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7/22/2019 Sedatives & Hypnotics Jan 2010
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HYPNOTICS, SEDATIVES,TRANQUILIZERS &
ANTI-DEPRESSANTS
MACP 2113
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OBJEKTIF1. Memberi definisi ubatan hypnotics,sedatives, tranquilizers dan antidepressants.
2. Menyatakan tujuan/ indikasi ubat.
3. Menyatakan dos dan contoh ubat.
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4. Menyatakan kaedah pemberian ubat.
5. Menyatakan tindakan ubat.
6. Menerangkan kesan sampingan dankontraindikasi ubat.
7. Memberikan nasihat spesifik dalampengambilan ubat.
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Sedatives &Hypnotics
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adalah ubat yang menghasilkankesan tenang dan relaksasi.
Ia juga menyebabkan kesanmengantuk drowsiness.
Sedatives
adalah ubat memberi kesan tidur(induce sleep).
Hypnotic
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Membantu meningkatkantindakan GABA (Gamma-
aminobutyric acid).
GABA adalah
neurotransmitter penghalangyang menghalang
penghantaran impuls.
Cara bertindak
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Maka pemberian sedatives &
hypnotics akan membantuGABA bagi menghalang
penghantaran impuls.
Bila penghantaran impuls
terhalang, tindakan CNS akan
berkurang. Ini akan memberikan kesan
tenang & mengantuk.
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Insomnia
Preoperative sedation
Indication
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Chloral Hydrate(Aquachloral)
Midazolam (Dormicum)
Contoh ubat
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1. Chloral Hydrate(Aquachloral 200mg/5ml)
Category: B
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Dose
Adult:0.5-1g/day hs (with plenty of
water)
Max: 2g/day
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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
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2. Midazolam HCl(Dormicum 7.5mg tab)
Category: A
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Dose
Usual:
7.5-15mg hs PO
Premedication:
15mg PO (30-60 min sebelum
prosidur)
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Elderly/ impaired liver or
kidney function:
7.5mg hs PO7.5mg PO (30-60 min sebelum
prosidur)
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3. Midazolam HCl(Dormicum 5mg/5ml inj)
Category: A
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Dose
Premedication:
70-100mcg/kg IM (30-60 minbefore surgery)
Usual:
7.5-15mg hs PO
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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
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Confusion (keliru)
CNS depression Hallucination
Dizziness
Abnormal thinking
Gastric irritation
Kesan Sampingan
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Hypoventilation
Respiratory depression
Nausea, vomiting, diarrhea
Hypotension
Bradycardia
Edema Liver damage
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Allergic to barbiturates
Liver failure
Severe respiratory distress
Ketagihan (sedative &
hypnotic) Pregnancy
Lactation
Contraindication
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Liver/ kidney disease
History of drug abuse
Mental illness
Cautious
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Alcohol, Antidepressants,
Narcotic analgesics, Anti-histamines or
Phenothiazines.
Meningkatkan kesansedatives & hypnotics.
Interactions
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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?
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Tranquilizers
(Anti-anxiety)
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Anxietyadalah perasaan
bimbang tanpa sebab dan rasatidak selesa.
Tranquilizer atau Anti-anxiety
adalah ubat untuk merawat
anxiety.
Terdapat 2 jenis tranquilizer:Barbiturates
Benzodizepines
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Membantu meningkatkan
tindakan GABA (Gamma-
aminobutyric acid).
GABA adalah neurotransmitterpenghalang yang menghalang
penghantaran impuls.
Cara Tindakan
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Maka pemberian Tranquilizers
akan membantu GABA bagimenghalang penghantaran
impuls.
Bila penghantaran impuls
terhalang, tindakan CNS akan
berkurang.
Ini akan memberikan kesan
tenang.
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Ada ubat yang bertindak ke
atas reseptor dopamine &
serotonin pada otak.
Ada juga ubat yang bertindak
ke atas hypotalamus & brain
stem.
