sedatives & hypnotics jan 2010

7/22/2019 Sedatives & Hypnotics Jan 2010

1/98

HYPNOTICS, SEDATIVES,TRANQUILIZERS &

ANTI-DEPRESSANTS

MACP 2113


2/98

OBJEKTIF1. Memberi definisi ubatan hypnotics,sedatives, tranquilizers dan antidepressants.

2. Menyatakan tujuan/ indikasi ubat.

3. Menyatakan dos dan contoh ubat.


3/98

4. Menyatakan kaedah pemberian ubat.

5. Menyatakan tindakan ubat.

6. Menerangkan kesan sampingan dankontraindikasi ubat.

7. Memberikan nasihat spesifik dalampengambilan ubat.


4/98

Sedatives &Hypnotics


5/98

adalah ubat yang menghasilkankesan tenang dan relaksasi.

Ia juga menyebabkan kesanmengantuk drowsiness.

Sedatives

adalah ubat memberi kesan tidur(induce sleep).

Hypnotic


6/98

Membantu meningkatkantindakan GABA (Gamma-

aminobutyric acid).

GABA adalah

neurotransmitter penghalangyang menghalang

penghantaran impuls.

Cara bertindak


7/98

Maka pemberian sedatives &

hypnotics akan membantuGABA bagi menghalang


Bila penghantaran impuls

terhalang, tindakan CNS akan

berkurang. Ini akan memberikan kesan

tenang & mengantuk.


8/98


9/98

Insomnia

Preoperative sedation

Indication


10/98

Chloral Hydrate(Aquachloral)

Midazolam (Dormicum)

Contoh ubat


11/98

1. Chloral Hydrate(Aquachloral 200mg/5ml)

Category: B


12/98

Dose

Adult:0.5-1g/day hs (with plenty of

water)

Max: 2g/day


13/98

Peads up to 1 yr:5 ml/day PO (well diluted with

water)

Peads > 1 yr:

30-50mg/kg/day PO (with

plenty of water)

Max: 1g/day


14/98

2. Midazolam HCl(Dormicum 7.5mg tab)

Category: A


15/98

Dose

Usual:

7.5-15mg hs PO

Premedication:

15mg PO (30-60 min sebelum

prosidur)


16/98

Elderly/ impaired liver or

kidney function:

7.5mg hs PO7.5mg PO (30-60 min sebelum

prosidur)


17/98

3. Midazolam HCl(Dormicum 5mg/5ml inj)

Category: A


18/98

Dose

Premedication:

70-100mcg/kg IM (30-60 minbefore surgery)

Usual:

7.5-15mg hs PO


19/98

Induction by slow IVinfusion:

Adult: 200-300mcg/kg/day

Elderly: 100-200 mcg/kg/day

Peads > 7 yr: 150-200

mcg/kg/day

Max: 350mcg/kg/day


20/98

Confusion (keliru)

CNS depression Hallucination

Dizziness

Abnormal thinking

Gastric irritation

Kesan Sampingan


21/98

Hypoventilation

Respiratory depression

Nausea, vomiting, diarrhea

Hypotension

Bradycardia

Edema Liver damage


22/98

Allergic to barbiturates

Liver failure

Severe respiratory distress

Ketagihan (sedative &

hypnotic) Pregnancy

Lactation

Contraindication


23/98

Liver/ kidney disease

History of drug abuse

Mental illness

Cautious


24/98

Alcohol, Antidepressants,

Narcotic analgesics, Anti-histamines or

Phenothiazines.

Meningkatkan kesansedatives & hypnotics.

Interactions


25/98

Soalan

1. Beri definisi Sedatives &

Hypnotics?

2. Terangkan cara tindakan

Sedatives & Hypnotics?

3. Senaraikan ubat Sedative &

Hypnotics?

4. Nyatakan kesan sampingan &

kontraindikasi ubat sedative &

hypnotics?


26/98

Tranquilizers

(Anti-anxiety)


27/98

Anxietyadalah perasaan

bimbang tanpa sebab dan rasatidak selesa.

Tranquilizer atau Anti-anxiety

adalah ubat untuk merawat

anxiety.

Terdapat 2 jenis tranquilizer:Barbiturates

Benzodizepines


28/98

Membantu meningkatkan

tindakan GABA (Gamma-

aminobutyric acid).

GABA adalah neurotransmitterpenghalang yang menghalang


Cara Tindakan


29/98

Maka pemberian Tranquilizers

akan membantu GABA bagimenghalang penghantaran

impuls.

Bila penghantaran impuls

terhalang, tindakan CNS akan

berkurang.

Ini akan memberikan kesan

tenang.


30/98


31/98

Ada ubat yang bertindak ke

atas reseptor dopamine &

serotonin pada otak.

Ada juga ubat yang bertindak

ke atas hypotalamus & brain

stem.


