Chemistryandthe brain

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  • Chemistryandthe brain

    1. 1. Chemistry and the BrainBy Patrick Halks, Jesse Hall and Jordan Hammuck
    2. 2. Psychotropic Drugs and The Brain
    3. 3. Psychotropic Drugs and The BrainA psychotropic drug is one that targets the central nervous systemThe brain acts as the control center sending signals through nerve cellswhich transmit messages via neurotransmitters.Some drugs interfere with this process by changing the amount ofneurotransmitters via agonists which bind to a receptor and enhanceneurotransmitter activity and antagonists which bind to a receptor todecrease neurotransmitter activity.The more these drugs are used the higher your tolerance becomes whichresults in more of the drug for the same effects.
    4. 4. The Blood Brain Barrier
    5. 5. The Blood Brain BarrierThe blood brain barrier are the cells that line the blood vessels of thebrain and are squeezed together to prevent materials from coming in oroutThis barrier makes it difficult to construct a pharmaceutical drug tohelp with CNS disorders, because many of these drugs can not pass theBarrierParkinson’s disease is a result of loss of neurons that producedopamine, treatment with dopamine is ineffective because it can notcross the Blood-Brain Barrier.
    6. 6. Different types of “Brain Drugs”
    7. 7. Different types of “Brain Drugs”Pain RelieversDepressantsStimulants
    8. 8. Pain Relievers
    9. 9. Pain RelieversNarcotic- an addictive drug that dullsyour senses and encourages sleepNonprescription Pain Relief
    10. 10. Narcotics
    11. 11. NarcoticsThese drugs are created from a plantcalled opium poppy. The mainfunction is to bind to opiate receptorswhich target the body’s pain relievers.Agonists-bind to receptors andactivate them creating a dream-likestate and pain reliefAntagonists-bind to the receptorsand block the response to opiates,these are normally used in drugoverdoseNarcotics includeMorphine,OxyContin, and Heroin
    12. 12. NarcoticsThese drugs are created from a plantcalled opium poppy. The mainfunction is to bind to opiate receptorswhich target the body’s pain relievers.Agonists-bind to receptors andactivate them creating a dream-likestate and pain reliefAntagonists-bind to the receptorsand block the response to opiates,these are normally used in drugoverdoseNarcotics includeMorphine,OxyContin, and Heroin
    13. 13. Side effects of Narcotics
    14. 14. 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
    15. 15. 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
    16. 16. Side effects of Narcotics
    17. 17. 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
    18. 18. 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
    19. 19. Side effects of Narcotics
    20. 20. 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
    21. 21. Side effects of Narcotics
    22. 22. Side effects of Narcotics• Cardiovascular Effects – Bradyarrhythmias (slow heart rates leading to aberrant rhythms), cardiac arrest, circulatory depression (dangerously low blood pressure), hypertension, palpitations, peripheral edema (swelling), shock, syncope (passing out), or tachycardia• Dermatologic Effects – Pruritis (itching), rash, recurrent herpes simplex (in someone already infected), sweating, urticaria (localized swollen ‘wheals’, similar to those induced by a positive PPD, or tuberculin skin test)
    23. 23. Side effects of Narcotics
    24. 24. 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)
    25. 25. Side effects of Narcotics
    26. 26. Side effects of Narcotics• Hematologic effects – In patients with Sickle Cell Disease, sickle-cell ‘crisis’ may ensue• Hepatic effects – Liver toxicity – Abnormal liver function tests• Immunologic effects – Anaphylaxis (leading to anaphylactic shock)
    27. 27. Side effects of Narcotics
    28. 28. Side effects of Narcotics• Musculoskeletal effects – Backache – Myoclonus (brief, shock-like jerking)• Neurologic effects – Asthenia (lack of strength / muscular control) – Confusion & dizziness – Increased intracranial pressure – Headache – Insomnia – Lightheadedness – Meniere’s Disease (lead to motion sickness & migraines) – Paresthesia (lack of sensation) – Unwanted sedation – Seizure
    29. 29. Side effects of Narcotics
    30. 30. Side effects of Narcotics• Opthalmic effects – Amblyopia (lazy eye) – Miosis (pupillary constriction)• Psychiatric effects – Anxiety – Capgras’ Syndrome (delusion of family-imposter conspiracy against the patient) – Delirium – Dysphoric / Euphoric mood – Hallucinations & Psychotic disorder
    31. 31. Side effects of Narcotics
    32. 32. Side effects of Narcotics• Renal effects – Nephrotoxicity – Urinary retention• Reproductive effects! – sexual dysfunction – Withdrawal symptoms in the newborn• Respiratory effects (besides respiratory depression) – Pulmonary edema – Irregular breathing – Cough suppression
    33. 33. Side effects FYI
    34. 34. 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!
