Psychotropic Drugs

Mental health dysfunction

Can be caused by drugs (LSD, prednisone), hormonal imbalances (thyroxine, cortisol), infections (AIDS, encephalitis), or trauma.

Neurotransmitters

Chemicals involved in mental health, including Dopamine (DA), Serotonin (5-HT), Norepinephrine (NE), Gamma-Aminobutyric Acid (GABA), and Glutamate.

Dopamine (DA)

Overactivity linked to schizophrenia; regulates movement and reward.

Serotonin (5-HT)

Low levels linked to depression and anxiety.

Norepinephrine (NE)

Involved in mood, attention, and arousal.

Gamma-Aminobutyric Acid (GABA)

Inhibitory neurotransmitter; abnormalities linked to anxiety.

Glutamate

Excitatory neurotransmitter; implicated in schizophrenia and mood disorders.

Pharmacodynamics

How drugs affect the body (agonists vs. antagonists).

Agonists

Activate receptors (e.g., SSRIs increase serotonin).

Antagonists

Block receptors (e.g., antipsychotics block dopamine).

Pharmacokinetics

How the body processes drugs (absorption, distribution, metabolism, excretion).

Metabolism

Occurs in the liver (CYP450 enzymes).

Pharmacogenetics

Genetic differences impact drug metabolism (CYP450 variations).

Benzodiazepines

GABA enhancers used to treat anxiety; examples include Diazepam (Valium), Lorazepam (Ativan), Alprazolam (Xanax).

Non-Benzodiazepine Sedatives (Z-Drugs)

Act on GABA receptors but have fewer muscle-relaxant and anticonvulsant effects than benzos; examples include Zolpidem (Ambien), Zopiclone (Imovane).

Buspirone (Buspar)

Anxiolytic without dependence; mechanism: Partial serotonin (5-HT1A) agonist.

Selective Serotonin Reuptake Inhibitors (SSRIs)

Block serotonin reuptake → more serotonin available in the synapse; examples include Fluoxetine (Prozac), Sertraline (Zoloft), Escitalopram (Lexapro).

Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)

Increase serotonin & norepinephrine; examples include Venlafaxine (Effexor), Duloxetine (Cymbalta).

Tricyclic Antidepressants (TCAs)

Block serotonin & norepinephrine reuptake; examples include Amitriptyline (Elavil), Nortriptyline (Pamelor).

Monoamine Oxidase Inhibitors (MAOIs)

Inhibit MAO enzyme → increased monoamine neurotransmitters; examples include Phenelzine (Nardil), Tranylcypromine (Parnate).

Hypertensive crisis

Can occur if MAOIs are taken with tyramine-rich foods (aged cheese, wine, cured meats).

Anxiety medications (anxiolytics)

Reduce excessive worry, panic, and nervousness by calming the central nervous system (CNS).

Generalized Anxiety Disorder (GAD)

A condition treated by anxiety medications.

Panic Disorder

A condition treated by anxiety medications.

Social Anxiety Disorder

A condition treated by anxiety medications.

Obsessive-Compulsive Disorder (OCD)

A condition treated by anxiety medications.

Post-Traumatic Stress Disorder (PTSD)

A condition treated by anxiety medications.

Side Effects of Benzodiazepines

Drowsiness, dizziness, confusion, risk of dependence/addiction, withdrawal symptoms (seizures, rebound anxiety).

Buspirone (Buspar)

Non-Addictive Anxiolytic used for Chronic anxiety (GAD).

Mechanism of Buspirone

Partial serotonin agonist.

Side Effects of Buspirone

Dizziness, nausea, headaches.

Patient Teaching for Buspirone

Takes 2-4 weeks for full effect, no sedation or dependence.

Selective Serotonin Reuptake Inhibitors (SSRIs)

First-Line for Chronic Anxiety.

Examples of SSRIs

Sertraline (Zoloft), Escitalopram (Lexapro), Fluoxetine (Prozac).

Side Effects of SSRIs

Insomnia, sexual dysfunction, serotonin syndrome.

Beta-Blockers

Used for Performance Anxiety.

Examples of Beta-Blockers

Propranolol (Inderal).

Mechanism of Beta-Blockers

Blocks adrenaline → prevents physical symptoms of anxiety (e.g., fast heartbeat, sweating).

Patient Teaching for Anti-Anxiety Medications

Avoid alcohol & sedatives (increased CNS depression).

Types of Antidepressants

Includes SSRIs, SNRIs, TCAs, and MAOIs.

Mechanism of SSRIs

Blocks serotonin reuptake → increases serotonin levels.

Side Effects of SSRIs

Sexual dysfunction, insomnia, agitation, serotonin syndrome (if combined with MAOIs, St. John's Wort).

Patient Teaching for SSRIs

Takes 4-6 weeks for full effect, do not stop abruptly.

Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)

Blocks serotonin & norepinephrine reuptake.

Examples of SNRIs

Venlafaxine (Effexor), Duloxetine (Cymbalta).

Side Effects of SNRIs

Similar to SSRIs + high blood pressure risk.

Tricyclic Antidepressants (TCAs)

Older, Used for Severe Depression & Pain.

Examples of TCAs

Amitriptyline, Nortriptyline.