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Anxiety disorder Sedatives (insomnia)
Muscle relaxants
Indication
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Chlorpromazine (Largatil)
Haloperidol (Serenace/ Haldol)
Diazepam (Valium)
Lorazepam (Ativan) Alprazolam (Xanax)
Contoh ubat
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1. Chlorpromazine
(Largactil 25mg, 100mg)Category: B
Adult:Permulaan: 25mg tds PO
Max: 1g/day
Dose
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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
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2. Chlorpromazine
(Largactil 25mg/ml in 2 ml inj)Category: B
Adult:25-50mg IM q 6-8 hr
Max: 1g/day
Dose
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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
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3. haloperidol
(Serenace 1.5mg, 5mg)
Adult:1.5-5mg bd-tds PO
Max: 30mg/day
Dose
Category: B
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Peads 3-12 yr:
Initial 0.5mg/day PO
Increase gradually 0.5mg q 5-
7days (divided dose)
Max: 10mg/day
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4. haloperidol
(Serenace 5mg/ml inj)
Adult:2-10mg IM/ IV q 4-8 hr
Max: 18mg/day
Dose
Category: B
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5. Diazepam
(Valium 2mg tab)
Category: B
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Adult:
2 mg tds PO
Severe anxiety: 15-30 mg/day
(divided dose)
Dose
Peads (night terrors):1-5mg hs PO
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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
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7. Lorazepam
(Ativan 1mg tab)
Category: A
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Adult:
Severe anxiety: 1-4mg/day PO
Increase up to 10mg/day(divided dose)
Insomnia: 1-2 mg hs PO
Dose
Peads:
Not recommended
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8. Alprazolam (Xanax
0.25mg, 0.5mg, 1mg)
Adult: Initial: 0.25-0.5mg tid PO
Max: 3mg/day
Category: A
Dose
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Drowsiness
Sedation
Depression
Confusion
Dry mouth Constipation
Kesan Sampingan
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Orthostatic hypotension Hypotension
Cardiac arrest
CV collapse
Bone Marrow depression
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Allergic to drugs
Pregnancy
Lactation Severe depression
Bone Marrow depression
Parkinsons disease
Liver damage
Contraindication
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Elderly Impaired liver & kidney
function
Cautious
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Alcohol, Tricyclic
antidepressants, Narcotic
analgesics, Anti-pyschotics.
Meningkatkan kesan
sedatives & hypnotics Dangerous (serious
respiratory depression)
Interactions
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Soalan
1. Beri definisi Tranquilizers?
2. Terangkan cara tindakanTranquilizers?
3. Senaraikan ubat Tranquilizers?
4. Nyatakan kesan sampingan dankontraindikasi ubat Tranquilizers?
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Anti-
Depressants
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Depressionis one of the most
common psychatric disorders.
Characterized by feeling ofintense sadness,
worthlessness & impaired
functioning.
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Terjadi kerana penghantaranimpuls berkurang & pesakit
menjadi murung dan tidak
aktif. Anti-depressantsadalah ubat
yang digunakan bagi merawat
depression.
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Terdapat 3 jenisAntidepressant yang utama:
Tricyclic Anti-depressants
(TCAs)Monoamine oxidase inhibitors
(MAOIs)
Selective Serotonin ReuptakeInhibitors
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Tricyclic Anti-depressants
Bertindak dengan menghalang
pengambilan semula
norepinephrine & serotonin di
presinaptik neuron.
Dengan ini lebih banyakneurotransmitters akan berada
di ruang sinaps.
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Maka penghantaran impulse
akan meningkat.
Ini akan menyebabkan CNS
terangsang dan pesakit akan
menjadi cergas.