32/98

Anxiety disorder Sedatives (insomnia)

Muscle relaxants

Indication


33/98

Chlorpromazine (Largatil)

Haloperidol (Serenace/ Haldol)

Diazepam (Valium)

Lorazepam (Ativan) Alprazolam (Xanax)

Contoh ubat


34/98

1. Chlorpromazine

(Largactil 25mg, 100mg)Category: B

Adult:Permulaan: 25mg tds PO

Max: 1g/day

Dose


35/98

Peads < 5yr:0.5mg/kg q 4-6 hr

Max: 40mg/day

Peads 6-12 yr:

1/3 or of adult dose

Max: 75mg/day


36/98

2. Chlorpromazine

(Largactil 25mg/ml in 2 ml inj)Category: B

Adult:25-50mg IM q 6-8 hr

Max: 1g/day

Dose


37/98

Peads < 5yr:0.5mg/kg q 6-8 hr

Max: 40mg/day

Peads 6-12 yr:

1/3 or of adult dose

Max: 75mg/day


38/98

3. haloperidol

(Serenace 1.5mg, 5mg)

Adult:1.5-5mg bd-tds PO

Max: 30mg/day

Dose

Category: B


39/98

Peads 3-12 yr:

Initial 0.5mg/day PO

Increase gradually 0.5mg q 5-

7days (divided dose)

Max: 10mg/day


40/98

4. haloperidol

(Serenace 5mg/ml inj)

Adult:2-10mg IM/ IV q 4-8 hr

Max: 18mg/day

Dose

Category: B


41/98

5. Diazepam

(Valium 2mg tab)

Category: B


42/98

Adult:

2 mg tds PO

Severe anxiety: 15-30 mg/day

(divided dose)

Dose

Peads (night terrors):1-5mg hs PO


43/98

6. Diazepam

(Valium 10mg/2ml inj)Category: B

Adult:

2-10mg by slow IV (not morethan 5mg/min)

Repeat if necessary q 3-4 hr

Dose


44/98

7. Lorazepam

(Ativan 1mg tab)

Category: A


45/98

Adult:

Severe anxiety: 1-4mg/day PO

Increase up to 10mg/day(divided dose)

Insomnia: 1-2 mg hs PO

Dose

Peads:

Not recommended


46/98

8. Alprazolam (Xanax

0.25mg, 0.5mg, 1mg)

Adult: Initial: 0.25-0.5mg tid PO

Max: 3mg/day

Category: A

Dose


47/98

Drowsiness

Sedation

Depression

Confusion

Dry mouth Constipation

Kesan Sampingan


48/98

Orthostatic hypotension Hypotension

Cardiac arrest

CV collapse

Bone Marrow depression


49/98

Allergic to drugs

Pregnancy

Lactation Severe depression

Bone Marrow depression

Parkinsons disease

Liver damage

Contraindication


50/98

Elderly Impaired liver & kidney

function

Cautious


51/98

Alcohol, Tricyclic

antidepressants, Narcotic

analgesics, Anti-pyschotics.

Meningkatkan kesan

sedatives & hypnotics Dangerous (serious

respiratory depression)

Interactions


52/98

Soalan

1. Beri definisi Tranquilizers?

2. Terangkan cara tindakanTranquilizers?

3. Senaraikan ubat Tranquilizers?

4. Nyatakan kesan sampingan dankontraindikasi ubat Tranquilizers?


53/98

Anti-

Depressants


54/98

Depressionis one of the most

common psychatric disorders.

Characterized by feeling ofintense sadness,

worthlessness & impaired

functioning.


55/98

Terjadi kerana penghantaranimpuls berkurang & pesakit

menjadi murung dan tidak

aktif. Anti-depressantsadalah ubat

yang digunakan bagi merawat

depression.


56/98

Terdapat 3 jenisAntidepressant yang utama:

Tricyclic Anti-depressants

(TCAs)Monoamine oxidase inhibitors

(MAOIs)

Selective Serotonin ReuptakeInhibitors


57/98

Tricyclic Anti-depressants

Bertindak dengan menghalang

pengambilan semula

norepinephrine & serotonin di

presinaptik neuron.

Dengan ini lebih banyakneurotransmitters akan berada

di ruang sinaps.


58/98


59/98

Maka penghantaran impulse

akan meningkat.

Ini akan menyebabkan CNS

terangsang dan pesakit akan

menjadi cergas.


60/98

Amitriptyline HCl (Elavil) Chlorpramine HCl (Anafranil)

Imipramine HCl (Tofranil)

Contoh ubat


61/98

1. Amitriptyline HCl(Laroxyl)

Category: B


62/98

Peads < 16 yr:

Not recommended

Adult:

Initial: 50-70mg/day (divided

dose) or single dose hs PO

Increase gradually 150-

200mg/day

Maintenance: 50-100mg/day

Elderly: 25-50mg/day

Dose


63/98

2. Chlorpramine HCl

(Anafranil)

Category: A


64/98

Adult: Initial: 10mg/day PO

Increase gradually 30-

150mg/day (divided dose orsingle hs)

Maintenance: 30-50mg/day

Elderly: 75mg/day (divided doseor single hs)

