Neuroleptics & CNS

Stimulants
MACP 2113

Disediakan oleh:
Pn. Nirmala Devi Tailan
Pengajar U41
Kolej Pembantu Perubatan, Ulu Kinta
 OBJEKTIF

1. Memberi definisi ubatan

‘Neuroleptics’ dan ‘CNS
Stimulants’.
2. Menyatakan tujuan/ indikasi ubat.
3. Menyatakan dos dan contoh ubat.
4. Menyatakan kaedah pemberian
ubat.
5. Menyatakan tindakan ubat.
6. Menerangkan kesan sampingan
dan kontraindikasi ubat.
7. Memberikan nasihat spesifik
dalam pengambilan ubat.
 Neuroleptics
(Antipsychotics)
 Psychotic Disorder

• Extreme personality disorder &

loss of contact with reality.
– Hallucinations (false perception
having no basis in reality)
– Delusions (false beliefs that
cannot be changed with reason).
 Neuroleptics
• Adalah ubat yang digunakan
untuk merawat masalah
psychotic dan schizophrenia.

Indication
• Psychotic disorders
 Cara bertindak

• Blocks postsynaptic
dopamine receptor in the
brain.
• Depress those parts of the
brain involved with
wakefulness & emesis(the act
of vomiting)
 Contoh ubat
• chlorpromazine HCl
(Largactil)
• haloperidol (Haldol)
• fluphenezine decanoate
(Modecate)
• quetiapine fumarate
(Seroquel)
• lithium carbonate (Lithobid)
 1. Chlorpromazine
(Largactil 25mg, 100mg)
Category: B

Dose
• Adult:
– Permulaan: 25mg tds PO
– Max: 1g/day
• Peads < 5yr:
– 0.5mg/kg q 4-6 hr
– Max: 40mg/day
• Peads 6-12 yr:
– 1/3 or ½ of adult dose
– Max: 75mg/day
 2. Chlorpromazine
(Largactil 25mg/ml in 2 ml inj)
Category: B

Dose
• Adult:
– 25-50mg IM q 6-8 hr
– Max: 1g/day
• Peads < 5yr:
– 0.5mg/kg q 6-8 hr
– Max: 40mg/day
• Peads 6-12 yr:
– 1/3 or ½ of adult dose
– Max: 75mg/day
 3. haloperidol
(Serenace 1.5mg, 5mg)
Category: B

Dose
• Adult:
– 1.5-5mg bd-tds PO
– Max: 30mg/day
• Peads 3-12 yr:
– Initial 0.5mg/day PO
– Increase gradually 0.5mg q 5-
7days (divided dose)
– Max: 10mg/day
 4. haloperidol
(Serenace 5mg/ml inj)
Category: B

Dose
• Adult:
– 2-10mg IM/ IV q 4-8 hr
– Max: 18mg/day
5. fluphenezine decanoate
(Modecate)

Category: B
 Dose
• Adult:
– Initial: 12.5mg/day deep IM
(elderly 6.25mg/day)
– Then increase to 12.5-100mg
after 4-7 days
– May repeat at intervals of 14-
35days
• Peads 6-12 yr:
– Not Recommended
6. quetiapine fumarate
(Seroquel)
Category: A*

Indication
• Schizophrenia
• Psychotic disorders
 Dose
• Adult:
– Initial: 25mg bd
– Increase by 25-50mg/day every
1-2 days to a target dose of
300-400mg/day
– Max: 800mg/day
 Kesan Sampingan
• Drowsiness
• Sedation
• Hypotension
• Orthostatic hypotension
• Dry mouth
• Photophobia
• Headache
• Tardive dyskinesia
– Irreversible, involuntary
dyskinetik movement (tongue,
face, mouth, jaw & sometimes
extremities)
• Extrapyramidal effects
– Disturbance in extrapyramidal
portion of nervous system
– Causes abnormal muscle
movement
 Contraindication
• Allergic to drugs
• Severe CNS depression
• Bone Marrow depression
• Blood dyscrasias
• Parkinson’s disease
• Liver damage
• CAD
• Severe hypotension
• Pregnancy & Lactation
 Cautious
• Respiratory disorders
• Glaucoma
• Prostatic hypertrophy
• Epilepsy
• Peptic ulcer
• Impaired renal function
 Interaction

• Alcohol
– Additive CNS depression
• Anticholinergics
– Reduce effects of
antipsychotics
 7. lithium carbonate
(Lithobid)
Category: A

Dose
• Adult:
– 600mg PO tid or 900mg PO bid
(slow release)
– Long term: 300mg PO tid-qid
Kesan Sampingan
• Drowsiness
• Confusion
• Muscle weakness
• Blurred vision
• GI upset
• Fatigue
• Goitre
• Seizure
 Contraindication

