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Schizophrenia & gangguan bipolar

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Farmakoterapi pada schizophrenia & gangguan bipolar

Motivation Disorder51Competence TargetAble to recognize schizophrenia symptomsAble to make therapeutic plan for acute psychosisAble to manage antipsychotic agent side effectAble to recognize altered mental status in bipolar disorderAble to prrovide appropriate pharmacological therapy in acute maniaAble to determine monitoring strategy for anticonvulsion therapy in bipolar disorder2SCHIZOPHRENIA 3Consideration 4EpidemiologyPresent in late adolescence & early adulthoodEqually prevalent between genderSymptoms appear earlier in males5Pathophysiology

7Characteristic symptoms8Schizophrenia Criteria9Pharmacological Agents Involved in Schizophrenia10Dopaminergic Treatment of Parkinson Disease May Lead Symptoms of Schizophrenia11Antidopaminergic Substance Can Improve Schizophreniaat present not used therapeutically12Neuroleptic (Antipsychotic) Role to Dopamine

13First-Generation Antipsychotics (FGAs)

14Long-Acting Neuroleptics

15FGAs Side Effect

16Second-Generation Antipsychotics

17Comparative Side Effects Among SGAs & Haloperidol

18

Schizophrenia Algorithm 19First-Line Antipsychotic Therapy in Specific Patients

20Metabolism and Drug Interactions with Antipsychotics

21Desired Outcomes22Monitoring Protocol for Patients

23BIPOLAR DISORDER24Consideration Bipolar disordercan be mixedWith/without psychosisIncrease suicide risk25Epidemiology 26Etiology Remain unclear27Secondary Cause of Bipolar Mania

28Pathophysiology Hypothesis29Bipolar Disorder Clinical Presentation30Pharmacological Agents Involved in Bipolar Disorder31Acute Manic Algorithm Therapy

32Acute Manic Algorithm Therapy Cont...

33Acute Depressive Episode

34Acute Depressive Episode Cont...

35Pharmacological Therapy of Bipolar Disorder

36Pharmacological Therapy of Bipolar Disorder Cont...

37Pharmacological Therapy of Bipolar Disorder Cont...

38Pharmacological Therapy of Bipolar Disorder Cont...

39Bipolar Disorder Medicine Absorption

40Bipolar Disorder Medicine Distribution

41Bipolar Disorder Medicine Renal Clearance

42Bipolar Disorder Medicine Metabolism

43Bipolar Disorder Medicine Side EffectValproic acidCarbamazepineLamotrigin Lithium saltsloss of appetite, nausea, dyspepsia,and diarrhea, tremor, and drowsiness. (gastrointestinal distresscan be reduced by co-administration with food), teratogenicdrowsiness,dizziness, ataxia, lethargy, and confusion, teratogenicmaculopapular rash, occurring in up to 10% ofPatientsgastrointestinal upset, tremor, & polyuria (dose-related).Nausea, dyspepsia, & diarrhea can be minimized by coadministration with food, use of sustained-release formulations,& giving smaller doses more frequently to reduce theamount of drug in the gastrointestinal tract at a given time44Bipolar Disorder Medicine Drug InteractionValproic acidCarbamazepine Lamotrigine Lithium saltsThe risk of a dangerous rash due to lamotrigine is increased when given concurrently with divalproexThe metabolism of divalproex can be increased by enzyme-inducing drugs such as carbamazepine & phenytoinWhile divalproex may simultaneously slow metabolism of the other agentsCarbamazepine induces the hepatic metabolism of many drugs & also autoinducerAntidepressants, macrolide antibiotics including erythromycin and clarithromycin, azole antifungal drugs including ketoconazole & itraconazole, and grapefruit juice may decrease the metabolism of CarbamazepineDivalproex slows the rate of elimination of lamotrigine by about half (necessitating dosage reduction)Carbamazepine increases the rate of lamotrigine metabolismThe ACEIs increase serum lithium with the potential for acute and fatal toxicityThiazide diuretics & NSAIDs increase Lithium retention45Monitoring Protocol for Patients

46Primary ReferencesWells, B., Dipiro, J.T., Schwinghammer, T.L., Dipiro, C.V., 2009. Pharmacotherapy Handbook. 7th Ed. Mc Graw Hill Companies. Inc. New YorkSchwinghammer, T.L. & Koehler, J.M. 2009. Pharmacotherapy Casebook: A Patient-Focused Approach. 7th Ed. Mc Graw Hill Companies. Inc. New YorkFletcher, A.J., Edwards, L.D., Fox, A.W., Stonier, P. 2002. Principles and Practice of Pharmaceutical Medicine. John Wiley & Sons, Ltd. UK47Thank You Very Much

48Post TestJelaskan peranan dopamin dalam pembentukan schizophrenia!Sebutkan sekurangnya 2 penggunaan lain dari antagonis reseptor D2!Bagaimanakah efek pemberian clozapine bersamaan dengan penggunaan antibiotik ciprofloksasin? Bagaimana mekanisme terjadinya efek tersebut?Bagaimanakah efek pemberian asam valproat bersamaan dengan pemberian lamotrigin? Bagaimanakah mekanisme terjadinya efek tersebut?Bagaimanakah cara meminimalisasi efek samping terapi Lithium terhadap saluran cerna?

49Genes Involved52