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Amitriptyline HCl (Elavil) Chlorpramine HCl (Anafranil)
Imipramine HCl (Tofranil)
Contoh ubat
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1. Amitriptyline HCl(Laroxyl)
Category: B
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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
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2. Chlorpramine HCl
(Anafranil)
Category: A
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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
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3. Imipramine HCl(Tofranil)
Category: B
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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
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Confusion
Anxiety
Orthostatic hypotension
Visual disturbance
Photosensitivity Nasal congestion
Nausea & vomiting
Kesan Sampingan
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Allergic to tricyclics
MAOIs therapy Recent MI
Pregnancy
Lactation
Contraindication
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Hepatic/ renal impairment
Heart disease
Increased IOP
Prostatic hypertrophy History of seizure (sawan)
Cautious
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MAOIs
Hypertensive episode,severe convulsion
MAIOs must be discontinued
at least 2 weeks beforetreatment with TCAs
Interactions
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Monoamine oxidaseinhibitors (MAOIs)
Bertindak dengan
memusnahkan enzim
monoamine oxidase.
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Enzim monoamine oxidase
boleh memusnahkanneurotransmitters &
menghalang penghantaran
impuls.
Bila enzim tersebut
dimusnahkan,neurotransmitters akan
terselamat.
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Dengan ini lebih banyak
neurotransmitters akan berada
di ruang sinaps.
Maka penghantaran impulseakan meningkat.
Ini akan menyebabkan CNS
terangsang dan pesakit akanmenjadi cergas.
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Phenelzine (Nardil) Tranylcypromine
(Parnate)
Contoh ubat
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1. Phenelzine (Nardil)
Category: A
Adult:
Initial: 15mg PO tid
Increase to 60mg/day (at leastfor 4 weeks)
Peads:Not recommended
Dose
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2. Tranylcypromine (Parnate)
Adult:
30mg/day PO (divided dose)
Maximum 60mg/day
Peads:Not for children < 16 yrs
Category: A
Dose
K S i
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Kesan Sampingan
Orthostatic hypotension Hypertensive crisisdue to
tyramine product(Strokes & Death
was reported)
Overactivity
Headache Anxiety
Nausea & constipation
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Allergic to MAOIs
Hepatic/ Renal disease Cerebrovascular disease
Hypertension
CV disease
Lactation
Contraindication
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Impaired liver function
History of seizure Parkinsonism
Diabetes
Hyperthyroidism
Cautious
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Food containing tyramine &adrenergic drugs.
Hypertensive crisis
Opiates
Serious adverse reactions
(hypertension, coma, death) Thiazide diuretics
Exaggerated hypotension
Interactions
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Selective Serotonin
Reuptake Inhibitors
Bertindak dengan menghalang
pengambilan semula serotonindi presinaptik neuron.
Dengan ini lebih banyak
neurotransmitters akan berada
di ruang sinaps.
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Maka penghantaran impulse
akan meningkat.
Ini akan menyebabkan CNSterangsang dan pesakit akan
menjadi cergas.
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Fluvoxamine (Luvox)
Fluoxetine HCl (Prozac)
Sertraline HCl (Zoloft)
Contoh ubat
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1. Fluvoxamine 50mg/100mg tab (Luvox)
Category: B
D
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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
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2. Fluoxetine HCl 20mgcap (Prozac)
Category: A
D
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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
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3. Sertraline HCl (Zoloft)
Category: B
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Peads:Not recommended
Adult:
50mg/day PO
Max: 200mg/day Increase dose at 1 week intervals
Dose
Kesan Sampingan
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Kesan Sampingan
Headache
Nervousness
Dizziness
Seizure
Insomnia
Anxiety
Tremor
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Tremor
GI disturbances
Dry mouth
Hepatotoxicity
Blurred vision
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Allergic to SSRIs
Pregnancy
MAOI therapy
Contraindication
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Diabetes
Impaired liver & kidney
function
Lactation
Cautious
I t ti
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MAOIs
Fatal reactions
TCAs Increase toxic effects
Cimetidine
Increase serum sertralinelevels
Interactions
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Cigarettes (Caffeine)
Decrease effects of SSRIs
Lithium
Increased lithium levels
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Soalan
1. Beri definisi Antidepressants?
2. Berikan jenis dan cara tindakan
Antidepressants?3. Senaraikan ubat Antidepressants?
4. Nyatakan kesan sampingan dan
kontraindikasi ubatAntidepressants?