CDC Module 2.4: Psychopharmacology

Psychoactive Properties

• Substances focused on chemical interactions with the brain

Psychoactive Drug Action

• Simple interaction between drugs and their receptors

Psychoactive Drug Effect

• The widespread changes in physiological or psychological function

What are the 10 major classes of psychoactive drugs?

• Antipsychotics

• Antidepressants

• Antianxiety (Anxiolytics)

• Mood Stabilizers

• Stimulants

• Depressants

• Hallucinogens

• Opiates

• Inhalants

• Cannabis

Antipsychotics

• Used to treat psychotic disorders, such as schizophrenia and bipolar disorder

  • Blocks dopamine receptors in the brain, which can reduce hallucinations and delusions

• Side effects

  • Dry mouth

  • Dizziness

  • Weight gain

  • Blurred vision

  • Fluid retention

• Adverse effects

  • Tardive dyskinesia

• Drug interactions common (pts likely to receive chronic treatment using several medications)

Antidepressants

• Not solely used for depression — can be used for certain anxiety disorders, eating disorders, impulse control disorders

• Side effects

  • Nausea

  • Weight gain/loss

  • Headache

  • Insomnia

  • Agitation

  • Fatigue

• Adverse Effects (under 25 seem particularly at risk)

  • Suicidal thoughts

  • Desire to self-harm

• 6 different classes:

  • SSRIs: Raise serotonin levels

    • Prescribed most often to ease moderate - severe depression

    • Relatively safe, less side effects than other classes

    • Examples include Prozac, Zoloft, Celexa

  • SNRIs: Raise serotonin and norepinephrine levels

    • Used to treat anxiety disorders and chronic pain

    • Examples include Cymbalta, Effexor, Savella

  • NDRI: Raise norepinephrine and dopamine levels

  • TCAs: Like SNRIs, but also affect other parts of brain and body

  • MAOIs: Block recycling of serotonin, norepinephrine, and dopamine

  • Others: Affect serotonin/norepinephrine in different ways

• Alcohol can counteract benefits

Antianxiety (Anxiolytics)

• Used to reduce anxiety but preserve cognitive and physical function

• Used to treat anxiety disorders (panic attacks, phobias, OCD), PTSD, and anxiety that accompanies depression

• Alcohol is the oldest antianxiety agent

• Side effects

  • Sedation

  • Impaired cognitive or motor performance

  • Tolerance

  • Addiction

• 3 types

  • SSRIs (Fluoxetine, Sertraline, Lexapro)

  • Benzodiazepines (Xanax, Klonopin, Valium)

    • Rarely prescribed in MTFs due to chemical composition and addictive properties

  • Barbiturates (ending in barbital)

• During short-term, low-dose therapy, drug interaction is low

  • However, pts who take higher doses over longer periods of time or prior substance abuse are at an increased risk

Mood Stabilizers

• Used to reduce mood swings and prevent manic and depressive episodes

• Treats bipolar disorder, mania, hypomania, mixed episodes, seizure disorders, and trigeminal neuralgia

• 3 types

  • Lithium

  • Anticonvulsants

  • Atypical Antipsychotics

• Should be used with caution when combined with other sedating medications like…

  • Antidepressants

  • Antipsychotics

  • Benzodiazepines

  • Alcohol

Stimulants

• Increases activity in the CNS (known as “uppers”), which increases alertness, attention, and energy

• Treats ADHD, narcolepsy, asthma, obesity, congestion, and hypotension due to anesthesia

• Meth produces the same effect

• 10 types

  • Caffeine

  • Pseudoephedrine

  • Nicotine

  • Cocaine

  • Ice

  • Khat

  • Synthetic Cathinone

  • Amphetamines

  • Betel Nut

  • Methylphenidate

• Can mask the effect of alcohol

• Use with antidepressants = high-risk behavior (could increase serotonin levels)

Depressants

• Suppresses CNS (known as “downers”), which causes sedative, tranquilizing, and hypnotic effects

• Used for insomnia, anxiety, panic attacks, stress, pain, and seizures

• Commonly prescribed benzodiazepines (Diazepam, Lorazepam, Midazolam)

• Alcohol consumption is dangerous and possibly lethal

Hallucinogens

• Changes perception of reality

• Not approved by FDA for treatment (consumed recreationally)

• Can be used to treat addiction, anxiety, MDD, PTSD, and individuals in hospice

• Peyote (mescaline) authorized for use in USAF with an approved religious exemption

• Common types

  • LSD

  • Peyote

  • MDMA

  • Shrooms

• May interact with medications that increase serotonin

Opiates

• Used for acute and chronic pain

• Relieves symptoms of pain or induces euphoria, which can change mood

• 6 most addictive opiates

  • Heroin (I)

  • Fentanyl (II)

  • Morphine (II)

  • Vicodin (II)

  • Oxycodone (II)

  • Methadone (II)

• Taking with depressants increases risk of life-threatening overdose

Inhalants

• Not approved by FDA for treatment; however, it is utilized for medical anesthetics like ether, chloroform, halothane, and nitrous oxide (laughing gas)

• Effects vary, but can induce a psychoactive or mind-altering effect

• Since not approved by FDA, drug interactions are not provided, but they are dangerous by themselves

Cannabis

• Not approved by FDA for treatment (consumed recreationally)

• Produces an enhanced sensory perception and euphoria followed by drowsiness/relaxation

• Off label use for glaucoma, muscle spasms, pain relief, nausea, vomiting related to chemo, anxiety disorders, sleep disorders, Tourette syndrome, and Crohn disease

• Common side-effect of synthetic cannabis is increased heart rate

• Enhances depressant effects when combined with alcohol, antianxiety agents, and depressants