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The Term metastasis means spread of cancers cells to distant sites away from the site where cancer has first appeared. Breast Cancer can be metastasized. Breast cancer can be speared to axillary lymph nodes and grows in size there.  Breast cancer can spread to almost any part of the body but the most common sites are bones followed by lungs and liver. Symptoms of metastatic breast cancer may include: Bone pain (possible indication of bone metastases) Shortness of breath (possible indication of lung metastases) Lack of appetite (possible indication of liver metastases) Weight loss (possible indication of liver metastases) Neurological pain or weakness, headaches (possible indications of neurological metastases) These symptoms are sometimes but not always associated with metastatic breast cance r, and having one or more of these symptoms does not necessarily mean a woman has metastatic breast cancer. Most women whose breast cancer has metastasized do not show symptoms u

Delusions -- Delusion is a false, firm belief in something which is not a fact. Delusions indicate psychological disorders such as schizophrenia . They are important from the medico-legal point of view. The patient may commit suicide, murder or other crime under the influence of delusions. Types Of Delusions.

Neuroleptics are antipsychotic drugs used for the treatment of schizophrenia . These are also called major tranquillizers. These drugs are also effective in the treatment of manic disorders, delusions and hallucinations. DRUGS and Their Classification. Typical Neuroleptics; Chlorpromazine Prochlorperazine Thioridazine Fluphenazine Haloperidol Thiothixene Chlorpromazine, Prochlorperazine and Thioridazine are low potency drugs Fluphenazine, Haloperidol and Thiothixene are high potency drugs. Atypical Neuroleptics: Aripiprazole Clozapine Olanzapine Quetipine Paliperidone Risperidone Ziprasidone Mechanism Of Action Of drugs: Neuroleptic drugs act through several mechanisms.  Typical neuroleptic drugs act through blocking Dopamine receptors such as D2 receptors . There are five types of Dopamine receptors from D1 - D5. clozapine blocks D4 receptor more than D2.  Those drugs which block the D2 receptors are responsible for extrapyramidal effects and  Parkinson  

Serotonin Receptors: Serotonin is 5 hydroxytryptamine (5HT).  Four families of Serotonin receptors, comprising of 14 subtypes have so far been recognized. Types of Serotonin (5HT) Receptors: 5-HT1 5-HT2 5-HT3 5-HT4-7 Location and effects of 5-HT receptors; 5-HT1 receptors: These are present in brain. most important location is raphe nuclei of brain stem and hippocampus, the anti anxiety drug buprione acts as a partial agonis of 5-HT1A receptor. other locations include substantia nigra basal ganglia cranial blood vessels ( cause contraction) 5HT1 receptors inhibit adenylyl cyclase and cause hyperpolarization of neurons and inhibit transmission. 5-HT2 Receptors: There are three subtypes of 5-HT2 receptors,  5-HT2a,  5-HT2b,  5-HT2c, these receptors are coupled to phospholipase C and act through generation of IP3 and GAG. 5HT2a is the most widely expressed postjunctional 5-HT receptor and located on vascular and viceral smooth muscles, platelets and cereberal neurones

Monoamine Oxidase is an enzyme responsible for the inactivation of monoamines i.e, nor epinephrine, dopamine and serotonin. By blocking this enzyme we increase the availability of these neurotransmitters in synapses. But one should monitor the blood pressure and cardiac condition. As the increased quantity of nor epinephrine can cause hypertensive crises in predisposed individuals. Following drugs come under this category Ø      Selegiline Ø      Phenelzine Ø      Tranylcypromine Indications: MAO inhibitors are indicated for depressive patients who are unresponsive to TCAs or TCAs are contraindicated (eg. Allergy). These agents are useful in the treatment of certain phobias. A condition called atypical depression can be treated by MAO inhibitors Adverse effects: Tyramine-containing foods must be avoided. Tyramine causes the release of stored catecholamines from nerve terminals, resulting in headache, stiff neck, tachycardia, nausea, hypertension, cardiac arrhythmias, seiz

