Sedatives antipsychotics

Chlorpromazine is the best known representative of the aliphatic phenothiazines. Although it is considered to be a low potency agent it is still frequently used. It is one of the most sedative antipsychotic agents and is therefore very effective in the treatment of agitated and violent patients. Extrapyramidal effects are seen with a rather low incidence. However it displays marked anticholinergic activity. There have been reports of hepatotoxicity, also in patients with previously normal hepatic function, due to chlorpromazine. Alimemazine and triflupro-mazine are other representatives from this group. 

Figure 1.4 Percentage of drugs that have been prescribed in the United States for 2003-2005 as a fraction of the top 200 most prescribed drugs. Note that the total of the top 200 most prescribed was 2.1 bilhon, 2.8 biUion, and 2.3 billion for 2003, 2004 and 2005, respectively. AC = Antihypertension/cardiovascular medication, SH = sedatives/antipsychotics, AI = analgesics/anti-inflammatory, AM = antimicrobial, GI = gastrointestinal, AD = antidiabetic, DE = diuretics/electrol3ftes, TH = thyroid drugs. Re = respiratory, CR = contraceptives/ reproductive therapy, BP = biophosphonates and other anti-bone loss, St = steroids. He = hematology, Nu = nutritional, Tr = triptan, AP = antineoplast, AN = anesthetic, and DI = dopaminergics and immunomodulators.

Fish, B., Campbell, M., Shapiro, T, and Floyd, A. (1969) Comparison of trifluperidol, trifluoperazine and chlorpromazine in preschool schizophrenic children the value of less sedative antipsychotic agents. Curr Ther Res 11 589-595. 

Pharmacodynamics, antipsychotics also differ in their pharmacodynamics, i.e. their pharmacological and clinical profiles of action. A rough distinction is made between highly sedative, hypnotic antipsychotics (e.g. clopenthixol, levomepromazine) and other products with weaker initial sedative action (e.g. fluphenazine and haloperidol). Sedative antipsychotics are prescribed for states of major unrest, often combined with insomnia, whereas the less sedative antipsychotics are preferred for patients suffering from delusions and hallucinations but in whom heavy sedation during daytime is undesirable. 

Area of assessment Clinically sedative antipsychotics, Less sedative antipsychotics, e.g. chlorpromazine, clozapine, e.g. haloperidol, perphenazine, olanzapine pimozide, sulpiride ... 

Pharmacological treatments were used by nearly half of the 149 services which offered any treatment, with a wide range of medications directed at various features of cocaine usage. Fluoxetine and desipramine were the most frequently prescribed antidepressants, with benzodiazepines used to aid sleep and reduce distress in withdrawal states. Sedative antipsychotics were used, apparently in states of severe agitation as well as more directly for psychotic complications. 

Diazepam is better indicated if insomnia is associated with daytime anxiety. Other benzodiazepines prescribed for insomnia include nitrazepam, flur-azepam, loprazolam, lormetazepam and temazepam. The non-benzodiazepine hypnotics zaleplon, zolpidem and zopiclone are not licensed for long-term use. The sedative antipsychotic promethazine hydrochloride is sometimes used to facilitate sleep, with a 25-50 mg recommended dose. Melatonin has proved effective for some clients, mostly in regulating the sleep/waking cycle. Although evidence of efficacy is limited, some clients use herbs such as valerian and chamomile. If Mr AB will finally be diagnosed with depression, a trial with an antidepressant will be indicated. 

Arrhythmias Antihypertensives TCA Sedatives Antipsychotics Hypoglycemics Alcohol... 

The short-acting clomethia2ole [533-45-9] (1), sometimes used as therapy for sleep disorders ia older patients, shares with barbiturates a risk of overdose and dependence. Antihistamines, such as hydroxy2iae [68-88-2] (2), are also sometimes used as mild sedatives (see HiSTAMlNES AND HISTAMINE antagonists). Antidepressants and antipsychotics which have sedative effects are used to treat insomnia when the sleep disorder is a symptom of some underlyiag psychiatric disorder. 

Other sedative-hypnotic medications, such as barbiturates, may play a useful role in severe withdrawal from this group of drugs. For example, in a case series of GBL withdrawal, use of intravenous pentobarbital in the range of 1-2 mg/kg/hour lowered the total requirement for intravenous lorazepam (Sivilotti et al. 2001). Antipsychotic medications are often used to reduce psychotic agitation. However, because antipsychotic medications lower the seizure threshold and may contribute to loss of central control of temperature leading to hyperthermia or neuroleptic malignant syndrome (NMS), they are not indicated as first-line medications for GHB withdrawal delirium (Dyer and Roth 2001 McDaniel and Miotto 2001 Sharma et al. 2001). If anti-... 

