Alternative approach: pick a phenothiazine that itself has anticholingeric properites - thioridazine

Phenothiazines: anti ACh effects-dry mouth, blurred vision, urinary, sexual problems(some tolerance develops)

Anti-NE effect:Orthostatic hypotension-get dizzy when standing up.Abnormal pigmentation response to sun, rare but sometimes fatal agranul ocytosis(white cell death)

called "speed" "bennies"

Dextro-(dexedrine) "dexies"

methamphetamine-"crank", "meth".when smoked: crystal or ice

It is the lightest metallized element, given as a salt. often given in the beginning of manic stage.

It is not a permentant cure, but it helps when given chronically and at the right blood levels with early recovery in mania and prevents depressive episods.

When treatment with lithium what does high blood level mean? What does low blood levels mean?

What is done to know what blood levels a patient has when on lithium?

High-serious side effects

Low-ineffective, keeps cycling

Blood levels are to be regularly monitored, different dose for different folks

occur at high blood levels

-heart problems

-kidney problems; only cleared through kidney, no liver involvement

-Thyroid problems( metabolism change)

-weight gain

-could create emotionless, no reaction, flatline of reaction

-oral

- I.V. injection

-inhalant

methamphetamine is often smoked

-Carbamazepine (Tegretol)

-Divalproes(Depakote)

1.reduce the neutral excitability by prolonging the closed period of ion channels. The drug may bind selectively to open channel. Therefore the drug has its greatest effect when the nerve cells are highly stimulated→ lots of action potential→ lots of open channels

2. Increase activity of GABA, main inhibitory transmitter in CNS. Helps to prematurely terminate mania

Blocks dopanine D2 receptors which is a good corrleation btwn receptors binding properties and clinical effectiveness.

Effective for positive symptoms, not effective for negative symptoms

Not a cure, if discountiune will relapse and not effective for everyone

-lose heat but feel warm

-diuretic effect on Kidneys

-black outs b/c of hippocampus and palecortical alcohol sensitive

Phenothiazines- ant-ACh effect: dry mouth,blurred vision, urinary, sexual problems. may get less over time

Anti-NE- orthostatic hypotension(get dizzy when stand up), abnormal pigmentation, rare but fatal agranul ocytosis

alcoholic dementia

generalized decline in CNS abilities

-liver problems

-alcoholic hepatitis

-cirrhosis of the liver

-Wernicke-Korsakove syndrome

-increase in spontaneous abortion

-Fetal alcohol syndrome

No safe amt of pregnant alcohol consumption

subcutaneous-skinpopping

intra-venous-mainlinig

methadone,codeine -orally

what other drugs does opium make?

herion(modified)

codeine(modified)

related

meperidine

methadone

oxycodone

-constipation

-nausea

-pupil constriction

-respiratory depression

-analgesia

-euphoria or relief from negative emotions

-high dose sedation/sleep

-dependence

-abstinence syndrome(withdrawal)

-anxiety restlessness-

high pain sensitivity

-depression

-extreme cogestion

-sympathetic arousal(↑BP,↑BSugar, loss of appetite, diarrhea,dilated pupils)

alcoholics to be not so different, not characterized by depression, anxiety,  multi problem families or unhappy childhood

only predicitve difference is 

-family occurance of alcohlism

-ethnic backgrounds

-antisocial adolescent behavior

-young alcoholic abusers/no dependence can if they change their peer group

-middle-aged with signs of dependence often requiring detox can not they either tetotalled or died

-substitute dependence

-external reminders of danger

-social support

-sources of hope and self-esteem

AA often provides all four

 Tardive Dyskinesia(slow to develop, poor movement)

-involuntary jaw/head/neck movements

-DA hypersensitivity( receptors↑), in response to blockade.

-may be opposite of parkinson

-may get worse after taken off drug

-racing thoughts

-pressured speech

-grandiosity

-increased activity(pleasurable activity)

-distractibility

-decreased sleeo

-over-optimism

-irritability

* severe staged psychotic symptoms (delusions, halluncinations)

one or more hypomanic disorder in btwn depressive disorders. Hard to distinguished from major depression, since the hypomanic disorder may be experienced as a brief return to"normality"

*poor prognosis/difficult to treat

rapid cycling( of either BP1 or BP2)often found in post-partum or post menopausal women.

runs in the family

closer the relation the higher concordance rate.

