Other Psychoactive Drugs

Question 1

What do the Sedatives, Hypnotics, and Anxiolytics include?

Answer 1

The sedatives, hypnotics, and anxiolytics include the benzodiazepines, barbiturates, and azapirones.

Question 2

What do the Benzodiazepines include?

Answer 2

The benzodiazepines include diazepam (Valium), alprazolam (Xanax), and lorazepam (Ativan).

Question 3

What do Benzodiazepines do?

Answer 3

These drugs increase GABA activity and are used to treat anxiety, insomnia, seizures, and alcohol withdrawal.

Question 4

What are the side effects for Benzos?

Answer 4

The most common side effects are drowsiness and sedation; others include weakness, unsteadiness, impaired memory and concentration, anticholinergic effects, sexual dysfunction, and, in older adults, disorientation and confusion.

These drugs can have a paradoxical effect and cause excitability and anxiety, and chronic use can result in tolerance, dependence, and withdrawal symptoms, which may cause rebound anxiety and depression, anorexia, delirium, and seizures.

Question 5

What can happen if Benzodiazepines are combined with alcohol?

Answer 5

Combining a benzodiazepine with alcohol can have a synergistic depressant effect that can be lethal. Also, combining a benzodiazepine with certain high blood pressure medications (e.g., central agonists, alpha blockers) can cause a dangerous drop in blood pressure.

Question 6

What do the barbiturates include?
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Answer 6

Thiopental (Pentothal), amobarbital (Amytal), and secobarbital (Seconal)

Question 7

How does GABA work?

Answer 7

These drugs enhance GABA activity and are used as a general anesthetic and as a treatment for anxiety, insomnia, and seizures.

Question 8

What are the side effects of GABA?

Answer 8

Side effects include drowsiness, dizziness, confusion, ataxia, cognitive impairment, and paradoxical excitement. Chronic use can lead to tolerance, dependence, and withdrawal symptoms, and sudden withdrawal can cause seizures, delirium, and death. Like the benzodiazepines, taking a barbiturate in conjunction with alcohol can be lethal.

Question 9

What do Azapirones include?

Answer 9

These drugs include buspirone (BuSpar), which is used to treat generalized anxiety disorder and other anxiety disorders.

Question 10

What are the side effects of Azapirones?

Answer 10

Side effects include dizziness, dry mouth, sweating, nausea, and headache. An advantages of buspirone is that it does not cause sedation, dependence, or tolerance.

Question 11

How do the Narcotic-Analgesics (Opioids) work?

Answer 11

The narcotic-analgesics mimic the effects of the body’s natural analgesics (endorphins and enkephalins) and include the natural opioids (opium, morphine, heroin, codeine) and synthetic and semi-synthetic opioids (methadone, oxycodone, hydrocodone, fentanyl).

Question 12

How are Narcotic-analgesics used?

Answer 12

Narcotic-analgesics are used as a pre-surgery anesthetic and to treat pain, and methadone is used for heroin detoxification. Methadone doesn’t produce the pleasurable effects of heroin, but it does reduce the craving for heroin and withdrawal symptoms.

Question 13

What are the side effects of narcotic-analgesics?

Answer 13

Side effects of the narcotic-analgesics include dry mouth, nausea, pupil constriction, postural hypotension, drowsiness, dizziness, constipation, and respiratory depression, and an overdose can cause convulsions, coma, and death.

Question 14

What does chronic use of narcotic-analgesics leads to?

Answer 14

Chronic use leads to dependence, tolerance, and withdrawal symptoms.

Question 15

What are the withdrawel sxs for narcotic-analgesics?

Answer 15

Initial withdrawal symptoms are similar to the flu (e.g., runny nose, watery eyes, nausea, muscle aches, fever, and yawning); these are followed by insomnia, abdominal cramps, vomiting, diarrhea, rapid heartbeat, and elevated blood pressure.
Note that drug overdose is the leading cause of accidental deaths in the United States, with opioids being the most frequent cause of these deaths (Schiller, Goyal, Cao, & Mechanic, 2020).

Question 16

How do Beta-Blockers work?