• Allergic to drugs
• Renal/ CV disease
• Patient on diuretics
• Pregnancy
• Lactation
 Cautious
• Elderly
• Electrolyte imbalance
• Impaired renal function
• CAD
 Interaction

• Other antipsychotics,
thiazide or loop diuretics
– Lithium clearence reduced &
causes litjium toxicity
• Antacids
– Reduce effects of lithium
 Soalan
1. Berikan definisi Neuroleptics?
2. Terangkan cara tindakan
Neuroleptics?
3. Senaraikan ubat Neuroleptics?
4. Nyatakan kesan sampingan
serta kontraindikasi ubat
Neuroleptics?
CNS Stimulants
 CNS Stimulants

• Adalah ubat yang digunakan

untuk meningkatkan aktiviti
sistem saraf pusat.
• Tiga jenis CNS Stimulants:
–Analeptics
–Amphetamines
–Anorexiants
 Analeptics

• Ubat yang merangsang

pusat respiratori pada CNS.
 Cara Tindakan
• Ubat ini merangsang reseptor
yang terletak pada ‘Carotid
artery’ dan ‘upper aorta’.
• Rangsangan reseptor tersebut
akan meningkatkan kadar
pernafasan.
 Indication

• Treat drug induced

respiratory depression
• Post-anesthestic
respiratory depression
 Contoh ubat

• doxapram HCl (Dopram)

1. doxapram HCl
(Dopram)

Category: A
 Dose
• Adult:
– Postanesthetic use: single inj
0.5 – 1mg/kg IV
– Do not exceed 1.5mg/kg
• Peads:
– Do not give children < 12 yrs
Kesan Sampingan

• Hyperactivity
• Headache
• Disorientation
• Tachycardia
• Hypertension
• Palpitation
Contraindication
• Allergic to drugs
• Newborn
• Epilepsy
• Head injury
• Stroke
• Pregnancy
• Lactation
 Interaction

• MAOIs
– Hypertensive crisis
 Amphetamines
• Ubat yang merangsang
sistem saraf pusat.
• Mempunyai potensi
ketagihan.
 Cara Tindakan

• Meningkatkan pembebasan
norepinephrine dalam CNS.
• Menyebabkan peningkatan
tekanan darah, ‘wakefulness’
& ‘alertness’.
 Indication

• Attention Deficit
Hyperactivity Disorders
(ADHD) difficulties
of inattention or hyperactivity and impulsiveness or a
combination of the two
 Contoh ubat

• Methylphenidate HCl
(Ritalin)
 1. Methylphenidate HCl
(Ritalin)
Category: A*

Dose
• Adult & Peads > 6 yr:
– 20mg once daily OM
– Increase to max dose:
60mg/day
Kesan Sampingan
• Insomnia
• Nervousness
• Tachycardia
• Anorexia
• Excitement
• Arrhythmias
• Blood dyscrasias
Contraindication

• Allergic to drugs
• Newborn
• Cardiac
arrhythmias
• Hyperthyroidism
 Cautious
• Epilepsy
• Psychotic patient
• Hypertension
• Child < 6 yr
• Pregnancy
• Lactation
 Interaction

• MAOIs
– Hypertensive crisis
– Intracranial hemorrhage
• TCAs
– Decrease the effects of
amphetamines
 Anorexiants

• Ubat yang digunakan untuk

mengurangkan selera makan.
 Cara Tindakan

• Suppress appetite by acting

on appetite center in the
hypothalamus
 Indication

• Short-term treatment of
exogenous obesity
• Only available by
prescription
 Contoh ubat

• Sibutramine HCl (Meridia)

 1. Sibutramine HCl
(Meridia)
Category: A*

Dose
• Adult:
– 5-15mg q PO (once daily)
• Peads:
– Do not give children < 12 yrs
Kesan Sampingan

• Excitement
• Insomnia
• Nervousness
• Tachycardia
• Headache
• Anorexia
Contraindication
• Allergic to drugs
• Newborn
• Epilepsy
• Head injury
• Stroke
• Pregnancy
 Cautious
• Lactation
 Interaction

• MAOIs
– Hypertensive crisis
– Intracranial hemorrhage
• TCAs
– Decrease the effects of
amphetamines
 Soalan

1. Berikan definisi CNS Stimulants?

2. Nyatakan 3 jenis CNS Stimulants
dan terangkan cara tindakannya?
3. Senaraikan ubat CNS
Stimulants?
4. Nyatakan kesan sampingan serta
kontraindikasi CNS Stimulants?