-much higher concordance with biological relative than with adoptive relatives, mutated  genes

-monozygotic vs. dizygotic twins

-mono have a higher concordance rate 60%

but what about the other 40% has to be something other than genetics

-different chromosomes carry the responsible genes in different families

-often on chromosome 22, as is also the case for schizophrenia

-geneics confused 

-kindling- repeated stimulation of certain neurons may make them or synapses onto them hyper-excitable. This can lead to seizures, do to overstimulus

-noteworthy that  some anticonvulsant drugs are effective against bipolar disorder

(.05)-lowers anxiety , disinhibition, elevated mood, lively activity

(.10)-imparied intellectual acticity particularly on complex learning tasks,poor coordination, slurred speech, loss of fear & anxiety, impulsive behavior

(.20)-clouded consciousness, sediation/sleepiness

(.35)-or combination with other downers, surgical anesthesia, respiratory arrest, death

the GABA antagonist drug RO causes near immediate sobering up in mice and ppl who are intoxicated

tolerance happens by increased metabolism by liver enzymes, nerve cells adjust to chronic alcohol levels

Behavioral tolerance :learning to compensate for alcohol effects

defined by withdrawal 

happens after regular high dose use

anxious, hyper-excitable, irritable, fearful, trembling, insomnia, hallucinations, seizures

Cyclic AMP theory

Antiopiate theory

additional effects of conditioning

animal studies-it can serve as a reinforcer and be self-administered in certain situation with certain genetic strands

Human show compulsive self-administration, paying high price, family disruption and loss of health to consume alcohol

-dependence

-disruption of normal life

-homicide

-suicide

-mental hospital admission

-general hospital admission

-auto accidents 

-Job loss

-alcoholism continued with bootleg liquor

-bad liquor- blindness, death

-more hard liquor (more compact for bootleg)

-no closing time for speakeasies

-base for organized crime

What are the antipsychotic drugs (traditional)

First/standard generation?

Phenothiazines: thorazine,stelazine,prolixih,mellaril

butyrophenones-haldol

-develop rapidly parkinson-like tremors and rigidity

-this happens when DA synapes are blocked and can't compete with ACh & GABA synapes in striatum. This imbalance inhibits movement and control

it is 2nd generation(atypical)SDA's

Side effects- rare case of aplastic anemia easily fatal blood disorder; requires regular blood tests

-better separation btwn effective dose and dose that causes side effects

-rarely need anticholinergic adjuctive drugs

-may help some patients resistant to 1st generation 

-may help more with negative and cognitive symptoms

- all helpful in treating positive symptoms

-clozapine(clozaril)

-risperidone(risperidal)

-olanzepine(zyprexa)

-quetiapine(seroquel)

-ziprasidone(geodon)

-CNS depression; sedation, blurred vision,lack of coorination

-digestive upset

-rash/itch(carbanazepine)

-reduces blood clotting(divalproes)

-need regular blood monitoring

Name the barbiturates

What is the source and route?

-pentobarbital

-secobarbital

-phenobarbital

source-synthetic

route-usually oral, emergency injection

-meprobamate(miltown,equanil)

-methaqualone(quaalude,sopor)

-diazepam(valium)

-chlordiazepoxide(librium)

-lorazepam(ativan)

-alprazolam(xanax)

-zdipidem(ambien)

-triazolam(halcion)

-doesn't respond to medication

-anhedonia

-apathy/blunted emotions

-poverty of thought & speech/feeling empty

-lack of motivation

-disorganization of thinking, behavior

-distractibility

-thought disorder

-social withdraw

-poor social skills

-feel inadequate

-respond to medication easily

-hallucination(auditory)

-delusions(grandeur ect.)

-bizarre thought patterns

-nervous,edgy,tense

-cant concentrate

-feeling of unreality

-sleeping problems

-dizzy,lightheaded, shortness of breath

-rapid HB

-frequent urination