Actual Unit 2 Flashcards
Main Types of Antidepressants
Barbiturates
Benzodiazepines
Anxiolytic / Downer
Recreational drugs of abuse that produce a relaxing (usually good) feeling
-anti-anxiety
Anxiogenic
Opposite of anxiolytic, causes anxiety
Anticonvulsants / Sedative-Hypnotics
Sedating, sleepy, ect.
-Sleeping pills
-Date rape drugs - Cause unconsciousness and amnesia
-“Truth serum” - Causes mental errors and makes person easy to suggestion
-Can stop or prevent seizures
GABA’s Effect in the Brain
Typical depressant drugs are modulators, binding at receptors, helping GABA inhibit neurons by allowing more Cl- (chloride) into the cell
-GABA-A receptor subtype
-Made of 5 proteins (subunits)
-Arranged like flower petals
-GABA-A receptor has multiple binding sites.
Benzodiazepines
GABA-A Modulators
-Change shape of receptor, making it easier for GABA to bind to it
-Safer, they’re Sched. IV
-Main medication for anxiety disorders now
-Discovered accidentally
-OD very rare but still risky (when driving or mixing with other substances)
Side effect of benzos
-Teratogens (birth defects)
-Cognitive impairments (loopy, foggy mind)
-Not very good for elders to take
-Sedatives (bad for driving)
-Poor interaction with other drugs
GHB (Gamma-hydroxybutyrate)
A neurotransmitter, an active metabolite of GABA that normally is present in the brain in lower quantities than what people abuse
-Sch I
-Used to poison people
-Odorless, colorless, and dissolves easily in liquids
-Usually in the form of sodium GHB (salty, not easily detected)
-Is an agonist at a GABA-B receptor
-Metabolized and excreted quickly: 1-4 hours effect, 24 hours in the system
-Nicknamed “Liquid ecstasy” when powder is dissolved into a liquid
GHB “Liquid ecstasy” Effects
High dose: Depressant effects
Low Dose: Alcohol w/out the hangover: euphoria and feelings of higher sex drive and social positivity
“Odd” GHB actions
Through a non-GABA action, GHB increases the production of human growth hormone (hGH)
-used as a performance-enhancing drug
-treat the sleep disorder narcolepsy
-at low doses to prevent alcohol cravings
Types of Anxiety Disorders
-Generalized Anxiety Disorder (GAD) - a person has excessive anxiety or worry more days than not, touching many different aspects of their life
-Specific Phobias
-Panic Disorder
-Social Anxiety Disorder
-Anxiety from other disorders (depression, PTSD, OCD, substance abuse, ect)
Preferred anxiety treatment
Benzodiazepines
Healthy Sleep
Stage 3 and 4 - Very deep sleep, with slow breathing and heart rate, and they can be very difficult to wake up.
Rapid Eye Movement (REM) sleep - INC brain activity and breathing rate, and the sleeper may have their most vivid dreams.
-REM sleep is important when people are sleep deprived, their next night of sleep features a lot of REM.
REM Rebound
Brain almost demanding you catch up on REM sleep after not having it
Z-Drugs
Best known modern sleeping pill.
-Work like benzodiazepines w/ different chemical structure (called benzodiazepine agonists).
-Zolpidem (Ambien®) and eszopiclone (Lunesta®). AKA Z-drugs.
Halcion® and Restoril®
Used to treat insomnia
-Only meant to be used for 7-10 days, because of addiction liability, and their negative effects on REM.
Other Sleep Medications
Ramelteon (Rozerem®) affects melatonin.
-Better at restoring normal sleep cycling than GABA-acting drugs
-People also take antihistamines (such as Benadryl®), because they are available over the counter, but these too can interfere with REM sleep.
Antidepressants as Anti-convulsants
Valproate, valproic acid, topiramate, and carbamazepine are used to prevent seizures. Benzodiazepines and barbiturates are also used (risk of tolerance and dependence).
Depressant Interactions
Depressants amplify the effects of other depressants.
-Adding a 2nd (or 3rd) depressant onto one can turn mild sedation into a stupor
-Confusion, intoxication, severe motor slowing, and incoordination
-Sleep into unconsciousness, coma, or death.
Depressant Abuse and Addiction
-It is said that barbiturates are more desirable than benzos
-Sedative, Hypnotic, or Anxiolytic Use Disorder in the DSM 5
-Tolerance and physical dependance
-Used to ween someone off of another drug
Depressant Withdrawal
-Benzo and Barb can be fatal
-Agitation, twitching, shaking, oversensitivity of the senses, and psychosis, convulsions or death
-Present in alcohol withdrawal because of its effect on the GABA-A receptor
Depressant OD
BARB:
-Inhibition of the brain to the point breathing is suppressed
-Spike during WWII and famous celebrity deaths
Benzos (more rare):
-Being more risky with benzos because of their perceived safety
-Most safe when taken ALONE
Euthanasia and depressants
-Death penalty, animal mercy killing, and physician assisted suicide
-Use of barbiturates, pancuronium, and potassium chloride to anesthetize people.
-Thiopental was the barbiturate used until Europe, the country who best produced it, stopped making it after outlawing the death penalty. This leads to the US trying to get it from questionable sources and few doctors who would use it.
Depressants and Interrogations, the “truth serum”
Depressants used to be used during interrogations, but it turns out that there are no drugs that will make someone tell the truth, only those that make people extremely suggestive.
