4. Psychotropic Drugs
and The Brain
A psychotropic drug is one that targets the central nervous system
The brain acts as the control center sending signals through nerve cells
which transmit messages via neurotransmitters.
Some drugs interfere with this process by changing the amount of
neurotransmitters via agonists which bind to a receptor and enhance
neurotransmitter activity and antagonists which bind to a receptor to
decrease neurotransmitter activity.
The more these drugs are used the higher your tolerance becomes which
results in more of the drug for the same effects.
7. The Blood Brain Barrier
The blood brain barrier are the cells that line the blood vessels of the
brain and are squeezed together to prevent materials from coming in or
out
This barrier makes it difficult to construct a pharmaceutical drug to
help with CNS disorders, because many of these drugs can not pass the
Barrier
Parkinson’s disease is a result of loss of neurons that produce
dopamine, treatment with dopamine is ineffective because it can not
cross the Blood-Brain Barrier.
16. Narcotics
These drugs are created from a plant
called opium poppy. The main
function is to bind to opiate receptors
which target the body’s pain relievers.
Agonists-bind to receptors and
activate them creating a dream-like
state and pain relief
Antagonists-bind to the receptors
and block the response to opiates,
these are normally used in drug
overdose
Narcotics include
Morphine,OxyContin, and Heroin
17. Narcotics
These drugs are created from a plant
called opium poppy. The main
function is to bind to opiate receptors
which target the body’s pain relievers.
Agonists-bind to receptors and
activate them creating a dream-like
state and pain relief
Antagonists-bind to the receptors
and block the response to opiates,
these are normally used in drug
overdose
Narcotics include
Morphine,OxyContin, and Heroin
20. Side effects of Narcotics
• Examples include, morphine,
heroin, Dilaudid, and fentanyl,
as well as Oxycodone and
numerous other oral medications
containing opioid compounds
and derivatives
• High potential for addiction
(habit forming)
– Can cause withdrawal symptoms
if stopped abruptly
• Early Symptoms
– Agitation, anxiety, muscle aches,
increased tearing, insomnia, Rhinorrhea
(runny nose), diaphoresis (sweating)
, yawning
21. Side effects of Narcotics
• Examples include, morphine,
heroin, Dilaudid, and fentanyl,
as well as Oxycodone and
numerous other oral medications
containing opioid compounds
and derivatives
• High potential for addiction
(habit forming)
– Can cause withdrawal symptoms
if stopped abruptly
• Early Symptoms
– Agitation, anxiety, muscle aches,
increased tearing, insomnia, Rhinorrhea
(runny nose), diaphoresis (sweating)
, yawning
24. Side effects of Narcotics
• Respiratory Depression
(i.e. hypoventilation,
hypoxemia, respiratory
acidosis)!
– Potentially life-threatening
– More likely to occur in those
who haven’t had morphine
before, as well as in elderly
or
debilitated patients
25. Side effects of Narcotics
• Respiratory Depression
(i.e. hypoventilation,
hypoxemia, respiratory
acidosis)!
– Potentially life-threatening
– More likely to occur in those
who haven’t had morphine
before, as well as in elderly
or
debilitated patients
28. Side effects of Narcotics
– Equally, or perhaps more devastating than death, is the common
phenomenon of anoxic brain injury resulting from respiratory
depression, whereby the person who (typically overdoses) has a
long-term depravation of oxygen from their blood supply,
including that which goes to their brain
• This results in a myriad of vegetative states or even total brain death
• Even though these patients are able to be resuscitated, they usually have
severe limitations in their cognitive and physical functionality, and
either:
– Are chronically hospitalized from anywhere from months to years or a period of a few
years
34. Side effects of Narcotics
• Endocrine/Metabolic Effects
– Alterations in body temperature
– Hypogonadism (low testosterone or gonadotropin and libido)
• Gastrointestinal effects
– Abdominal pain
– Biliary Colic (caused by contraction of the sphincter of Oddi – controlling the flow of
bile into the duodenum)
– Constipation
• This can cause something called parylitic ileus, whereby GI motility ceases, and this can lead to
bowel ischemia, which can be quite deadly
– Diarrhea
– Loss of appetite
– Nausea and vomiting
– Xerostomia (dry mouth)
49. Side effects FYI
• Opioid Strength comparison
• Done in relation of various pain medicine’s strength to that of morphine, i.e., 1mg morphine = 1
‘standard unit’
• Just a few comparisons follow, with most commonly prescribed / abused drugs discussed
• 1mg oral morphine is equivalent to…
– 100mg codeine or Tramadol
– 20mg methadone
– 16.67mg hydrocodone
• These medications in 1mg dosages are equivalent to the specified dosage of oral morphine
– 1mg oxycodone = 5-6mg morphine
– IV morphine = 2.5mg oral morphine
– Heroin = 2.25mg morphine
– Hydromorphone (dilaudid) = 2mg morphine
• Fentanyl, a commonly used pain medicine within the intensive care / hospital environment is
50-100 times stronger than morphine, and is given in dosages of micrograms/hour!
