pharm W 9 (mine)

Overview of CNS Depressants and Antidepressants

• CNS Depressants

  • Discussion on Discontinuation: Patients must not stop taking antidepressants without consulting a healthcare provider.

  • Signs of Overdose: Important to communicate overdose symptoms while emphasizing not to abruptly stop medications.

Neuropsych Medications

• Topics Covered: Focus on psychosis agents, substance use medications, and ADHD treatments.

• Psychosis Agents: Divided into first-generation and second-generation antipsychotics (FGAs and SGAs).

  • First Generation (FGAs): More research and studies available; used to treat schizophrenia, psychosis, and bipolar disorder.

  • Differences Between FGAs and SGAs: Primarily historical; FGAs came before SGAs.

Understanding Psychosis and Schizophrenia

• Definitions:

  • Psychosis: Reduced ability to comprehend reality; can be acute and reversible.

  • Schizophrenia: Chronic disorder that includes various forms and is characterized by recurrent episodes.

• Symptoms:

  • Positive Symptoms: Hallucinations, delusions, agitation, disorganized speech.

  • Negative Symptoms: Emotional and social withdrawal, flat affect, lack of motivation, poverty of words.

• Treatment Challenges: Management complexity due to poor understanding of causes, including genetic and neurodegenerative factors.

Antipsychotic Medications

• First Generation Antipsychotics (FGAs):

  • Mechanism of Action: Block numerous neurotransmitters; particularly dopamine.

  • Examples: Thorazine (chlorpromazine) and Haldol (haloperidol).

  • Adverse Effects: Risk of central nervous system (CNS) depression, hypotension, extrapyramidal symptoms (EPS), and tardive dyskinesia.

    • EPS Symptoms: Acute dystonia, akathisia, tardive dyskinesia.

• Second Generation Antipsychotics (SGAs):

  • Examples: Risperdal (risperidone), Clozaril (clozapine), Abilify (aripiprazole).

  • Mechanism of Action: Block dopamine receptors, serotonin receptors, and affect multiple neurotransmitter systems.

  • Adverse Effects: More metabolic side effects such as weight gain, diabetes, and dyslipidemia. Lower remission rate for EPS compared to FGAs.

ADHD and CNS Stimulants

• CNS Stimulants:

  • Types: Amphetamines (Dexedrine, Adderall), Ritalin, Strattera (atomoxetine).

  • Mechanism of Action: Increase levels of norepinephrine and dopamine in the synapse.

  • Adverse Effects: Insomnia, anxiety, weight loss, potential for misuse and dependence.

• Atomoxetine (Strattera): Non-habit forming with lower misuse risk, used as a second-line treatment for ADHD.

Substance Use Disorders

• Substance Use Disorder: Characterized by cognitive, behavioral, and psychological symptoms despite issues caused by substance use.

  • Key Concepts:

    • Withdrawal: Maladaptive behavior and physiological symptoms following reduction of substance use.

    • Tolerance: Increased need for larger doses to achieve desired effects.

• Alcohol Use Disorder Treatments:

  • Librium: For acute withdrawal management.

  • Antabuse (disulfiram): Causes adverse reactions to alcohol consumption, used for sobriety maintenance.

  • Naltrexone: Reduces cravings and relapse risk for alcohol and opioid use.

• Opioid Treatments:

  • Methadone: Used in treatment clinics to help users transition and reduce illicit opioid dependency.

  • Buprenorphine (Suboxone): Used for maintenance therapy while decreasing withdrawal symptoms and cravings.