-1960s drugs were banned for use during interrogation
Date Rape Drugs
Roofies, Ketamine, Alcohol, and GHB. Roofies:
-Unconsciousness and amnesia
-Sched. IV
-Rohypnol turns blue in a drink (ON BRAND)
-Odorless and tasteless
-Takes effect in 15-20 minutes, lasting 4-6 hours
-Can be detected in urine for 72 hours or more, depending on the dose and other factors
First Generation Antipsychotics
Dopamine receptor antagonists
-Typical antipsychotics
-Can cause Parkinson’s like syndromes (Tardive Dyskinesia and Extrapyramidal Syndrome (EPS) aka Thorazine shuffle)
-Brain Atrophy and Disorganization
DA Hypothesis
Antipsychotics antagonize the D2 receptors.
-Not as a simple dopamine imbalance.
-Antipsychotics can take weeks to take effect despite blocking receptors in minutes
-Ventricles and sulci in the brain are larger in those with SCZ. In the hippocampus, there is a lot of cell misconnection.
Second Generation Antipsychotics
serotonin-dopamine antagonists
-Atypical antipsychotics (esp 5-HT2A)
-Less parkinson syndrome
-Less neg symp
-Dirty drug (blocking positive symptoms as well)
Side effects of 2nd generation antipsychotics
-Agranulocytosis - Drop white blood cells
-Weight gain and metabolic issues
*Child obesity and gynecomastia issues
-Stroke (giving it a black box warning)
-TD and akathisia (can’t sit)
-Suicide
-Abnormal heart rhythm
Major Depressive Disorder (MDD)
Sadness, hopelessness, guilt, worthlessness, anhedonia, and/or lack of energy
-More understood
-Negative views
-Anhedonia - Lack of pleasurable feelings
-Sleep and eating problems
-Lack of motivation
-Suicidal thoughts or actions
Monoamine Hypothesis
Depletion in the levels of SA, norepinephrine, and/or DA in the CNS
-Cause diet restriction
SSRIs
Selective serotonin reuptake inhibitors
SNRIs
Serotonin–norepinephrine reuptake inhibitor
Benefits and side effects of taking depression medication
-40-50% symptom reduction, 30-40% with placebo
-Also used for anxiety, OCD, PTSD, and pain
-Suicidal thoughts
-Sexual dysfunction
-Withdrawal
Bipolar Disorder
Cycles of mania
-Lithium treatment
-Anticonvulsants
-Atypical antipsychotics
Parkinson’s disease
Neurodegenerative Disorder
-L-Dopa, dopamine agonists
Alzheimer’s Disease
Neurodegenerative Disorder
-Block cholinesterase enzyme
Opium
derivative, coming from poppy plants
-Called “joy plant”
-Synthetic and semisynthetic drugs
-Sched. III
-Plant has a milky resin that can be dried
Opiates
Psychoactive chemicals that grow naturally in a certain kind of poppy plant (papaver somniferum)
Opioids
All drugs that act the way that opium does
-Includes synthetic drugs such as fentanyl
-Agonists that mimic the natural effects of endorphins
4 Chemicals present in opium
Morphine (15% of dried opium)
Can cause a positive drug test if consuming poppy seeds
Codeine (1-3% of dried opium)
Thebaine - Has a similar enough chemical structure to morphine that it is used as a precursor when making opioid drugs
Papaverine - Used medicinally as a muscle relaxant for certain conditions
Semisynthetic Opioids
Made by modifying the chemical structure of morphine, codeine, or thebaine. Heroine is most commonly known.
-Oxycodon
Synthetic Opioids
Not made by altering the structure of natural opiates.
-Fentanyl
-Methadone
Pharmacodynamics of Opioids
Opioids are agonists at the μ (mu) endorphin (or opioid) receptor.
-Delta (𝜹) and Kappa (𝟆)
Endorphines
Keys to opioid receptors
Opioid antagonists
The mu receptor can be blocked by antagonists:
-Naloxone and naltrexone.
-Are used to reverse overdose and are also part of strategies to decrease abuse.
Effects of Opioids
Euphoria
Pain killing
Warmth
Nausea and vomiting
Respiratory and cough suppression (possibly fatal)
Constipation
Sensorimotor depression
Itching
Diarrhea
Analgesia
Causing you to not feel pain
-Opioid receptors in the spinal cord
-Doesn’t work against neuropathic pain (damage to NS)
Signs of opioid abuse
-Sensorimotor Depression - DEC response and coordination
-Pinhole pupils in the eyes - Particularly when it’s dark and one would expect wide pupils
-Weight loss - appetite suppression
-Tracks or Track Marks - Bruises or scabs along veins from repeated injection due to the injection itself
*Opposite arm of dominant
*Long sleeves to cover
Patterns of abuse in US
Use and abuse pre-date the Revolutionary War, and have been a major issue since the late 1800s.
-The 1990s saw the introduction of prescription painkiller tablets such as Oxycontin® (oxycodone), Vicodin® (hydrocodone and acetaminophen), and Percocet® (oxycodone and acetaminophen).
Overprescribing Pain Killers
-Aggressive marketing from pharmaceutical companies
-Bonuses for Drs prescribing them
-Pain is 5th vital sign
-Tried to say they’re less addictive than older pain killers, causing Oxytocin to lose millions
Opioid Diversion
Made for medical purpose and diverted into illegal uses
-Oxycodone or hydrocodone pills
-Fentanyl
-Cough syrups
-FDA approved opioids