Answer 16

Beta-blockers inhibit the activity of the sympathetic nervous system and are used to treat hypertension, cardiac arrhythmias, migraine headache, and essential tremor.

Question 17

What drugs are included as a Beta-Blocker? What is it effective in treating?

Answer 17

These drugs include propranolol (Inderal) which is also used to treat anxiety, with research suggesting that it’s more effective for alleviating the somatic symptoms of anxiety than its psychological symptoms (e.g., apprehension, worry, dread).

Question 18

What are the side effects of propranolol?

Answer 18

Hypotension, decreased sex drive, insomnia, nausea and vomiting, dry eyes, dizziness, and depression.
Abrupt discontinuation is contraindicated because it can cause rebound hypertension, tremors, headaches, confusion, and cardiac arrhythmia.

Question 19

What do mood stabilizers treat? What drugs are do they include?

Answer 19

The mood stabilizers are used to treat bipolar disorder and include lithium and anticonvulsant medications.

Question 20

What is Lithium treat?

Answer 20

Lithium (Eskalith, Lithobid) is the first-line drug for acute mania and classic bipolar disorder (euphoric mania without rapid cycling).

Question 21

What are side effects of lithium?
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Answer 21

Common side effects include nausea, vomiting, diarrhea, a metallic taste, increased thirst, weight gain, hand tremor, fatigue, and impaired memory and concentration. Lithium levels must be regularly checked to avoid lithium toxicity, which can cause seizures, coma, and death

Question 22

What do Anticonvulsant Drugs treat? What are some of the meds?

Answer 22

These drugs are used to treat acute mania and bipolar disorder with mixed episodes and include carbamazepine (Tegretol) and valproic acid (Depakene).

Question 23

What are the side effects of Anticonvulsant Drugs?

Answer 23

Side effects include nausea, dizziness, sleepiness, lethargy, ataxia, tremor, visual disturbances, and impaired concentration. Blood levels must be monitored to avoid liver failure when taking valproic acid or carbamazepine and to avoid agranulocytosis (low white blood cell count) and aplastic anemia when taking carbamazepine.

Question 24

What are the drugs used to treat Alzheimer’s Disease?

Answer 24

These drugs include cholinesterase inhibitors and an NMDA receptor antagonist and are used to slow the progression of Alzheimer’s disease.

Question 25

How do cholinesterase inhibitors work? What are the names of the inhibitors?

Answer 25

The cholinesterase inhibitors delay the breakdown of acetylcholine and include

tacrine (Cognex)
donepezil (Aricept)
rivastigmine (Exelon)
galantamine (Razadyne).

All four have been approved for mild and moderate Alzheimer’s disease, and donepezil has also been approved for severe Alzheimer’s disease.
(Because of the risk for liver failure and other serious side effects, tacrine is no longer commonly prescribed.)

The NMDA receptor antagonist memantine (Namenda) has been approved for moderate to severe Alzheimer’s disease and is believed to exert its effects by regulating the activity of glutamate

Question 26

What are the first-line treatment for ADHD?

Answer 26

Psychostimulants are the first-line pharmacological treatment for ADHD

Question 27

What are the psychostimulants?

Answer 27

Methylphenidate (Ritalin, Concerta), pemoline (Cylert), and amphetamine-dextroamphetamine (Adderall).

Question 28

How do psychostimulants work?

Answer 28

These drugs increase attention and concentration and reduce hyperactivity and impulsivity in children with ADHD, but their effects on academic achievement when used as the sole treatment are unclear. There’s evidence that methylphenidate and other psychostimulants exert their therapeutic effects by increasing dopamine and norepinephrine activity in the prefrontal cortex (Arnsten, 2009).

Question 29

What are the side effects for psychostimulants?

Answer 29

Common side effects are insomnia, nervousness, decreased appetite, weight loss, and abdominal pain. These drugs can also suppress growth in children, but this can be reversed with “drug holidays” during school vacations.

Question 30

How do ADHD drugs enhance cognitive functioning for those who do not have it?

