Psychotropic drugs/PGS (VPL)

This article is intended for postgraduate studies in General Practice Medicine The article is part of the prepared certification questions,a list of which can be found on the portal of General Practitioner Medicine .

Drugs Affecting

• Vigilance :
  • + Nootropics, Cognitive .
  • Psychostimulants .
  • - Hypnotic.
• Affectivity:
  • + Antidepressants .
  • Anxiolytics .
  • - Dysphoria .
  • - Thymoprophylaxis .
• Thinking :
  • + Antipsychotics .
  • - Hallucinogens .

Nootropics

Indications: AS cerebri, st.p. TIA , senior vice president stroke , central nervous system damage due to intoxication or injury ...

• Piracetam (Oikamid, Geratam,...) 1.6-4.8 g/day .
• Vinpocentine (Cavinton,...) 5-10 mg 3 times a day .
• Gingo - from the double-lobed ginko.

Cognitive

Indications: m. Alzheimer , indicated by a neurologist or a psychiatrist.

• Donezepil, Rivastigmine.

Hypnotics

• Benzodiazepine - easily addictive.
  • Midazolam (Dormicum).
• "From" hypnotics .
  • Zopiclone (Zopitin).
  • Zolpidem (Stilnox, Hypnogen...).
  • Zaleplon (Sonata).

• Melatonin (Circadin).

Antidepressants

Acute therapy 6-8 weeks, continued 4-9 months, maintenance .

Cave " activation sy ." = a sudden increase in the patient's energy due to a rapid increase in the activity of the serotoninergic system, risk of suicide! – frequent checks at the beginning of treatment.

In patients with associated anxiety, start therapy with half doses .

In anxiety disorders, the effect of antidepressants begins later (in 2-4 weeks).

I. generation

Monoamine reuptake inhibitors.

Tricyclic antidepressants: Imipramine, Amitriptyline, Dosulepin ;

• today rather indicated for the treatment of chronic pain,
• do not stop suddenly
• increase the concn. serotonin and noradrenaline, but also affect other receptors (M, H, alpha).

II. generation

It disappeared, the pharmacy was classified elsewhere.

III. generation

• Medicines that increase the concentration of only one monoamine.

SSRI

• 1st choice for depression and anxiety disorders,
• there is no need to titrate the dose (except for anxiety),
• n.u.: serotonin syndrome , withdrawal syndrome (most pronounced with Paroxetine, least with Fluoxetine).
• Fluoxetine (Deprex), Citalopram (Citalec), Escitalopram (Cipralex), Paroxetine (Remood), Sertraline (Asentra, Zoloft), Trazodone (Tritico).

NARI, DARI

• they are not registered in the Czech Republic.

IV. generation

• Drugs that increase the concentration of 2 of the 3 monoamines.

SNRI

• do not have antihistamine and adrenolytic effects,
• have fewer drug interactions than III. generation.

Cave sy. from suspension

• Venlafaxine (Agrofan).
• Duloxetine (Cymbala) is also very effective in diabetic neuropathy.
• Bupropion (Wellbutrin) indicated for tobacco dependence.

Others - Mirtazapine , Tianeptine (Coaxil).

Anxiolytics

The first choice for the treatment of anxiety disorders are SSRIs and SNRIs , but they have a longer onset of action, the target dose is reached gradually.

Benzodiazepines

Acute, rapid onset of effect, calms the agitated, suppresses physical symptoms of anxiety, bridging treatment, dop. administration period max. 4 weeks.

• Contraindications: in alcoholics!
• Alprazolam (Neurol), Bromazepam(Lexaurin), Diazepam (Apaurin), Clonazepam (Rivotril).

Other psychotropic drugs do not belong to the competence of the general practitioner.

Links

Sources

• SUCHOPÁR, Josef and Štěpánka VALENTOVÁ, et al. Remedia compendium. 4th edition. Prague: Panax, 2009. 1000 pp.  ISBN 978-80-902806-4-9 .