Max: 250mg/day

Dose


65/98

3. Imipramine HCl(Tofranil)

Category: B


66/98

Adult:

75mg/day PO (divided dose)

Increase gradually to 150-

200mg/day Elderly :

10mg/day

Increase gradually to 30-50mg/day

Peads:Not recommended

Dose


67/98

Confusion

Anxiety

Orthostatic hypotension

Visual disturbance

Photosensitivity Nasal congestion

Nausea & vomiting

Kesan Sampingan


68/98

Allergic to tricyclics

MAOIs therapy Recent MI

Pregnancy

Lactation

Contraindication


69/98

Hepatic/ renal impairment

Heart disease

Increased IOP

Prostatic hypertrophy History of seizure (sawan)

Cautious


70/98

MAOIs

Hypertensive episode,severe convulsion

MAIOs must be discontinued

at least 2 weeks beforetreatment with TCAs

Interactions


71/98

Monoamine oxidaseinhibitors (MAOIs)

Bertindak dengan

memusnahkan enzim

monoamine oxidase.


72/98

Enzim monoamine oxidase

boleh memusnahkanneurotransmitters &

menghalang penghantaran

impuls.

Bila enzim tersebut

dimusnahkan,neurotransmitters akan

terselamat.


73/98


74/98

Dengan ini lebih banyak

neurotransmitters akan berada

di ruang sinaps.

Maka penghantaran impulseakan meningkat.

Ini akan menyebabkan CNS

terangsang dan pesakit akanmenjadi cergas.


75/98

Phenelzine (Nardil) Tranylcypromine

(Parnate)

Contoh ubat


76/98

1. Phenelzine (Nardil)

Category: A

Adult:

Initial: 15mg PO tid

Increase to 60mg/day (at leastfor 4 weeks)


Dose


77/98

2. Tranylcypromine (Parnate)

Adult:

30mg/day PO (divided dose)

Maximum 60mg/day

Peads:Not for children < 16 yrs

Category: A

Dose

K S i


78/98

Kesan Sampingan

Orthostatic hypotension Hypertensive crisisdue to

tyramine product(Strokes & Death

was reported)

Overactivity

Headache Anxiety

Nausea & constipation


79/98

Allergic to MAOIs

Hepatic/ Renal disease Cerebrovascular disease

Hypertension

CV disease

Lactation

Contraindication


80/98

Impaired liver function

History of seizure Parkinsonism

Diabetes

Hyperthyroidism

Cautious


81/98

Food containing tyramine &adrenergic drugs.

Hypertensive crisis

Opiates

Serious adverse reactions

(hypertension, coma, death) Thiazide diuretics

Exaggerated hypotension

Interactions


82/98

Selective Serotonin

Reuptake Inhibitors

Bertindak dengan menghalang

pengambilan semula serotonindi presinaptik neuron.

Dengan ini lebih banyak

neurotransmitters akan berada

di ruang sinaps.


83/98

Maka penghantaran impulse

akan meningkat.

Ini akan menyebabkan CNSterangsang dan pesakit akan

menjadi cergas.


84/98


85/98

Fluvoxamine (Luvox)

Fluoxetine HCl (Prozac)

Sertraline HCl (Zoloft)

Contoh ubat


86/98

1. Fluvoxamine 50mg/100mg tab (Luvox)

Category: B

D


87/98

Peads:

Not recommended

Adult:

Initial: 50-100mg/day PO (In

evening)

Increase gradually to 300mg/dayif necessary (over 150mg give in

divided dose)

Maintenance: 100mg/day

Dose


88/98

2. Fluoxetine HCl 20mgcap (Prozac)

Category: A

D


89/98

Peads:

Not recommended

Adult: Initial: 20mg/day PO (increase

after 3 weeks if necessary)

Usual dose: 20-60mg/d (Elderly20-40mg/d)

Max: 80mg/day (Elderly 60mg/d)

Dose


90/98

3. Sertraline HCl (Zoloft)

Category: B


91/98


Adult:

50mg/day PO

Max: 200mg/day Increase dose at 1 week intervals

Dose

Kesan Sampingan


92/98

Kesan Sampingan

Headache

Nervousness

Dizziness

Seizure

Insomnia

Anxiety

Tremor


93/98

Tremor

GI disturbances

Dry mouth

Hepatotoxicity

Blurred vision


94/98

Allergic to SSRIs

Pregnancy

MAOI therapy

Contraindication


95/98

Diabetes

Impaired liver & kidney

function

Lactation

Cautious

I t ti


96/98

MAOIs

Fatal reactions

TCAs Increase toxic effects

Cimetidine

Increase serum sertralinelevels

Interactions


97/98

Cigarettes (Caffeine)

Decrease effects of SSRIs

Lithium

Increased lithium levels


98/98

Soalan

1. Beri definisi Antidepressants?

2. Berikan jenis dan cara tindakan

Antidepressants?3. Senaraikan ubat Antidepressants?

4. Nyatakan kesan sampingan dan

kontraindikasi ubatAntidepressants?

sedatives & hypnotics jan 2010

Documents