Antipsychotic Medications and Substance Abuse Quiz

Central Nervous System Depressants and Muscle Relaxants

• CNS depressants are drugs that inhibit the central nervous system.
• They reduce nervousness, excitability, and irritability.
• Sedatives are a type of CNS depressant.
• Hypnotics are a type of CNS depressant that induces sleep. High doses of sedatives can be hypnotics.
• Sedative-hypnotics calm the central nervous system (CNS) at low doses and cause sleep at high doses.
• Sedative-hypnotics are grouped into barbiturates, benzodiazepines, and miscellaneous drugs.
• Benzodiazepines were formerly the most commonly prescribed sedative-hypnotic drugs.
• Nonbenzodiazepines are currently more frequently prescribed.
• Benzodiazepines work by depressing CNS activity affecting the hypothalamic, thalamic, and limbic systems of the brain.
• Benzodiazepines work by potentiating the action of GABA (gamma-aminobutyric acid), the primary inhibitory neurotransmitter in the brain.
• Benzodiazepines do not suppress REM sleep as much as barbiturates.
• They have a calming effect on the CNS, control agitation and anxiety, reduce excessive sensory stimulation, and induce skeletal muscle relaxation.
• Benzodiazepines are used for sedation, sleep induction, skeletal muscle relaxation, anxiety relief, anxiety-related depression, treatment of acute seizures, treatment of alcohol withdrawal, agitation relief, and balanced anesthesia.
• Contraindications include drug allergy, narrow-angle glaucoma, and pregnancy.
• Mild and infrequent adverse effects include headache, drowsiness, dizziness, cognitive impairment, vertigo, lethargy, and 'hangover' or daytime sleepiness, especially in older adults.
• Benzodiazepine overdose symptoms include somnolence, confusion, coma, and diminished reflexes.
• Flumazenil is an antidote for benzodiazepine overdose.
• Interactions include azole antifungals, verapamil, diltiazem, macrolide antibiotics, grapefruit juice, and CNS depressants (alcohol, opioids).
• Midazolam (Versed) is commonly used preoperatively for moderate sedation and causes amnesia and anxiolysis.
• Liquid oral dosage is also available for children.
• Temazepam (Restoril) is an intermediate-acting benzodiazepine metabolised from diazepam. It is normally effective within 20-40 minutes. It is recommended to take it about 1 hour before bed.
• Ramelteon (Rozerem) is a nonbenzodiazepine structurally similar to melatonin. It's used as a hypnotic, not a controlled substance, and indicated for sleep onset issues.
• Barbiturates were the standard drugs for insomnia and sedation in the early 20th century but are less commonly used now due to safety concerns. They have a low therapeutic index and are habit forming.
• Barbiturates work by potentiating GABA's (gamma-aminobutyric acid) action, inhibiting nerve impulses in the cerebral cortex.
• Barbiturates have ultrashort-acting, short-acting, intermediate-acting, and long-acting types.
• Indications include anesthesia for short surgical procedures, anesthesia induction, control of seizures, and reduction of intracranial pressure in neurologic patients.
• Contraindications include drug allergy, pregnancy, significant respiratory difficulties, and severe kidney or liver disease. Caution in older adults.
• Adverse effects include drowsiness, lethargy, vertigo, vasodilation, reduced REM sleep, agitation, and inability to deal with normal stress.
• Overdose includes CNS depression and respiratory depression, requiring symptomatic and supportive treatment involving maintaining an adequate airway, assisted ventilation, oxygen therapy, fluids, and pressor support.
• Interactions with barbiturates include additive effects with alcohol, antihistamines, benzodiazepines, opioids, and tranquilizers. Higher metabolism of some drugs can occur.
• Phenobarbital is a prototypical long-acting barbiturate for prevention of tonic-clonic seizures and febrile convulsions.
• Nonprescription sleeping aids often contain antihistamines with CNS depressant effects.
• Muscle relaxants relieve skeletal muscle spasms.
• Muscle relaxants are centrally acting, similar in structure and action to other CNS depressants.
• Muscle relaxants act directly on skeletal muscle and resemble GABA.
• Indications involve relief of painful musculoskeletal conditions, muscle spasms, and management of spasticity.
• Adverse effects include extension of CNS effects, euphoria, lightheadedness, dizziness, drowsiness, fatigue, and muscle weakness.
• Overdose management is primarily focused on CNS support, with no specific antidote.
• Interactions of muscle relaxants are generally with other CNS depressants (e.g. benzodiazepines and alcohol).

