84.2015 Psychotropic Drugs Il. Pharmacotherapy of Bipolar Disorder, Depression, Sleep Disorders, Anxiety Tar nia eng ge Bipolar Disorder Dipolar Disorder Bipolar Disorder "may peas, denon Forel pcsea aes pes skates. ‘ter se upton Tate month leymptomsof ating) 3) Mops morethans year Peep en Bch hn Treatment - Mood Stabilizers a es |-Mood Stabilizers Lithium — Therapy and Adverse Effects ewe pnd! 3 Npibrgepenscat mol Fepaeis'o9-sslararpiensce stm ane) i incon eden ‘Vii anges Lithium — Adverse Effects + Pluto (9 -e pe ner enpat ‘olen cent asst sme pea Yipee pL mnt fritter Seles Cater pone eo eee {plots ren, seven) Nelcompone = memes eer eprachn sin die (Gea AE“ 8 charges -epraten ase (Clem sao) Dermalpie-piss sree Lithium overdose and toxicity + Mild intoxication (-x.5mmol/D bantu es + Severe intoxication (up to 25 mmol/l): nea i ee eee a thal intoxication (over 2-smmol/): great ‘Soa gn esl see dh ‘Tip hema84,2015, F see ii | Lithium - Interactions 4 Nac-indlet-1 cece Na reabsorption Li psa SAD retest ten posandnes-owr etn) Fame fren 5) {xD apemiom clnmepon dency) 1 Phencberbal| ‘Arinpy, Thephyin, Vapi, Deas (ley tomer) + RGeowneficof mace ear anes 7 (aes used in BP Samar 1 ge tenets deem tn dll ne RT ~Giher agents used in BP at =, es a earn pecan ae emo pic Antinchaics- chm hoe) Affectivity Disorders + Major Depressive Disorder + Depressive Syndrom + Bipolar Disorder + Seasonal affectwedlsorder + Reactive depression Depression + Dente and Symp: Fras net eps eet ‘ieee pane tar cer pcan | Depression (Differential Diagnosis) 1 Autolmmane diondes (cen ces) 1 Hosea Viator bees + Chron Fatigue Spareme Enderne sen Usd aisha 5 Gaertn hme smi «Negeri ruin tla «+ Nasional dees - Be aid tian, omg Sines ays + Skopdnrdes I-Dépressive Symptoms Substance-Induced + Digital, Propranalo,methyops ‘Tretinoin + tterrons + yeomtics * Ranitidine © corcasterods + Oral Contraceptives, Anabolic steroids +820, anupsyhetes‘Antidepressants |.Generation a SSE iors scene atbetaine ati NEES seranon ERR eareraaceiresen. 84.2015 Adverse Effects of TCA, TetCA + CVS orthostatichypotension srytmia, catdiotonicty * Antiholinergc~ sedation, urine retention, obstipation, + Antihistamine activites + Adrenoyticeficts + Proconvulive effects + Sema dysfunction «Skin reactions Newer Antidepressants + Mile monensin ins) “napopae ot hfs. ng tm omni agit ‘SR pn ah dns pressants ‘Mechanisms of action of _enewest * Sele rittts + RISSi merce + Mirtazapine LSulatidutnn ay ives spate gMTsendg Ty, Tore + Tianeptine Mods -nt Sly ended 1 Atonmpansctasuen ised dein 1 Stngeteronsonasecompnet “sp CIT Lehtonen hearer |The newest... ‘Agomelatin (Valdoxan) +s octeigene ntti + eencmmmnee nee nineteen man beige eh stain af estore inanimate cacntncain porea ~ inhibitor of monoamine reuptake Hypericum perforatum ‘+ mild NA, Dopamine, Seroconin reuptake ‘ahibitor «affects GABA a L-gatamate transmission * Antidepressanc substance hyperforin ‘© NU: photosensitivity, GIT, vertigo ‘inducer CYP3A4 8.4.2015 + eine apse elgepnin sen aineton a eter ees ae Pan Therapy 1 Dc AE SSL ba oenthan TCA ‘Other agents used for augmentation > Lithium (4-08 mm) > Vapi acd (Carbamazepine, Lamotrigine) 7 Apia Ansipjchotis (Risperidone, Olnzspie.) > BED only inact pase ~ ifs dependence ater ¢wecke SS Severe serotonin toxicity ane oe ORe ao eee + faiumiesse iets + ofr maroon Serotonin Syndrome - Diagnosi + Seembach (got) developed dagnosticeritera for serotoningyndrome:‘Serotonin Syndrome Treatment + Fntline-semtonerg pete oot iicsniess WED krempe pod name Peete yeaati ay! 1 Gopher HTamag)-4 8 mg. (mos mpg) 1 Chbpamsine + Suppose cae: calneo 1 rechnieavemaitan Srecomdangagen| Sreiypenense apne 8.4,2015 Ss Anxiety Disorders hee iereen 1 Seeman Seattle nxiety Disorders epic endematoa 7 oot ips 1 Some ono Hire Ste FAnxiolytic Drugs neler a Dilerences Durten cto posts aint teen eee eaboliom CYP om, lceroniacon = DTT ean ptm ene st nrc dere 1 som Seep duntsces 2 Sfeecoreestiaaeleyte ily Drugs Pere bees Benzodiazepines Benzodiazepines erryjolytic Drugs Buspirone * poles te pean + Sanna ere La ron (Ci renal/bepacc suction substrate CYP3A4 0.206, Iypeterson crs, SII pr-eomulsve eect 8.4.2015 — Anxiolytic Drugs eee aetna * niece «set nt Sen RtaR oS SNS a Eg Other drugs used in pharmacotherapy of AD ae che elaine, tone, miaapne “TOA amie Inprimin clomipain SE rs ed eee eee oe 1 emai sig >> Sleep disorders cae ee cece Insomnia - Pharmacotherapy HyNonics Mechanism of ction: benzodiazepine GABA. complex ie oeninoteteteestrenrensteatentenearen) 1. Generation Bansediaepines 1 inten 2H NO I, Generation selective benzodiazepine epoca Ting crite ye ra i 3aSnesrInsomnia- Pharmacotherapy Properties of am ideal hypnotic drug: 1) Nochangesin slep physiology 2) Nocumulation 2) Notolerance 41) Nodependence 5) Novesdual sedation (6) No cognitive function impairment 1) Nointeractions 84.2015, Insomnia- Pharmacotherapy 2alpide mate pd Shesargerte iors Insomnia- Pharmacotherapy + Zaeplon + Rapdonaet and shor dso ofaton + frat eopertsforlingarlepcies Sacral ifn mater hati 1 Monin * eto rectors MT, MTs Thich probaly cones hs popertennsuppotingsey “feitionotGrcnipee eenanerseit oe gem Herbs as Hypnotics Bs + Melasaot Walerana of ag + Humalae lupus + Crataegus manogyea + Passos incarnate Hypericum psfortumt Conclusion ~~ Principles of Treatment 1) Precise diagnose~ cause 2) Secondary insomnia ~ frst prim, disease twcatment 3) Low dose 4) Nolonger than 4 weeks regulary / 4.6 nights month seat 5) Interactions 6) Informed patent imitations, dependence Thank you for your attention