Substance Abuse and Overdose

Substance Abuse and Psychiatric Medications

• Cocaine abuse: euphoria through uptake of dopamine, toxicity includes agitation, dizziness, tremor, blurred vision, hyperpyrexia, convulsions, ventricular dysrhythmias, and hemorrhagic stroke, anxiety, paranoia, and hallucinations.

• Ecstasy abuse: euphoria, psychedelic effects in low dose and amphetamine-like effects in high doses, toxicity includes neurotoxicity, seizures, excessive cardiac stimulation, and hyperthermia.

• Marijuana abuse: euphoria, sedation, and hallucinations, increased sensitivity and humor, delusions, toxicity includes antimotivation syndrome, cannabinoid hyperemesis syndrome, increased HR, orthostatic hypotension, and reddening of conjunctiva, bronchodilation, but constriction of airway with chronic use, decreased sperm count, reduction in size of hippocampus and amygdala.

• Methamphetamine abuse: increases norepinephrine and dopamine uptake, produces arousal and elevation of mood, euphoria, and talkativeness, increased physical strength and mental capacity, toxicity includes delusions, paranoia, hallucinations, psychosis, vasoconstriction, angina, hypertension, and weight loss.

Neurotransmitters in Psych

• Dopamine: influences how we interact with the world, found in all areas of the brain, involved in psychosis, associated with schizophrenia, bipolar, and Alzheimer's.

• Norepinephrine: excitatory impact, major role in mediating mood and anxiety, regulation of NE is generally used in treating mood and anxiety disorders, associated with major depression, bipolar, Alzheimer's, and anxiety.

• Serotonin: influence temperature, sensory, sleep, and assertiveness areas of the brain, serves as chemical mediator in pain perceptions, normal and abnormal behaviors, moods and drives, regulation of food intake, and neuroendocrine functions, associated with major depression, bipolar, Alzheimer's, and anxiety.

• GABA: chemical made in the brain, inhibitory NT that reduces a nerve cells' ability to send and receive chemical messages through CNS, linked with anxiety, autism, and Parkinson's, bipolar, and anxiety.

• Acetylcholine: first NT, plays a major role in encoding memory and cognition, associated with Alzheimer's and bipolar.

Adverse Reactions and Management

• Classic adverse reactions associated with first-generation antipsychotic medications include orthostatic hypertension, prolonged QTc interval, anticholinergic, weight gain, diabetes, sexual side effects, blood disorders, neuroleptic malignant syndrome, photosensitivity, and lowered seizure threshold.

• Education for patients and families regarding possible side effects and patient monitoring when prescribing clozapine: blocks receptors for serotonin and dopamine, used for schizophrenia and reducing suicidal behavior when other drugs have failed, monitor CBC, cardiovascular exam, and blood glucose, adverse effects include sedation, weight gain, lowered BP, anticholinergic effects, new onset diabetes, dyslipidemia, and seizures.

• Managing sexual dysfunction caused by antidepressant medications: reducing the dosage of the medication or switching to a high potency FGA may reduce adverse effects.

• Why MAOIs and SSRIs should not be taken together: combining MAOIs and SSRIs leaves a patient vulnerable to serotonin syndrome, prevention includes tapering off the original antipsychotic, followed by a washout period, and then starting a slow and tapered dose of the second medication.

• Patient education for MAOI: the greatest risk is hypertensive crisis due to eating foods high in tyramine, which leads to a buildup of tyramine in the body, causing massive vasoconstriction and intense stimulation of the heart.

• Conditions treated by Risperidone: BPD manic episodes.

• Conditions treated by Lithium: mania and depressive episodes of bipolar illness, Lithium can be combined with Risperidone to control symptoms during an acute manic episode.

• Signs and symptoms of serotonin syndrome: mental status changes, autonomic instability, neuromuscular problems, and GI disturbances.

• Signs and symptoms of drug withdrawal: dilated pupils, increased vital signs, physical fatigue, rhinorrhea, sleep disturbances, N/V, cramping, diarrhea, anxiety, irritability, and depression.

Psychiatric Medications and Conditions

• Conditions that may develop as a result of taking lithium and their treatments: tremors, polyuria, goiter and hypothyroidism, and lithium toxicity.

• Drug of choice for different types of mania: pure manic episode (Euphoria mania), hypomanic episode, major depressive episode, and mixed episode.

• Drug of choice for depression: SSRI (e.g., Fluoxetine), atypical antipsychotic, or a mood stabilizer/antipsychotic plus an antidepressant.

• Drug of choice for panic attacks: SSRI (e.g., Prozac) or SNRI (e.g., venlafaxine), benzodiazepines (e.g., Xanax, Valium, and Ativan) are also a first-choice treatment for anxiety disorders.

• Psychiatric medications that potentiate asthma: typical antipsychotics (e.g., clozapine), anticholinergics (e.g., amitriptyline), and imipramine.

• Health information to be monitored in patients receiving methylphenidate: considered an amphetamine, releases norepinephrine and dopamine, increases wakefulness, alertness, mood, stimulates respiration, decreases appetite, increases heart rate, and has high potential for tolerance as well as abuse, can cause insomnia and restlessness, weight loss, and increased HR and BP, which can cause issues in patients with previous cardiac disorders.