52. Nonprescription Pain
Relief
Aspirin-salicylic acid, belongs to a group known as non-steroid anti-
inflammatory drugs (NSAIDs). In this group is also ibuprofen, Advil,
and Motrin
These drugs inhibit synthesis of prostaglandins, or the chemical
messengers that mediate pain, blood clotting, fever and inflammation.
Tylenol- acetaminophen, is a pain and fever reducer that lacks any
anti-inflammatory benefit.
64. Side effects of OTC
• Acetaminophen (Tylenol)
– Common
• Pruritis
• Constipation, nausea / vomiting
• Headache
• Agitation
• Atelectasis (partial closure / closing of pulmonary alveoli)
– Serious
• Stevens-Johnson Syndrome & Toxic epidermal necrolysis
– Two very similar diseases involving progressive decay and sloughing off of skin tissue.
This can involve anywhere from 50% to 100% of a patients’ skin. Quite rare, but can result
in death.
71. Barbituates/
Benzodiapines
(depressants)
Tranquilizers- reduce
anxiety, while increasing
GABA (the
neurotransmitter that
normally counteracts the
signals that cause fear and
anxiety)
72. Barbituates/
Benzodiapines
(depressants)
Tranquilizers- reduce
anxiety, while increasing
GABA (the
neurotransmitter that
normally counteracts the
signals that cause fear and
anxiety)
75. Side effects of
Depressants
• Including: Barbiturates & Benzodiazepines
• Barbiturates
– Modern use is almost solely for suppression or prevention of
seizures
– Include: phenobarbital, phenytoin (Dilantin), phosphenytoin,
levetiracetam, and Gabapentin
81. Side effects of
Depressants
• Benzodiazepines include…
– Valium (diazepam)
– Ativan (lorazepam)
– Versed (midazolam)
– Xanax (alprazolam)
– Klonopin (Clonazepam)
– Also including date-rape drugs such as rohypnol, GHB, and
Ketamine
– Side effects are very similar for all of these
84. Side effects of
Depressants
• Benzodiazepine side effects ( much more dangerous when
combined with other drugs acting on the brain & CNS)
– With high doses, Central nervous system depression potentially
leads to…
• Respiratory depression / arrest
• Coma
• Hypotension
• Hypothermia
• Rhabdomyolysis (condition in which Fe / Iron is released from
intracellular fluid / tissues into bloodstream, causing acute renal failure
when becoming clogged in the kidneys’ circulation
87. Side effects of
Depressants
• Benzodiazepine side effects also include (at ‘therapeutic doses’)
– Nystagmus, tachycardia, bradycardia, hypotension
– Decreased respiratory rate (sometimes good!)
– Drowsiness, slurred speech, dyskinesia (jittery movement), disorientation
– Nausea / vomiting
– Teratogenic effects (cause fetal abnormalities & spontaneous abortion)
– Habit forming / addictive, leading to withdrawal
• Benzos’ are relied on heavily within the context of ICU and OR patient care, for
their calming action, but also for their side effect of memory loss, which is a good
thing for many ICU patients!
97. •
References
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page3_em.htm#Cocaine Abuse Symptoms
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9th, 2011. Available from http://www.nlm.nih.gov/medlineplus/ency/article/000949.htm
• Micromedex 2.0, available via Shands.org ‘VPN’ network from Shands Teaching Hospitals and
Clinics @ The University of Florida (available to employees only). Retrieved April 10th, 2011 from
https://vpn.shands.org/micromedex2/librarian/ND_T/evidencexpert/ND_PR/evidencexpert/CS/
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Millard, J.; Adventures in Chemistry; Houghton Mifflin: 2008; pp. 356-68.Tough, P.; “The
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