Answer 30

Note that, while some college students and adults without ADHD use stimulant drugs to enhance cognitive functioning, there’s evidence that these drugs increase attention and positive mood but do not improve reading comprehension and fluency and may have negative effects on working memory and academic performance (Weyandt et al., 2018).

Question 31

When are second and third line drugs prescribed for patients with ADHD?

Answer 31

Second- and third-line pharmacological treatments are prescribed when patients with ADHD have an inadequate response to psychostimulants or are unable to tolerate their side effects, have significant comorbidities that interfere with treatment, or are at high risk for stimulant misuse.

Question 32

What are some second-line medications?

Answer 32

Second-line medications include atomoxetine (Strattera), guanfacine (Intuniv), and clonidine (Kapvay).

Question 33

How does Atomoxetine work?

Answer 33

Atomoxetine (second-line medication for ADHD) is a norepinephrine reuptake inhibitor and is the most commonly prescribed nonstimulant drug for ADHD. It has been found to improve the core symptoms of ADHD and to be more effective than stimulants for patients with certain comorbidities such as a tic, sleep, or anxiety disorder or depression.

Question 34

How does Guanfacine and clonidine work?

Answer 34

Guanfacine and clonidine (second-line medication for ADHD) are both alpha-2-adrenergic agonists that were developed as treatments for high blood pressure. They improve the core symptoms of ADHD but are usually prescribed only when patients also have Tourette’s disorder or other tic disorder.

Question 35

What are some 3rd line treatments for ADHD?

Answer 35

Several antidepressants are considered to be third-line pharmacological treatments for ADHD. These include the tricyclic desipramine (Norpramin) and the NDRI bupropion (Wellbutrin) which, like stimulant drugs, reduce symptoms of ADHD by increasing brain levels of dopamine and norepinephrine.

Question 36

What drugs are used to treat alcohol use disorder?

Answer 36

Drugs used to treat alcohol use disorder include:
disulfiram (Antabuse)
naltrexone (ReVia)
acamprosate (Campral)
topiramate (Topamax).

Question 37

What are the dangers of taking Disulfiram with alcohol?

Answer 37

Disulfiram causes nausea and vomiting, shortness of breath, tachycardia, a throbbing headache, dizziness, and other unpleasant symptoms when taken in conjunction with alcohol.

Question 38

How does Naltrexone work? How does it compare with acamprosate?

Answer 38

Naltrexone reduces the pleasurable effects of and craving for alcohol, while acamprosate just reduces craving.

Question 39

How does Topiramate work?

Answer 39

Topiramate is an anti-seizure medication that has not been approved by the FDA for treating alcohol use disorder but is used off-label. Like naltrexone, topiramate reduces craving for alcohol and the pleasurable effects of alcohol.

Question 40

What drugs are used to treat tobacco use disorder?

Answer 40

Drugs used to treat tobacco use disorder include nicotine replacement therapy (NRT), bupropion, and varenicline.

Question 41

What assumptions is NRT based on?

Answer 41

The use of NRT is based on the assumption that a stable low level of nicotine prevents the withdrawal symptoms that often trigger relapse when a person stops smoking.

Question 42

What is Bupropion used for?

Answer 42

Bupropion was originally used to treat major depressive disorder but has also been found to prevent relapse following smoking cessation by reducing nicotine craving and withdrawal symptoms.

Question 43

What is Varenicline used for?

Answer 43

Varenicline reduces nicotine craving, and there’s evidence that it also reduces the rewarding effects of smoking.

Question 44

What is used for Cocaine disorder? What has a recent metanalysis found?

Answer 44

No medication has been approved by the FDA for cocaine use disorder, and the research has not provided strong support for the effectiveness of any particular drugs. However, a recent meta-analysis found that there is some evidence that bupropion, topiramate, and several psychostimulants (e.g., modafinil, dextroamphetamine, mixed amphetamine salts) may be effective for increasing abstinence (Chan et al., 2019).

Question 45

What is the main active ingredient in cannabis?
How does it work?

Answer 45

THC is the main active ingredient of cannabis and exerts its psychoactive effects by stimulating the release of dopamine in the ventral striatum (nucleus accumbens), which is an essential component of the brain’s mesolimbic dopaminergic reward pathway (Bossong et al., 2009).