    35. 35. Nonprescription Pain Relief
    36. 36. Nonprescription Pain ReliefAspirin-salicylic acid, belongs to a group known as non-steroid anti-inflammatory drugs (NSAIDs). In this group is also ibuprofen, Advil,and MotrinThese drugs inhibit synthesis of prostaglandins, or the chemicalmessengers that mediate pain, blood clotting, fever and inflammation.Tylenol- acetaminophen, is a pain and fever reducer that lacks anyanti-inflammatory benefit.
    37. 37. Side effects of OTC
    38. 38. Side effects of OTC• NSAIDS (non-steroidal anti-inflammatory drugs): targeting the COX-1 enzyme – Include: aspirin, ibuprofen – Cox-2 inhibitors • Vioxx• Aspirin (NSA) – Gastrointestinal ulceration and bleeding – Tinnitus (persistent ringing in ears) – Bronchospasm – Angioedema, Reye’s syndrome (usually in children with existing viral illnesses)
    39. 39. Side effects of OTC
    40. 40. Side effects of OTC• Ibuprofen – (relatively) Common adverse effects (many these only reported with IV/intramuscular administration) • Hypotension (mild) • Rash • Hypernatremia, hypoalbuminemia, hypoproteinemia (high blood sodium and low blood protein respectively) • Heartburn, nausea / vomiting, flatulence • Thrombocytosis (elevated platelet levels) • Dizziness, headache • Urinary retention and elevated blood urea nitrogen
    41. 41. Side effects of OTC
    42. 42. Side effects of OTC• Ibuprofen – Serious effects (except for neutropenia, all < or = to 1% chance) • Congestive heart failure, hypertension, heart attack • Stevens-Johnson syndrome, toxic epidermal necrolysis • Gastrointestinal ulceration, perforation, and hemorrhage • Pancreatitis • Anemia, neutropenia (low white blood cell counts), thrombocytopenia • Hepatitis, jaundice, and liver failure • Anaphylactic shock • CVA, aseptic meningitis • Amblyopia • Hearing loss • Depression
    43. 43. Side effects of OTC
    44. 44. 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.
    45. 45. Depressants
    46. 46. DepressantsDepressants- Slow physicaland mental activity,producing relaxationBarbiturates-InducesedationBenzodiazepines- treatinsomnia, anxiety andpanic disorders
    47. 47. DepressantsDepressants- Slow physicaland mental activity,producing relaxationBarbiturates-InducesedationBenzodiazepines- treatinsomnia, anxiety andpanic disorders
    48. 48. Barbituates/Benzodiapines(depressants)
    49. 49. Barbituates/Benzodiapines(depressants) Tranquilizers- reduce anxiety, while increasing GABA (the neurotransmitter that normally counteracts the signals that cause fear and anxiety)
    50. 50. Barbituates/Benzodiapines(depressants) Tranquilizers- reduce anxiety, while increasing GABA (the neurotransmitter that normally counteracts the signals that cause fear and anxiety)
    51. 51. Side effects of Depressants
    52. 52. 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
    53. 53. Side effects of Depressants
    54. 54. Side effects of Depressants• Barbiturate side effects include – Somnolence, ataxia (inappropriate gait), dizziness, headache, insomnia, paresthesia, slurred speech, nystagmus (‘typewriter-like’ gaze) – Syncope, drug-induced coma – Osteomalacia (abnormal bone weakness) – Anemia, leukopenia, thrombocytopenia – Dermatologic alterations, rash, eczema, Stevens-Johnson syndrome, toxic epidermal necrolysis – Liver damage – Immune hypersensitivity reaction – Hallucinations, confusion, nervousness, hostile behavior, suicidal ideation
    55. 55. Side effects of Depressants
    56. 56. 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
    57. 57. Side effects of Depressants
    58. 58. 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
    59. 59. Side effects of Depressants
    60. 60. 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!