Tricyclic Antidepressants: Tricyclic antidepressants inhibit the retake of both serotonin and nor epinephrine. TCAs also block alpha adrenergic receptors, serotonergic, histaminic, muscarinic receptors. And blockage of these receptors is the cause of a big profile of side effects. TCAs include the following drugs: 1)     Tertiary amines: Ø      Imipramine Ø      Amitriptyline Ø      Clomipramine Ø      Doxepin Ø      Trimipramine 2)     Secondary amines: Ø      Desipramine Ø      Nortriptyline 3)     Tetra cyclic antidepressants: Ø      Maprotiline Ø      Amoxapine Indications: ü      Moderate to Severe Depression ü      Panic disorder ü      Imipramine is used to control bed-wetting in children of more than 6 years of age ü      Amitriptyline has been used to treat migraine headache and chronic pain syndromes (e.g. naturopathic pains) and when the cause of pain is not clear. Adverse Effects: Adverse effects are because of unwanted effects of TCAs on alpha-adrenergic an

Atypical Anti Depressants: Atypical antidepressants have actions at several different sites. They are not SSRIs or SNRIs. They have different mechanisms of actions. They are different in the side-effect profile and have additional beneficial effects and indications. However, they are more efficacious than TCAs (tricyclic antidepressants) Following drugs come under this category Ø      Bupropion Ø      Mirtazapine Ø      Nefazodone Ø      Trazodone Bupropion: It is weak dopamine and nor epinephrine reuptake inhibitor. It has a short half-life and requires more than once dosing. The unique characteristic of Bupropion is that it reduces the craving for nicotine in individuals who wish to quit smoking. Side effects Of Bupropion:     Dry mouth     Sweating     Nervousness     Tremor     Increase risk of seizures at high doses     Relatively low drug-drug interaction     Low incidence of sexual dysfunction. Mirtazapine: It blocks presynaptic alpha 2 receptors and enhances the

Serotonin-Norepinephrine  Re-uptake  Inhibitors – SNRI’s SNRI’s inhibit the presynaptic reuptake of both serotonin and nor epinephrine. Those patients who don’t respond to SSRI,s may show response to SNRI,s These drugs are similar in the action of Tricyclic antidepressants but differ in side effects profile. SNRI’s have fewer side effects and are better tolerated than TCA,s. SNRI,s also reduces the backache and other neuropathic pains associated with depression. SSRI,s (selective serotonin reuptake inhibitors) have no effect on pain. The following two drugs come into this category Ø      Venlafaxine Ø      Duloxetine Indications: ü      Depression ü      Obsessive Compulsive Disorder (OCD) (Fluvoxamine) ü      Panic disorder ü      Generalize anxiety disorder ü      Post traumatic Stress disorder ü      Bulimia Nervosa (Fluoxetine) Adverse Effects: Venlafaxine side effects:     Nausea     Headache     Sexual dysfunction

1.      Selective Serotonin Reuptake Inhibitors Selective Serotonin Reuptake Inhibitors (SSRIs), a class of antidepressant drugs, inhibit the reuptake of serotonin in the presynaptic terminal and increases the availability and hence, transmission of serotonin. Following drugs are used to inhibit the serotonin Reuptake. Ø      Fluoxetine Ø      Paroxetine Ø      Fluvoxamine Ø      Citalopram Ø      Escitalopram Ø      Sertraline Serotonin reuptake inhibitors have largely replaced the old Tricyclic antidepressants. These drugs have fewer side effects as compared to TCA,s. Indications of SSRIs: SSRIs are indicated in following disorders: ü      Depression ü      Obsessive Compulsive Disorder (OCD) (Fluvoxamine) ü      Panic disorder ü      Generalize anxiety disorder ü      Post traumatic Stress disorder ü      Bulimia Nervosa (Fluoxetine) Adverse Effects Of SRRI’s: Following are the common adverse effects related To SSRI’s     Nausea     Anxiety     Drowsiness     Ins