drugs test
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| Psychotherapeutic Drugs categories | antianxiety, anitdepressants, moodsatbilizers, antipsychotics (category names should be viewed as indicating one prominent use of drug)
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| prescriptions a year? (psychotherapeutics) | 230 million in US, at least 10 -15% of the population receiving, very likely to be encountered
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| antidepressants | many different categories of this drug, each individual may prefer a diff drug
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| symptoms of major depression | persistent depressed mood, loss of interest or pleasure, significant change in appetite/weight, insomnia, may move/talk slowly, fatigue, no energy, motivation, apathetic, nothing matters, feel worthless, inappropiate guilt, cant make decisions/concentrate
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| brain changes in depression | much more activity in not depressed people than depressed
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| neurotransmitters involved in mood | dopamine, serotonin, norepinephrine all contribute to mood. family known as monoamines. need a perfect balance to experience good mood.
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| monoamine theory of mood | normal mood depends on adequate levels of monoamine activity in brain, levels too low depression, levels too high euphoria/mania, all with depression probably don't experience exactly the same chemical imbalance
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| categories of antidepressants | tricyclic antidepressants (TCA's) monoamine oxidase inhibitors (MAOIS) selective serotonin reuptake inhibitors (SSRIs) most common..serotonin & NE reuptake inhibitors (SNRIS)
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| Tricyclics | three rings in chemical structure
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| tricyclic antidepressants examples | imipramine, amitriptyline, desipramine, nortriptyline..the last two are more common now less side effects
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| tricyclic effects | significantly more effective than placebo in providing relief, usually taken once a day at bedtime, very inexpensive; no significant withdrawal effects, not effective for extreme/atypical forms of depression
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| how they work? tricyclics | block reuptake sites for neurotransmitters, allows the neurotransmitters to remain active longer..stronger effect of 5ht and NE.
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| problems with tricyclics | delayed effectiveness (3-6 weeks); therapeutic window for effectiveness, not good for the really depressed. some also block Ach and histamine causing annoying side effects before benefits.
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| side effects with tricyclics | anticholinergic:dry mouth, dizzy, blurred vision, constipation, urinary hesitance, tachycardia, possible memory problems (not recommended for young or old) antihistamine: sedation,
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| extremely harmful side effects for tricyclics | small safety margin, can cause death in overdose. cardiac arrhythmia and heart failure, coma, respiratory distress, 10,000 ER, 800 deaths); interact with a wide variety of drugs. has been #1 cause of prescription overdose death in US
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| other uses for tricyclics | dysthymia (mild depressive disorder, functioning) panic disorder/agoraphobia and probably other anxiety disorders, treatment of chronic pain (brain pain suppression system uses serotonin,boosting it reduces pain) treatment of enuresis(bedwetting)ADHD,OCD
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| Monamine Oxidase Inhibitors (MAOIs) examples | examples:phenelzine (nardil), tranycypromine (parnate), isocarboxazid (marplan)
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| Monamine Oxidase Inhibitors (MAOIs) drug action | inhibit action of MAO, an enzyme which breaks down 5ht, DA and NE, allowing more transmitter release/action
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| MAOI problems | fight or flight system because unregulated because of this,could cause increase heart rate, need to follow a strict diet foods with high levels of tyrmaine can cause hypertension...
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| dangerous effects of drug interactions with MAOI | can cause life threatening hypertensive crisis (severe headache, skyrocketing blood pressure, heart palpitations) must continue restrictions.
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| new developments in MAOI | selegillin patch-slow absorption seems to avoid food/drug interactions and onset of effect seems faster (really expensive) moclobemide, gentle MAOI few side effects improves energy, concentration and memory..
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| Selective Serotonin Reuptake Inhibitiors (SSRIs) examples | fluoxetine (prozac, serafem), paroxetine (paxil) sertraline (zoloft) flvuxoamine (luvox) citalopram (celexa, lexipro)...
