Other Psychotropic Meds

Narcotic-Analgesics (opioids) (act on, uses)

-mimic endogenous opioids (endorphins and enkephalins, neuropeptides produced in CNS and pituitary gland)

-Uses: anesthetics for surgery, pain/analgesic

-methadone only is used for opioid UD (reduces cravings + withdrawal sxs)

Natural and synthetic/semi-synthetic opioids (names)

Natural: opium, heroin, codeine, morphine

Synthetic/semi-synthetic: oxy/hydrocodone, methadone, fentanyl

Methadone (uses, acts on)

-synthetic opioid for opioid UD and treatment-resistant severe pain

-direct opioid agonist (mimicking endorphins + enkephalins) at Mu-opioid receptors

-NMDA receptor antagonist (blocks glutamate, dampens excitatory pain pathways)

-inhibits S and N reuptake

Side effects of narcotic-analgesics

-respiratory depresssion

-pupil constriction, postural hypotension

-constipation

(think opioids have CNS depressant effect, can’t breathe, see, or poop)

Sudden withdrawal from opioids →

-flu-like sxs (initial 24 hrs): yawning, runny nose, watery eyes, muscle aches, fever

-later: high BP, high HR, GI distress (cramps, diarrhea, vomiting)

Opioid overdose leads to

convulsions, coma, death

Two psychedelics that are labeled FDA ‘breakthrough’ drugs

Form of LSD: for GAD

• serotonin agonist, and increases dopamine

Psilocybin: for MDD, treatment-resistant depression

• serotonin agonist, and increases glutamate (neuroplasticity)

Benzos + barbituates (act on)

-increase GABA

Benzodiazepines (names, uses, which ones have slightly longer half-life)

Uses:

-anxiety/insomnia

-seizures (CNS depressant)

-alcohol withdrawal (similar CNS depressant effects as alcohol)

-Diazepam (Valium)

-Alprazolam (Xanax) and Lorazepam (Ativan) – shorter HL, need longer taper

Benzodiazepine withdrawal can be

-life-threatening (withdrawal seizures, delirium, rebound anxiety/depression)

(sudden stopping of GABA inhibition → hyperexcitability)

Barbituate withdrawal can be

FATAL (barbituates are stronger than benzos)

-seizures, delirium, death

(sudden stopping of GABA inhibition → hyperexcitability)

Benzos + barbituates cannot be taken with…

-Alcohol (can be lethal)

-Some high BP medications (→ dangerous drop in BP)

Benzodiazepine Side Effects

(Too much slowing + possible paradoxical effect, esp. in children and older adults)

-sedation + weakness/unsteadiness + cognitive slowing

-anticholinergic effects, sexual dysfunction

-in older adults, benzos process slower (72 instead of 24 hrs): SEs of disorientation/confusion

-paradoxical effect = excitability + anxiety (in children and older adults)

Barbituates Side Effects

(same as benzos + ataxia – even more severe unsteadiness/poor balance)

-sedation + ataxia + cognitive slowing

-paradoxical excitement

Barbituates (names, uses)

-thiopental (Pentothal)

-amobarbital (Amytal), secobarbital (Seconal)

Uses:

-anxiety/insomnia

-seizures

-general anesthetic (even more depressant than benzos)

Azapirone (Buspirone) (use, side effects)

-GAD and other anxiety disorders

-advantage of buspirone: doesn’t cause sedation or dependence/tolerance

-SEs: nausea/dizziness, some initial drowsiness (but not same sedative effects as benzos/barbituates), dry mouth, sweating, headache

Beta blockers/propanolol (act on, uses)

-block SNS activity (epinephrine + norepinephrine)

Uses:

-high BP, heart arrythmias

-essential tremor

-migraine headache

-physiological anxiety

Beta blockers side effects

-low BP

-depression, dry eyes, decreased sex drive

-insomnia

Suddenly stopping beta blockers →

-rebound sxs of all the things it treats (suddenly stopped blocking adrenaline) → high BP, arrhythmia tremors, headaches, confusion

Mood stabilizers for bipolar (which drugs, their names)

1.) Lithium

2.) Anticonvulsants: carbamazepine + valproic acid (for mixed episodes, acute mania)

Why is regular blood testing needed for lithium, carbamazepine, and valproic acid?

