January 26, 2023

Escitalopram is a Selective Serotonin Reuptake Inhibitor (SSRI) and chemically it is the S-isomer of citalopram. This drug acts blocks serotonin reuptake transporter (SERT) both at primary and allosteric sites.

Hi everyone today in this video we are going to discuss about acetylopram what is this drug acetylopram this is one of the ssri select two serotonin reuptake inhibitor and within the name we can observe the prefix es which indicates this drug is a s isomer of acetyl operon c law problem is again ssri which is available as rasmic mixture both are isomer as well as

S isomer is present and within these the pure s isomer of cetaloprom is nothing but acetyl prop so today in this video we are going to discuss how this drug acts where the stereo active center is present what are the precautions side effects and clinical use of acid law prompt we will discuss in this video this drug is useful in the treatment of major depressive

Disorder commonly known as depression similarly this drug is also useful in the treatment of generalized anxiety disorder generalized anxiety disorder is one of the condition in the patient where anxiety is observed at many of the situations without any proper reason in such conditions acetyl problem can be used but the main use of this drug is in the treatment

Of major depressive disorder which is associated with the depressive symptoms such as irritability pessimism feeling of guilt apathy lack of initiation restlessness and insomnia lack of sleep both psychological as well as biological symptoms are present in the major depressive disorder in such conditions acetyl problem can be used both in the adults as well as

Adolescents what is the chemical nature of this drug so this is the structure of acetyl operon and here one of the heterocyclic ring system is present this is nothing but benzofuron so acetolopram is a benzo-feuron derivative and we can observe a stereo active center at the first position so this structure is available as both r isomer as well as s isomer but

Acetyl-prompt is a pure s isomer of this structure how it acts just we have seen that acetylaprom acts by inhibition of the serotonin reuptake so this is the pre-synaptic neuron which is storing phi hd and this is a postsynaptic neuron which is equipped with post synaptic receptors such as phi ht2 receptors now when the action potential reaches to the presynaptic

Neurons the calcium can enter into the presynaptic nerve terminals which results in the calcium-mediated exocytosis and release of the serotonin this serotonin can bind to 5-2 receptors thereby can produce post-synaptic stimulation so the post-synaptic action depends on the physical levels within the synaptic cleft but what of the release of isd can also be taken

Into the neural terminals by one of the transporter scrt serotonin reuptake transporter so this transporter is having the two important sites this is the primary site and this is the aerostatic site now the firestick can be reuptaken through this sert through primary as well as allosteric sites in this way the fire state which is going to be released can act on the

Post synaptic receptors at the same time it can be reuptaked into the nerve terminal which is again stored into the vesicles now here acetylopram inhibits this scrt serotonin reuptake transporter but this drug is having two binding sites it can bind to the primary site as well as it can bind to the endosteric site by binding to both of the sites acetylopram can

Inhibit the reuptake of 5ht now the firestick cannot be reuptaken into the negative terminal because of this block produced by acetloprom and this results in the increased physical levels within the synaptic cleft and as the physical levels are increased they can also affect the autoinhibitory presynaptic receptors within the presynaptic neurons we can observe

And the type of receptors these are the five step one receptors which are autoinhibitory nature they can inhibit the release of ist from the presynaptic neurons now when these five stables are excessively increased they can produce the desensitization of these five t1 receptors which results in the further form classical actions of acetloprom in this way this drug

Produce form classical actions by blocking the serotonin reuptake as well as by desensitization of the autoinhibitory 5-t1 receptors what are the precautions one of the important precautions of acetoprime is that this drug can increase the angle closure glaucoma acg so this is one of the condition where there is increased levels of intraocular pressure because

Of the decreased drainage of aqueous humor in such conditions if any drug further increase in the intraocular pressure may increase the glaucoma here acetylopram increase the pupillary dilatation and when this pupillary dilation is increased it can cause the narrowing of canal of slam which is the drainage channel for aqueous humor so when this is going to be

Narrowed it increase the accumulation of aqueous humor resulting in the increased intraocular pressure so in the patients already having angle closure glaucoma if acetyl probe is given it can further increase the glaucoma resulting in blood vision as well as loss of vision similarly another important precaution is that acetyl problem can increase the serotonin

Syndrome so this is one of the syndrome observed with many of the drugs such as ssris and snris so this syndrome produced few of the symptoms such as agitation hallucinations confusion anxiety tachycardia hyperthermia the increased body temperature diaphoresis increased sweating flushing increased vasodilation tremor and muscle rigidity all these symptoms can

Be precipitated by acetyl-prompt and particularly this syndrome is observed when this acetyl problem is given with other drugs which are again increase the serotonin syndrome particularly mao inhibitors when they are given the slow problem they can produce serotonin syndrome similarly slow problem can also reduce the cognitive as well as motor performance in the