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| SSRI's effectiveness | same effectiveness as other antidepressants, but have more acceptable side effects, and few overdose deaths/risks
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| side effects SSRI's | side effects more like stimulant drugs in most feel anxious, hyper, restless, suffer insomnia, stomach upset, diarrhea) early in treatment, shows less side effects and caused them to be more popular
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| SSRIs in kids | too high dose in kids may be mistaken for bipolar disorder symptoms so could be wrongly diagnosed; only fluoxetine shown to be effective for kids..
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| drug action of SSRIs | affects the serotonin reuptake
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| SSRI problems | significant proportion (40-60%) will have sexual side effects (loss of desire, impotence, difficulty achieving orgasm) risk of serotonin syndrome risk of serotonin syndrome (overstimulated nervous system, confusion) may be mistaken for bipolar disorder,
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| withdrawal symptoms (syndrome) of SSRI | when stop using SSRIs (dizziness, ataxia, nausea, flu-like illness, headache, sensory abnormalities, insomnia, vivid dreams) can cause electric shock sensations back of one s head
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| Other uses for SSRI's | treatment of dysthmia, pre-menstrual dysphoria, postpartum depression, bipolar disorder. used for anxiety disorders/phobias, panic disorder, PTSD< generalized anxiety disorder, OCD, addiction, eating disorders, headaches, schizzotypal disorders
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| Increased suicidality in young patients and adolescent on antidepressants | a metanalysis of 24 studies showed an increase risk when starting drug use, risk in untreated group;2/10..in treated group 4/10. New FDA warnings; change in drug materials, recent research has showed no correlation between antideps and suicide,
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| re-interpretation of anti depressants | anti-deps are only partially effective, 0f 2,000 receiving antideps expect: 1 will make a serious suicide attempt, 800 will still have serious depresion to augment treatment psychotherapy..abilify (aripiprazole) or lamictal (lamotrigine)better to be treat
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| Other anti-depressants | wellbutrin (bupropion, DRI+5ht agonist) some seizure risk; can worsen anxiety disorders, trigger panic) SNRIs dual action(increases NE and 5HT) examples Effexor, Cymbalta, Remeron, NRIs(Vestra, Edronaz, Strattera) affect NE only, Desryel promotes sleep
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| St. Johns-Wort (Hypericum Perforatum) | active ingredient hypericin, effective for treating mild moderate depression (not for severe) takes several weeks to work, combination of SSRI and MAOI actions, side effects of restlessness and stomach upset, don't use with other antideps
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| The Monoamine Theory | old theory:modd depends on adequate levels of monoamine, availability is not enough however, the effectiveness of the drug takes weeks, hypothesis is that having a improved mood depends on a slower CNS synapse
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| Depression as a brain disease | research shows depression is associated with stress induced loss of neurons, antidepressants also be theraputic because they increase neurotropic or nerve growth factors that may reverse this pathology/prevent further neuron loss
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| Bipolar Disorder-manic depressive disorder | disordered mood includes not only periods of depression but also periods of abnormally elevated mood,l
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| symptoms of Bipolar | symptoms;inflated self esteem, decreased need for sleep, increased speech and thoughts, energy, excitement, impulsive behavior, delusional, social sexual increase, purchasing and working....20-25% increase in suicide risk if untreated
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| mood stabilizers for bipolar disorder | drug of choice has been lithium carbonate, seems to increase reuptake and alter receptor sensitivity but the way it moderates both extremes of mood is really not understood.
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| lithium carbonate effects/actions | takes 7-10 days to act, 2-3 weeks for maximal effects, 60-80% effectiveness in reducing manic episode, that level is not typically maintained (around 50% control) miss highs and feeling good so don't want drug treatment
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| element Lithium | akali metal like sodium or potassium, is usually consumed as a salt side effects:thirst, increased urination, gastric upset, tremor, skin problems, weight gain, cognitive slowing.
