpalan

Isocarboxid

Deprenyl

Selegiline

Aurorix

Moclobemide

GROUP

MAO
INHIBITOR

RIMA

: ) ,( , , , . , , /
, , / / , , , , ,
, , , , )( , ,
) ( . : , , ,.
- Tyramin Induce Hypertensive Crisis , , , ,
, , .
)Mianserin (Bonserin
Indications: Major depressive disorder, insomnia, anxiety disorders
: , ,somnolence , , . :
, .

.1 - - SSRI .
'.
.2 MAO .
.2 . , ,
, . -
.
, - .
,
.

21

LICARBIUM, LITHIUM
Lithium , .
. .
. .t=24hr . 5-7 . ,
: , .
, , - - .
.0.6-1.2 mml/l 0.6 - ,
1.2 .Lithium Bipolar Affective
Disorder ,Mix Episode .
.
. ""
7-10 .
: ,ECG' , ,' ,' .
600-1800 :" . 5 . :
, Tartrazine - , , .

.1 : , , , ,
,.
.2 : , , , . -
, .
.3 : .
.4 - : .. . , , ,
.
.5 : , , ,
.
.6' ,- ,,
.
.7 " ".
.8 .
ADH .
.9 .
.10

22

: , , , , ,Polyuria , ,
, , , .
, , , .

Polyuria - .
. .
, , ,
. .

, , , ,
, .
, .

, , .. ,
.
.
, ,
. .
, ) (.
, . : 4
.ECT NSAID - . ACE .
' . 2.5 .

.
: .
.GABA - , ,Glutamate
- . :
.
,PTSD ,
. .
.

23

(microgram/
)liter
, , ,
, .
, ,,
.

50-100

, ,

4-12

Valproic Acid
(Depalept,
)Depakin
,

Carbamazepine

GIT " ,

(Trigeminal

(Tegretol, Teril,

neuralgia).

,
,,

)Timonil

and

bipolar 1 disorder

- Stevens- :

Lamotrigine

,Johnson

)(Lamictal

,
)( ,. :,
,, ,,
,, .
. : ,
,.
, , ,,
, , ,
.

Topiramate
)(Topamax

Gabapentin .GABA
: , , , ,
, .
,somnolence : , , ,.

24

.1 , , , , ,
, . :. .
.2 , , . :. .
, .
. .
, . .
.3 . :. ) ,
(.
.4 ) ( ..:.
.
.5 . :. .
.
.6 ) ( . :. ,
.
.
.7 . :.
. .
.
. .
.8 . :.
. 3.
.9 - , .
.10 : , .
.11 : , ,
. : , , , .
) (.
.12 :
) ( . . :
.
, , , , , .
.

.MAO

. .
.12 : . E.P.S
. .
.13 .
.14 .

25

)Buspirone (Sorbon
.
: , , . .
.

BENZODIAZEPINES
:
.1
.2
.3
.4 \
.5 : \ .

, , ,
, ,
.

Valium, Assival

Diazepam

)
( ,

.

"

Clonex

Clonazepam

"

Librium, Servium

Clordiazepoxide

"

Vaben

Oxazepam

"

Ativan, Lorivan

Lorazepam

26

"

Xanax

Alprzolam

"

Halcion, Bondormin

Triazalam

"

Hypnodorrn

Flunitrazepam

"

Numbon

Nitrazepam

BENZODIAZEPINES

"

Nocturno

Zopiclon

"

Stilnox

Zolpidem

,
, , .
. , ,GABA
, , , ,- ,
. . , :
, , . ,
- . .
) -( -
,
.

.1 :- , , , , , ,
, , .. :.
. . .
.Normapressan, clonidine
.2- .
' , ,
) (.

27

.1
.
.2 , ,
.
.3 , ,
.
.4 ,E.C.T -
.
.5 -
.
.6 '.
.7 .
.8 .
.9 ,
.
.10 , , , , ,
.

28

o 1.

Karch, A., M. (2007). Lippincott's Nursing Drug Guide.

Lippincott, New-York.