Patients so when this drug is prescribed it can produce decreased skills like decreased judgment decreased thinking and it can also reduce the motor activities motor skills which may result in the poor driving performance so this drug should be carefully given in the elders because of motor as well as cognitive impairment another important precaution of this

Drug is that this drug can increase the risk of bleeding on prolonged use this drug can increase the epistaxis nasal bleeding hematoma increased spreading of the blood outside the blood vessels gastrointestinal bleeding all this can be observed with the acetyl-prompt on prolonged use and particularly this risk is further increased with other drugs like aspirin

Which is an anti-platelet agent warfarin which is an oral anticoagulant similarly anasites which also increase the risk of bleeding all these drugs when they are co-administered with acetyl prime they can further increase the risk of bleeding so they should be carefully prescribed with the acetyl problem another important precaution is that this drug can increase

The suicidal initiation it can produce few of the symptoms in the patient such as anxiety agitation irritability and insomnia along with these symptoms it can also increase the suicidal thoughts particularly in the adolescence is less than 18 years and in the young patients with age 18 to 24 years risk of suicidal initiation is more absurd so this structure be

Careful given the adolescents and young patients in order to prevent this suicidal initiation and acetyl problem can also increase the risk of seizures so if already patient is having any risk of induction of seizures in such patients this drug should be carefully given and since this is an antidepressant this drug can produce two phases within the patients it

Can produce either mania or hypomania that means it can produce some hyperactive disorder or depressive disorder since in the central nervous system it is a sensitive balance this drug may stimulate the symptoms of either mania or hypomania and this can also increase the qtc interval the corrected qd so care should be taken in the cardiovascular patients in

Order to prevent fatal cardiac arrhythmias another important precaution of this drug is that this drug can produce hyponatremia decrease sodium levels within the body the serum sodium levels may be reduced less than 110 millivolts per liter so this condition produces few of the symptoms such as headache confusion impaired memory weakness and all these effects

Of acetyler problem are mainly due to decreased action of antidiuretic hormone so when this hormone is not working it increase the diuresis and loss of sodium resulting in the hyponatremia few of the conditions in the patients like volume depletion or patients who are taking diuretics similarly in the elders there may be an increased risk of hyponatremia when

This is low problem is given what are the side effects important side effects mainly include dry mouth dizziness sweating indigestion constipation abdominal pain and it can also produce fatigue ejaculation disorders which may lead to importance rhinitis nausea and some loss of libido can be observed in the patients how it is given this drug is available as

A tablet as well as orally disintegrating tablet both film coated tablet as well as orally disintegrated tablets are available and this drug is also available as a solution the dose of this drug for major depressive disorder is initiated at a dose of 10 mg once daily the dose can be increased based on the symptoms in the patients but these increments should

Be done at least after one week of the treatment the dose can be increased up to 20 mg once daily but this increment should be slow in the adolescence with is less than 18 years in the adolescents after three weeks of the treatment only the increment should be done in order to prevent unwanted effects of istelopram similarly for the treatment of generalized

Anxiety disorder again the dose is initiated at 10 mg once daily and after one week of the treatment the increments can be done based on the situation and those can be increased up to 20 mg once daily so that’s about this acit acetyl-prompt which is a selective serotonin reuptake inhibitor and this is the s isomer of acetyl operon this track mainly inhibits

The serotonin reuptake transporter and it binds to the both primary site as well as allosteric site thereby inhibits the reuptake of isd which increases the physical levels within the synaptic cleft resulting in the antidepressant activity the razer physics levels within the synaptic cleft may also desensitize the autoinhibitory facet1 receptors which is also

Responsible for antidepressant activity this drug should be careful given the patients who are having angle closure glaucoma and the patients who are suffering with seizures and this drug may increase the suicidal initiation particularly in the young and adolescent patients it can precipitate the serotonin syndrome because of increased physical levels it can

Also increase the risk of bleeding and cognitive as well as water impairment this drug can reduce the anti-diuretic hormone activity thereby can produce hyponatremia all these factors should be considered before this h2o problem is prescribed and this drug can also increase acute interval so it may present fatal cardiac arrhythmias so case should be taken when

This drug is prescribed to cardiovascular patients and finally this drug can produce either manic or hypomanic phase because of fluctuations of five steel levels this drug is available as a film coated tablet or waterline disintegrating tablet as well as solution for both major depressive disorder as well as generalized anxiety disorder the initial dose is 10

Mg once daily the dose can be incremented after one week of treatment and based on the condition the dose may be increased up to 20 mg per day but in the adult sense that those increments should be done after three weeks of the treatment so that’s about this acetyl-opram which is the s isomer of acetyl operon so that’s for today hope you have enjoyed this video

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Transcribed from video
Escitalopram – Mechanism, precautions, side effects & uses By egpat