Side Effects of TCAs

Sedation, dry mouth, constipation, orthostatic hypotension, cardiac toxicity.

Monoamine Oxidase Inhibitors (MAOIs)

Last Resort for treatment.

Examples of MAOIs

Phenelzine (Nardil), Tranylcypromine (Parnate).

Risk of MAOIs

Hypertensive Crisis with Tyramine Foods (cheese, wine, aged meats).

Patient Teaching for Antidepressants

Do not stop abruptly (risk of withdrawal symptoms).

Lithium

Gold Standard for Bipolar Disorder (manic & depressive episodes).

Mechanism of Lithium

Affects serotonin & glutamate to stabilize mood.

Side Effects of Lithium

Tremors, weight gain, thirst, polyuria, hypothyroidism, kidney damage (long-term use), lithium toxicity (confusion, vomiting, seizures).

Anticonvulsants as Mood Stabilizers

Examples include Valproate (Depakote), Carbamazepine (Tegretol), Lamotrigine (Lamictal).

Side Effects of Anticonvulsants

Weight gain, liver toxicity (Valproate), rash (Lamotrigine).

Typical Antipsychotics

Used for Schizophrenia, psychosis, agitation.

Examples of Typical Antipsychotics

Haloperidol (Haldol), Chlorpromazine (Thorazine).

Mechanism of Typical Antipsychotics

Dopamine D2 receptor blockade → reduces positive symptoms (hallucinations, delusions).

Side Effects of Typical Antipsychotics

Extrapyramidal Symptoms (EPS), Neuroleptic Malignant Syndrome (NMS), Hyperprolactinemia.

Atypical Antipsychotics

Used for Schizophrenia, bipolar disorder, psychosis.

Examples of Atypical Antipsychotics

Risperidone (Risperdal), Olanzapine (Zyprexa), Quetiapine (Seroquel), Clozapine (Clozaril).

Mechanism of Atypical Antipsychotics

Block Dopamine (D2) & Serotonin (5-HT2A) → treat both positive & negative symptoms.

Side Effects of Atypical Antipsychotics

Metabolic Syndrome (weight gain, diabetes, high cholesterol), Less risk of EPS compared to FGAs, Clozapine Risk: Agranulocytosis.

Extrapyramidal Side Effects (EPS)

Movement disorders caused by dopamine blockade from antipsychotics.

Acute Dystonia

Muscle spasms (neck, eyes).

Akathisia

Restlessness, pacing.

Parkinsonism

Tremors, rigidity, slow movement.

Tardive Dyskinesia

Involuntary face & tongue movements (long-term).

Neuroleptic Malignant Syndrome (NMS)

A life-threatening reaction to antipsychotics.

NMS Symptoms

High fever, muscle rigidity, altered mental status, autonomic instability.

NMS Treatment

STOP the antipsychotic, give Dantrolene (muscle relaxant).

Metabolic Syndrome

Common with atypical antipsychotics.

Metabolic Syndrome Symptoms

Weight gain, High blood sugar (diabetes risk), High cholesterol.

Metabolic Syndrome Prevention

Monitor diet, exercise, and blood sugar levels.

Lithium Carbonate

Affects neurotransmitter balance, protects neurons.

Lithium Risks

Low therapeutic index, toxicity (tremors, seizures, kidney damage, hypothyroidism).

Lithium Requirements

Blood level monitoring, hydration, stable sodium intake.

Anticonvulsants

Valproate (Depakote), Carbamazepine (Tegretol), Lamotrigine (Lamictal).

Anticonvulsants Mechanism

Reduce excitability, increase GABA.

First-Generation Antipsychotics

Examples: Haloperidol (Haldol), Chlorpromazine (Thorazine).

First-Generation Antipsychotics Mechanism

Dopamine D2 receptor blockade → reduces positive symptoms (hallucinations, delusions).

First-Generation Antipsychotics Side Effects

EPS (Extrapyramidal Symptoms): Muscle rigidity, tremors, tardive dyskinesia.

Second-Generation Antipsychotics

Examples: Clozapine (Clozaril), Risperidone (Risperdal), Olanzapine (Zyprexa).

Second-Generation Antipsychotics Mechanism

Block dopamine (D2) & serotonin (5-HT2A) receptors → treat both positive & negative symptoms.

Second-Generation Antipsychotics Side Effects

Metabolic syndrome: Weight gain, diabetes risk, hyperlipidemia.

Dopamine (DA)

Schizophrenia (high DA), Parkinson's (low DA).

Serotonin (5-HT)

Depression, anxiety.

Norepinephrine (NE)

Mood disorders, ADHD.

GABA

Anxiety, seizures.

SSRIs & SNRIs

Increase serotonin/norepinephrine (depression).

Benzos

Enhance GABA (anxiety, seizures).

Neurotransmitters

Chemicals that transmit signals across synapses between neurons.

Neurotransmitter Function Steps

Synthesis, Storage, Release, Binding, Deactivation.

Serotonin (5-HT) Function

Regulates mood, sleep, and appetite.

Dopamine (DA) Function

Affects motivation, reward, and movement.

Gamma-aminobutyric acid (GABA)

The main inhibitory neurotransmitter, reducing brain activity.

Norepinephrine (NE)

Involved in alertness and arousal.