Question 46

What does Dronabinal contain? What is it approved for?

Answer 46

Dronabinal oral solution (Syndros) contains THC and has been approved by the U.S. Food and Drug Administration for the treatment of anorexia and weight loss for patients with AIDS and for chemotherapy-induced nausea and vomiting for patients with cancer who have not responded to other antiemetic treatments.

Question 47

What is the drug half-life?

Answer 47

The half-life of a drug is the time needed for the blood level of the drug to decrease to 50% of its peak level.

Question 48

What is a drug half-life used to determine?

Answer 48

It’s used to determine the time interval between doses: For drugs with a short half-life, the interval between doses is short, and vice versa.

Question 49

What is the half-life of anxiolytics, antipsychotics, antidepressants like?

Answer 49

Note that anxiolytics, antipsychotics, antidepressants, and many other drugs have a longer half-life for older (versus younger) adults due to age-related changes in the metabolism and elimination of these drugs.

Question 50

What kind of half-life do benzodiazepines have?

Answer 50

Benzodiazepines are categorized as having either a short or long half-life. Benzodiazepines that have a long half-life are ordinarily eliminated from the body in 24 hours but, for older adults, elimination may take more than 72 hours (Eby, Molnar, & Kartje, 2009).

Question 51

What is the rule when prescribing anxiolytics, antipsychotics, antidepressants for older adults?

Answer 51

Because of the increased half-life of many drugs for older adults and their greater sensitivity to the effects of these drugs, the rule of thumb when prescribing them for these individuals is to “start low and go slow” – i.e., to start at a low dose and gradually increase the dose until the desired effects are obtained.

Question 52

When does Drug Tolerance occur?

Answer 52

Tolerance occurs when repeated use of a drug results in a gradual reduction in the drug’s effects, resulting in the need to increase the dose of the drug to produce the effect previously produced by a lower dose.

Question 53

When does Cross-tolerance occur?

Answer 53

Cross-tolerance occurs when tolerance to one drug produces tolerance to other drugs in the same class. For example, alcohol is a central nervous system depressant, and tolerance to alcohol produces tolerance to benzodiazepines and barbiturates, which are also central nervous system depressants.

Question 54

What is the therapeutic index used for?

Answer 54

The therapeutic index (TI) is used to measure a drug’s safety.

Question 55

How is TI calculated in animal studies?

Answer 55

There are several ways to calculate TI. In animal studies, the most common way is to divide LD50 by ED50 (LD50/ED50): LD50 (lethal dose 50) indicates the minimum drug dose that had a lethal effect in 50% of the test sample. A drug with a low LD50 is more lethal than a drug with a high LD50. ED50 (effective dose 50) is a measure of the drug’s effectiveness and indicates the minimum drug dose that produced the therapeutic (desired) effect in 50% of the test sample.

Question 56

How is TI calculated in human-studies?

Answer 56

In human studies, the most common way to calculate TI is to divide TD50 by ED50 (TD50/ED50): TD50 (toxic dose 50) indicates the minimum drug dose that had a toxic (harmful) effect in 50% of the test sample and ED50 is the same as it is for animal studies (Sarker, Sarker, Ghosh, & Sen, 2016).

Question 57

What happens when the ED50 is the same or higher than its LD50 or TD50?

Answer 57

When a drug’s ED50 is the same as or higher than its LD50 or TD50, TI equals 1.0 or less, and the drug is said to have a narrow therapeutic window. Drugs with a narrow therapeutic window are not very safe and require close monitoring because the dose that produces the desired therapeutic effect is equal to or higher than the dose that produces a lethal or toxic effect.

Question 58

What happens when the ED50 is lower than LD50 or TD50?

Answer 58

In contrast, when ED50 is lower than LD50 or TD50, TI is larger than 1.0 and the drug is said to have a wide therapeutic window. Drugs with a wide therapeutic window are most desirable because they are safer: The dose that produces the desired therapeutic effect is lower than the dose that produces lethal or toxic effects.