    61. 61. Stimulants and side effects
    62. 62. Stimulants and side• effects Include cocaine (and derivatives such as crack) and amphetamines (such as Methamphetamine)• Side effects of cocaine include… – Delusions of grandeur, euphoria, emotional instability, insomnia & restlessness, hallucinations, mania and paranoid psychosis – Dilated pupils, headache, vertigo / dizziness, loss of consciousness, seizures – Nausea / vomiting – Nasal septal defects (from snorting) – Chronic bronchitis, coughing, pulmonary edema, respiratory failure and death (esp. with crack) – Chest pain, tachycardia, cardiomyopathy, aortic rupture / dissection, myocardial infarction, cardiac arryhthmias, palpitations
    63. 63. Stimulants and side• effects Include cocaine (and derivatives such as crack) and amphetamines (such as Methamphetamine)• Side effects of cocaine include… – Delusions of grandeur, euphoria, emotional instability, insomnia & restlessness, hallucinations, mania and paranoid psychosis – Dilated pupils, headache, vertigo / dizziness, loss of consciousness, seizures – Nausea / vomiting – Nasal septal defects (from snorting) – Chronic bronchitis, coughing, pulmonary edema, respiratory failure and death (esp. with crack) – Chest pain, tachycardia, cardiomyopathy, aortic rupture / dissection, myocardial infarction, cardiac arryhthmias, palpitations
    64. 64. Stimulants and side• effects Include cocaine (and derivatives such as crack) and amphetamines (such as Methamphetamine)• Side effects of cocaine include… – Delusions of grandeur, euphoria, emotional instability, insomnia & restlessness, hallucinations, mania and paranoid psychosis – Dilated pupils, headache, vertigo / dizziness, loss of consciousness, seizures – Nausea / vomiting – Nasal septal defects (from snorting) – Chronic bronchitis, coughing, pulmonary edema, respiratory failure and death (esp. with crack) – Chest pain, tachycardia, cardiomyopathy, aortic rupture / dissection, myocardial infarction, cardiac arryhthmias, palpitations
    65. 65. • Amphetamine side effects include… – Hypertension, tachycardia, heart failure, aortic dissection, heart attack, angina, cardiac arrest – Tachypnea, pulmonary hypertension, pulmonary edema, Acute Respiratory Distress Syndrome – Seizures, coma – Agitation, paranoia, delusions, hyperactivity, severe psychosis (acute or chronic) – Hyperthermia, rhabdomyolysis, coma, metabolic acidosis – Renal failure, hepatic injury, coagulopathy, renal tubular necrosis – Vomiting, diarrhea, gastrointestinal bleeding – Fetal abnormalities & spontaneous abortion (& can be passed via breast milk)
    66. 66. Stimulants and side effects• Amphetamine side effects include… – Hypertension, tachycardia, heart failure, aortic dissection, heart attack, angina, cardiac arrest – Tachypnea, pulmonary hypertension, pulmonary edema, Acute Respiratory Distress Syndrome – Seizures, coma – Agitation, paranoia, delusions, hyperactivity, severe psychosis (acute or chronic) – Hyperthermia, rhabdomyolysis, coma, metabolic acidosis – Renal failure, hepatic injury, coagulopathy, renal tubular necrosis – Vomiting, diarrhea, gastrointestinal bleeding – Fetal abnormalities & spontaneous abortion (& can be passed via breast milk)
    67. 67. References
    68. 68. • References Barbiturate retrieved from Wikipedia, April 10th, 2011 from http://en.wikipedia.org/wiki/Barbiturate• EMedicineHealth, retrieved April 9th, 2011 from http://www.emedicinehealth.com/cocaine_abuse/ page3_em.htm#Cocaine Abuse Symptoms• Medline Plus, National Institutes of Health & National Library of Medicine Database. Retrieved April 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/ A5B79F/ND_AppProduct/evidencexpert/DUPLICATIONSHIELDSYNC/35310D/ND_PG/ evidencexpert/ND_B/evidencexpert/ND_P/evidencexpert/ PFActionId/,DanaInfo=.awxyCxmut0xxsoMq32+pf.HomePage• Opioid Comparison, retrieved April 9th, 2011 from http://en.wikipedia.org/wiki/Opioid_comparison Millard, J.; Adventures in Chemistry; Houghton Mifflin: 2008; pp. 356-68.Tough, P.; “The Alchemy of OxyContin: From Pain Relief to Drug Addiction,” The New York Times Magazine; July 29, 2001. “OxyContin,” Wikipedia. http://en.wikipedia.org/wiki/ Oxycontin (accessed 10 Apr 2011).• “Alprazolam,” Wikipedia. http://en.wikipedia.org/wiki/Xanax (accessed 10 Apr 2011). “Cocaine,” Wikipedia. http://en.wikipedia.org/wiki/Cocaine (accessed 10 Apr 2011). Brieter, H.C., et al.; “Acute Effects of Cocaine on Human Brain Activity and Emotion,” Neuron, vol. 19, no. 3; September 1997; pp. 591-611.

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