Psychotherapeutic Drugs

• Psychotherapeutic drugs are used to treat various emotional and mental disorders, ranging from occasional anxiety to chronic distress.
• The exact cause of many mental disorders isn't fully understood, but they're thought to arise from abnormal levels or imbalances of neurotransmitters like dopamine, epinephrine, serotonin, histamine, and GABA (gamma-aminobutyric acid) and acetylcholine.
• The three main emotional and mental disorders treated are anxiety, affective disorders (mood disorders), and psychoses.
• Psychotherapeutic drugs include anxiolytics, mood stabilizers, antidepressants, and antipsychotics.
• Anxiety disorders, such as obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), generalized anxiety disorder (GAD), panic disorder, social phobia, and simple phobia, are treated with specific medications.
• Affective disorders, such as bipolar disorder (BPD), are characterized by mood swings between mania and depression.
• Psychoses, such as schizophrenia, are severe conditions causing impairment in daily life, characterized by loss of contact with reality.
• Anxiolytic drugs, such as benzodiazepines like alprazolam (Xanax), diazepam (Valium), and lorazepam (Ativan), reduce anxiety by reducing overactivity in the central nervous system.
• Mood stabilizers, such as lithium carbonate and lithium citrate, are used to treat bipolar disorder and may be combined with benzodiazepines, antipsychotics, antiepileptic drugs, and dopamine receptor agonists.
• Lithium is the drug of choice in treating acute mania but has a narrow therapeutic range.
• Lithium levels exceeding 1.5 to 2.5 mEq/L may produce serious side effects up to death.
• Adverse effects include cardiac dysrhythmia, drowsiness, slurred speech, seizures, movement disorders, and hypotension.
• Antidepressants increase neurotransmitter concentration in the central nervous system.
• They should be used with psychotherapy.
• Antidepressant types include tricyclic antidepressants, monoamine oxidase inhibitors (MAOIs), and second-generation antidepressants (SSRIs and SNRIs).
• Tricyclic antidepressants (TCAs) have been largely replaced by SSRIs are used as a second line. They act by blocking the reuptake of neurotransmitters, increasing their concentration.
• Indications include depression, childhood enuresis, OCD, and adjunct analgesics for chronic pain.
• Adverse effects can include sedation, impotence, orthostatic hypotension, and dizziness, particularly in older patients. Overdoses can be lethal, and treatment needs to manage CNS and cardiovascular effects.
• Monoamine Oxidase Inhibitors (MAOIs) are generally not used as first-line treatment for depression due to possible hypertensive crisis from tyramine. Also used in parkinson's disease.
• Second-generation antidepressants, like SSRIs and SNRIs, have fewer adverse effects and fewer drug interactions than TCAs and MAOIs.
• Symptoms of serotonin syndrome can occur.
• A typical antipsychotic, such as clozapine (Clozaril), risperidone (Risperdal), quetiapine (Seroquel), and aripiprazole (Abilify), are used to treat drug-induced psychosis, schizophrenia, and other severe mental illnesses.
• Antipsychotics block dopamine receptors, particularly D2 receptors.
• Antipsychotics treat positive symptoms of schizophrenia, but conventional drugs are less effective in managing negative symptoms.

Substance Use Disorder

• Substance abuse affects people of all ages, sexes, ethnicities, and socioeconomic groups.
• It leads to physical dependence, psychologic dependence, habituation, and addiction.
• Commonly abused substances include opioids (synthetic pain relievers, heroin, codeine, hydrocodone, hydromorphone, morphine, oxycodone).
• Opioids bind to specific opioid receptors in the brain, producing an analgesic response and euphoria, which makes them prone to abuse.
• Intended effects of opioids include relieving pain, reducing cough, relieving diarrhea, and inducing anesthesia.
• Opioid withdrawal symptoms can range from mild to severe and last for several days to a week. Often include CNS depression (diuresis, miosis, convulsions, nausea, vomiting, respiratory depression), hypotension, constipation, urinary retention, flushing, and urticaria.
• Naloxone is a commonly used opioid antagonist to reverse opioid overdose and withdrawal symptoms.
• Detoxification and relapse prevention programs, including naltrexone and acamprosate, are used.
• Alcohol or ethanol causes CNS depression by dissolving in lipid membranes.
• Chronic alcohol ingestion can cause nutritional deficiencies (especially B vitamins), leading to Wernicke's encephalopathy, Korsakoff's psychosis, polyneuritis, and nicotinic acid deficiency encephalopathy. It can also cause seizures, alcoholic hepatitis, and cirrhosis.
• Chronic drinking can also lead to FAS (fetal alcohol syndrome) in children of pregnant women, which is characterized by craniofacial abnormalities and CNS dysfunction, leading to prenatal and postnatal growth retardation.
• Alcohol interactions can intensify sedative effects of medications, interact with antibiotics like metronidazole, cause hepatotoxicity with acetaminophen, and increase blood thinner warfarin bioavailability.
• Ethanol withdrawal can present with elevated blood pressure, pulse rate, and temperature. Symptoms include insomnia, tremors, and agitation. Withdrawal treatment often involves benzodiazepines, disulfiram (Antabuse), and support.
• Nicotine is commonly used to "calm nerves". It releases epinephrine, and physical and psychological dependency commonly occurs, causing withdrawal symptoms like craving, irritability, reduced heart rate, and BP. Nicotine use has no known therapeutic uses.

Test your knowledge on antipsychotic medications and substance abuse. This quiz covers side effects, long-term effects, therapeutic outcomes, and the impacts of ethanol use. Enhance your understanding of these critical topics in mental health and addiction treatment.