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| lithium problems | need regular blood tests to assure therapeutic levels to avoid non effectiveness and lethalness, when toxic can cause increased side effects, seizures and comas can occur
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| alternatives for mania that are taking over number 1 drug | tegretol,valproate/divalproex used for controlling seizures but can also stabilize mood. works faster than lithium. new neuromodulator anticonvulsants look promising, lamotrigine, also good for other agitated, aggressive, anger..antipsychotics used too
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| antipsychotic medications | used to treat psychoses/aka neuroleptics, major tranquilizers, and anti-schizophrenics...
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| Schizophrenia syndrome | (positive symptoms)hallucinations, delusions, disordered thought, inappropriate emotion, often bizarre behavior/speech, (negative symptoms) normal emotion lost, decreased motivation, decreased social interaction, decreased speech
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| first typical/traditional antipsychotics | phenothiazines, 1950's-chlopromazine (thorazines) became first antipsychotic..considered wonder drug for its time. chemically complex-blocks or decreases the action of DA, NE, 5Ht,Ach, and histamine
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| other traditional antipsychotic | .others:mellaril, stelazine, proxilin, differ potency/side effects. inexpensive and long acting; injecting forms available...
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| Main side effects | most troubling is extrapyramidal motor disorders, affects the basil ganglia, dry mouth, blurred vision, constipation, sedation, decreased response to stimuli, low blood pressure, disturbed hypothalamic functions; skin photosensitivity
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| important Neuro transmitter in Schizzophrenia | dopamine is main one involved. a lot of synapses occur in limbic system, also important in frontal lobe, affects not just schizophrenia but other functions
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| dopamine hypothesis | schizophrenia is associated with excessive dopamine activity in brain, if blocked than behavior becomes more normal.
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| support for DA hypothesis | effectiveness of typical anti-psychotic is strongly correlated with dopamine blockage, drugs that only block DA work well, drugs that increase DA cause more schizophrenic symptoms. brains of schizzos show more abnormalities in DA activity.
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| evidence against DA hypothesis | other transmitters (serotonin and glutamate) are involved, blocking DA receptors primarily decreases symptoms.
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| extra pyramidal motor symptoms/effects | parkinson's-like decreased movement (akinesia) in over 30%, involuntary movements of face/limbs (dyskinesia) 20% compulsive restlessness (20%) sometimes strong involuntary muscle spasms(2%) drugs like artane, congentin treat side effects
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| Tardive Dyskinesia (TD) | most common involuntary movement pattern. involves movement of lips and facial movements. may appear in15-25% after 2+ yrs of use; more common with more use of drug, may continue after the drug use, may get worse(permanent)..
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| newer atypical antipsychotic, improvements over old drugs.. | prototype:clozaril (clozapine) block specific DA and 5ht receptors, fewer extrapyramidal side effects, helps more people, improvement of negative symptoms, less suicides,
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| side effects of atypical antipsychotics | side effects:weightgain, constipation, sedation. but can cause agranulocytosis in 1-2% so requires blood monitoring..
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| other examples of newer atypical antipsychotics | risperidone, olanzapine, quetiapine,zirprasidone...show less agranulocytosis, but may not be quite as effective as clozapine in all areas, shown to have less weight gain and diabetes, more anxiolytic and antidepressants
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| Other uses for antipsychotics | other psychotic conditions; some bipolar cases, anti-aggression, agitation. some developmental disorders like autism, decrease symptoms of huntington's disease and tourette syndrome, anti-nausea, anti-itching, treat intractable hiccups;
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| forms available marijuanna/cannabis | marijuana, bhang, leaves, fine stems, some flowers/seeds Sinsemilla, Ganja- leaves and flowers from unpollinated female plants, hashish, charas, dried resin from female flowers, hash oil is used to extract THC from plant, HASHISH MOST POTENT
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| concentration | cannabis indiga is strongest available, they were weaker concentrations in the 60's to the 80's (1-3%) now stronger (5-6%)
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| Active ingredients in cannabis | major psychoactive ingredient: delta 9 tetrahydrocannabinol (THC) dose depends on how much one smokes, same with tobacco, only a fraction of THC is absorbed, 60 or more related cannabinoids in pot are psychoactive, others may modulate action of THC.