There is, however, a unique risk in the bipolar form that antidepressant treatment may trigger a switch into mania. This may occur either as the natural outcome of recovery from depression or as a pharmacological effect of the drug. Particular antidepressants (the selective serotonin reuptake inhibitors) seem less liable to induce the switch into mania than other antidepressants or electroconvulsive therapy. Treatment for mania consists initially of antipsychotic medication, for instance the widely used haloperidol, often combined with other less specific sedative medication such as the benzodiazepines (lorazepam intramuscularly or diazepam orally). The manic state will usually begin to subside within hours and this improvement develops further over the next 2 weeks. If the patient remains disturbed with manic symptoms, additional treatment with a mood stabilizer may help. 

Taper off antipsychotics, benzodiazepines or sedative-hypnotic agents if possible... 

A number of medications have been associated with an increased risk of falling, including drugs affecting mental status such as antipsychotics, benzodiazepines, tricyclic antidepressants, sedative-hypnotics, anticholinergics, and corticosteroids. Some cardiovascular and antihypertensive drugs also can contribute to falls, especially those causing orthostatic hypotension.9... 

If sedatives, barbiturates, antipsychotic drugs, stimulants, opiates and thyroid medications all outperform inert placebos in the treatment of depression, does this mean that any active drug can function as an antidepressant Apparently not. In September 1998 the pharmaceutical company Merck announced the discovery of a novel antidepressant with a completely different mode of action than other medications for depression. This new drug, which they later marketed under the trade name Emend for the prevention of nausea and vomiting due to chemotherapy, seemed to show considerable promise as an antidepressant in... 

Sleep and sedative effects of the atypical antipsychotics could be related to different mechanisms antagonism of 5-HT2 receptors, antihistaminic and antimus-carinic effects, and probably an a-1 noradrenergic effect. The difference in the effect on sleep between risperidone and haloperidol may be due to their differential actions on serotoninergic receptors (Trampus and Ongini 1990 Trampus et al. 1993). 

General anesthetics Intravenous (IV) anesthetics Sedatives and hypnotics Ethanol and related alcohols Psycho t o m i m etic s Antipsychotics... 

Information about prescription drag use alcohol or other substance use family medical history and history of trauma, depression, or head injury should be obtained. It is important to rule out medication use as a contributor or cause of symptoms (e.g., anticholinergics, sedatives, hypnotics, opioids, antipsychotics, and anticonvulsants) as contributors to dementia symptoms. Other medications may contribute to delirium, e.g.,... 

Most antipsychotic drug interactions are relatively minor and often involve additive CNS, ACh, or sedative effects. 

Benzimidazole is an important heterocyclic nucleus in the field of medicinal chemistry. The most prominent benzimidazole compound in nature is N-ribosyldimethylbenzimidazole, which serves as an axial ligand for cobalt in vitamin B12. The versatile nature of benzimidazole makes it a highly explored molecule in medicinal chemistry. A number of pharmacological activities are associated with benzimidazole derivatives such as anthelmintic, antiulcer, antipsychotic, proton pump inhibitor, antianxiety, anti-emetic and sedative, vasodilator, anticancer, analgesic, antihistaminic, antifungal, antiviral and antimicrobial. 

Typical Antipsychotics. Low doses of high potency typical antipsychotics such as haloperidol or fluphenazine (0.5-2mg given once or twice daily) are generally quite effective for psychotic symptoms after TBI. Unfortunately, as noted earlier, many post-TBl patients are susceptible to the extrapyramidal side effects of these medicines, especially if there was any injury to brain regions such as the basal ganglia. Low potency antipsychotics are not a viable alternative, because their anticholinergic and sedative effects are equally, if not more, problematic for patients who have suffered TBI. We recommend using typical antipsychotics, even for psychotic symptoms, as briefly as possible and in the lowest effective dose, if at all. Fortunately, there are now alternatives. 

Chlorpromazine is an aliphatic antipsychotic with marked sedative properties. A45 C... 

A. Neuroleptics Antipsychotic potency, sedative, and extrapyramidal motor effects... 

Antipsychotics are drugs that have a specific sedative effect, and which improve the attitude and calm the behavior of psychotic patients. They do not cause dependence, and have been proposed for treating psychotic disorders (elimination of psychotic symptomatology— delirium, hallucinations) and schizophrenic patients. Drugs of this group are also frequently referred to as neuroleptics. The term major tranquilizer was used previously to distinguish them from minor tranquilizers/anxiolytics. 

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