Lithium: lithium toxicity (seizures, coma, death)

Carbamazepine: agranulocytocis (extremely low WBC count) + aplastic anemia (bone marrow unable to produce all 3 types of blood cells), and liver failure

Valproic acid: liver failure

Side effects of lithium

-metallic taste, increased thirst (think: to rid of the metal taste)

-hand tremor

-weight gain (ppl don’t like being on lithium)

Lithium pts shake, drink, and gain weight

Anticonvulsant Side Effects

-sedation (sleepy, lethargic)

-ataxia, tremor (unsteady)

-visual disturbances, impaired concentration

Alzheimer’s disease drugs (what type of drugs)

1.) Cholinesterase inhibitors (increase ACh, by blocking cholinesterase enzyme that breaks down ACh)

2.) NMDA receptor antagonists (blocks glutamate) – Memantine, approved for moderate to severe Alzheimer’s

Cholinesterase inhibitors for Alzheimer’s (names)

-Donepezil – only one approved for severe Alzheimer’s

-Tacrine – risk of liver failure and serious SEs, no longer prescribed

-Galantamine

-Rivastigmine

Stimulants (act on, names, additional info)

-increases dopamine + norepinerphrine in PFC (same as bupropion)

-Pemoline (Cylert)

-Methylphenidate (Ritalin, Concerta), Amphetamine-dextroamphetamine (Adderall)

-concern about growth suppression in children––reversible with drug holidays in summers

-in ppl w/o ADHD: increases attention + positive mood (NOT reading comprehension + fluency); worsens WM and academic performance

Other ADHD Medications (prescribed with comorbid tic disorder)

-Atomexetine (Strattera): Norepinephrine reuptake inhibitor; also for sleep and anxiety/depression

-Guanfacine + Clonidine: alpha-2-adrenergic agonists, originally high BP meds (regulates Norepinephrine)

Antidepressants used with ADHD

-desipramine (TCA, secondary amine, Norpramin)

-bupropion (NDRI)

Alcohol use disorder drugs

-Disulfiram (Antabuse) = Deterrent (violent vomiting, throbbing headache, fast HR)

-Naltrexone and Topiramate – targets cravings + pleasurable effects

-Acamprosate – reduces cravings, doesn’t target pleasurable effects of alcohol

Topiramate (Topamax)

-an anti-seizure medication; not FDA-approved for alcohol UD

-Uses: alcohol UD, some evidence for cocaine UD

-reduces cravings + pleasurable effects of alcohol (just like Naltrexone)

Tobacco use disorder drugs

-Nicotine replacement therapy (stable low level nicotine reduces withdrawal sxs that lead to relapse)

-Varenicline – reduces craving + rewarding effects

-Bupropion – reduces cravings + withdrawal sxs

Cocaine Use Disorder drugs

-No FDA approved drugs

-some evidence for bupropion, topiramate, and some psychostimulants (modafinil, dextroamphetamine, mixed amphetamine salts)

TetraHydroCannabinol (THC, acts on)

-main active ingredient of cannabis

-stimulates release of Dopamine in ventral striatum (nucleus accumbens), an essential part of the mesolimbic pathway (dopaminergic reward system)

Dronabinol oral solution (Syndros, uses)

(Think THC munchies)

-For anorexia/appetite and weight loss in AIDS

-and nausea/vomiting in chemotherapy pts

Two FDA-approved psychedelic drugs: form of LSD and Psilocybin (uses, act on)

-both serotonin agonists (think Peter’s depression)

-form of LSD – for GAD; also increases dopamine

-Psilocybin – for MDD, treatment-resistant depression; also regulates glutamate

Half-life of drugs in older adults

e.g., benzos with longer HL are eliminated in 24 hrs; but 72 hrs in older adults

“Go low and slow”

Cross-tolerance

e.g., tolerance to alcohol → tolerance to benzos + barbituates (all CNS depressants)

-tolerance to 1 drug produces tolerance in other drugs of same class

Therapeutic index (TI)

-measures drug’s safety

-ratio of lethal/toxic dose to effective dose

LD50/ED50 or TX50/ED50

Wide vs. narrow therapeutic window

-We want BIG TIs, wide therapeutic windows (TI > 1.0)

-narrow therapeutic window = lethal/toxic dose is ≥ the effective dose (not safe, requires close monitoring)