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| cannbinoid receptors | 1990-found THC binds to specific receptors (CB1) in limbic system, cortex, motor system, spinal cord but not brainstem..other receptors in immune system, anandamide is the natural receptor (may be others) THC is a amandamide agonist..
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| oral route in cannabis | slower less complete absorption-2-3 hr delay in action, other compounds likely to be absorbed as well- more chance of nausea "hangover" more side effects....
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| cannabis common body effects | red eyes, droopy eyelids, dry mouth and throat, increased pulse, Blood pressure, muscle relaxation, impaired coordination, mixed bronchial effects...
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| effects on appetite | dose dependent effect on appetite (higher less munchies)
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| cannabis effects on sex | dose dependent effect on sexual function, higher less function, decreased hormones....
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| common psychological effects cannabis | relaxation sedation, euphoria; but labile mood changes, intensifies emotions, sensory enhancement, impaired short-term memory & learning, impaired attention, longer reaction time, impaired visual tracking spatial processing, decreased problem solving,
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| side effect problem of cannabis | impairments outlast high-half life=30 hrs...
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| impairment of driving cannabis | 40% of those under 30 in accidents have cannabis in system, twice as likely to be ticketed as non users, even greater impairment when combined with alcohol; affects perception, judgment, vigilance, reaction time, steering
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| Cannabis vs tobacco smoke | cannabis has more tars, carcinogens;not filtered..however smoke less but inhale more. decrease in ciliated cells that clean lungs out can cause joint cough/bronchitis, 1-3 joints=that of 5-15 cigarettes..can contain contaminants
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| short term cannabis risks | short term include driving, increased pulse, attention and memory, 25,000 emergencies involve cannabis each yr
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| long term of cannabis | long term risk to lungs; may lower fertility; adverse effects on fetus; suppresses immune system, not sure how much it affects, heavier use/higher potency..dependency can occur
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| dependency of cannabis | occassional use-no physical dependency-may develop a psychological dependency, higher dose regular use can produce tolerance and delayed withdrawal syndrome
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| withdrawal syndrome of cannabis | restlessness, irritabaility, craving, insominia, aches, sweating anxiety,depression, nausea,cramping, now being studied with newly discovered anandamide antagonists
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| possible useful effects of cannabis | anti-nausea and appetite-stimulant, analgesic, euphoric to ease suffering, relaxation on muscles for muscle tension related disorders, can reduce glaucoma (other drugs available) can be used for acute asthma attacks...
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| decriminalization of medical use of marijuanna | conflict between federal and state, concern about medical cannabis being distributed recreationally
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| legal prescription cannabinoids | marinol (dronabinol) 2.5 mg capsules, most patients prefer marijuana because it is faster through smoking use, able to titrate dose, perceived as more effective...
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| Hallucinogens | have similar chemical structure to serotonin
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| LSD history | created by Albert Hoffmann for Sandoz Pharmaceuticals, was studying vasoconstriction produced by ergot alkaloid, initial exposure was accidental absorption thru skin, so potent ED is in millionths of a gram (25-250micrograms)
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| characteristics of LSD and other typical hallucinogens | autonomic changes occur first, sensory/perceptual changes follow, cognitive changes occur even later, hallucinogenic effects last 6-10 hours rapid tolerance but no dependence quality of effects very user-dependent
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| common effects of LSD | sensory distortions (color, size, shape, movement) constantly changing, vivid closed eye imagery, synesthesia (crossing of senses) altered recognition, feelings of novelty, altered body image and feelings of self, decreased logic and reality testing
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| brain areas for cannabis | limbic systems
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| half life of cannabis | 30 hours
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| risks of hallucinogenic amphetamines | increased hr/pressure, dehydration...
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| traditional hallucinogen with shortest time course | DMT (lunch break drug)
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| poisoning effects of antichlonergic hallucinogens influence what? | parasympathetic..
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| schizophrenic symptoms most responsive to typical antipsychotics | blocks positive symptoms of schizzo
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