PSY 320 - Exam #3 Study Guide
PSY 320 - Exam #3 Study Guide PSY 320
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This 37 page Study Guide was uploaded by Elliana on Tuesday March 29, 2016. The Study Guide belongs to PSY 320 at University of Miami taught by Dr. Marc Gellman in Spring 2015. Since its upload, it has received 87 views. For similar materials see Drugs & Behavior in Psychlogy at University of Miami.
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Date Created: 03/29/16
PSY 320 Drugs & Behavior Exam #3 Study Guide on chapters 6, 7, 8, & 13 Stimulants Chapter 6 Overview • S▯mulants - Substances that keep a person "going" mentally & physically • Cocaine & amphetamine restricted s▯mulants: ◦ Originate from plants ◦ More similar than diﬀerent ◦ Alike in subjec▯ve eﬀects, toxici▯es, pa▯erns of abuse, tolerance, & dependence • Produce heightened awareness • Decrease sleep & appe▯te • Increase motor ac▯vity • High intake = psychosis ◦ Important diﬀerence in oral availability & dura▯on of ac▯on • Amphetamines orally swallowed & last longer History Cocaine • Coca: bush primarily growing in the Andes ◦ Harvested for thousands of years ◦ Ac▯vely cul▯vated for over 800 years ◦ Cocaine - the ac▯ve chemical in the coca plant • Na▯ve workers chew leaves for a boost the same way we drink coﬀee for s▯mula▯on ◦ Important part of the Inca culture s e i nome r e c s uo i g i l e r n i de◦s U ◦ Used as currency • Colonizing/se▯ling Spaniards: ◦ Disgusted by chewing prac▯ce ◦ Tried to take it away ◦ Realized it was the backbone of the economy & labor ◦ Let workers keep chewing it to maintain produc▯on & mining of gold, etc. • 1800s scien▯sts started to study plant & medicinal eﬀects ◦ Put extracts into products like patent medicines, teas, coca cola, lozenges, wine, etc. ◦ Coca Wine • Angelo Mariani • French chemist, developed wine w/ coca leaf extract • Indirectly introduced coca leaf to the general public ◦ Con▯nues to serve as an important medica▯on • Schedule 2 substance b/c it has medicinal use • 1860 Anesthe▯c use discovered by den▯st Dr. W. S. Halsted ▪ Not used medically un▯l 1884 ▪ Used as local anesthesia (injected into gums) 5 0▪9 1 Novocain - Synthe▯c drug modeled a▯er cocaine w/ similar proper▯es • Cheaper to manufacture, doesn't come from plant, easier to control, doesn't produce "high" ▪ Synthesized drugs have largely replaced cocaine for medical use ◦ Very popular drug in late 1800s PSY 320 Drugs & Behavior • Sherlock Holmes stories highlighted posi▯ve & nega▯ve psychological eﬀects • Early psychiatric use by Freud ◦ Used cocaine as treatment for depression & morphine dependence ◦ Wrote extensively about studies on use ◦ Later in career opposed use a▯er nursing a friend thru cocaine psychosis • Legal controls on cocaine: ◦ 1887 - 1914 46 states passed laws regula▯ng use/distribu▯on ◦ Use increased at end of 1960s ◦ 1914 Harrison Act • Taxed importa▯on/sale of coca & opium ◦ Rela▯vely expensive, use associated w/ status, wealth, & fame ◦ Supply was in such surplus manufacturers didn't know what to do w/ it • 1980s used frequently by athletes • 1986 An▯-Drug Abuse Act ◦ Powder cocaine is more expensive & consumed typically by white upper class ◦ Crack cocaine is sold at cheaper prices & reaches lower income popula▯ons including oppressed African American neighborhoods ◦ Law targeted crack cocaine dealers & manufacturers (lower class, less wealthy) ◦ 100:1 quan▯ty ra▯o btwn amounts of powder & crack cocaine needed to trigger mandatory minimum traﬃcking sentences • Basically punishes crack dealers/users but not coke users/dealers ◦ Law revised 2 yrs later to apply to possession of just 5 grams of crack ◦ Basically punishes primarily lower income popula▯ons & doesn't really address use of coke by wealthy popula▯on ◦ Ra▯o reduced to 18:1 in 2010 Amphetamines • Chinese used medicinal tea made from ephedra/Ma Huang herb ◦ Ac▯ve ingredient = ephedrine (sympathomime▯c drug used in trea▯ng asthma) • Ephedrine is a sympathomime▯c drug ◦ S▯mulates sympathe▯c branch of autonomic nervous system • Amphetamine - a synthe▯c CNS s▯mulant & sympathomime▯c ◦ New synthesized chemical similar to ephedrine 2391 n i d e t ne t◦ a P • History: ◦ Use by soldiers in WW2 to ﬁght fa▯gue • Addic▯on remained when they came home ◦ 1920s & 30s: Amphetamines (cocaine) + heroin injected together = speedball s 06◦ 9 1 • Most street amphetamines came from prescrip▯ons • "Speed scene" = a ▯me & place in which ppl used & became dependent on intravenous amphetamine • Liquid methamphetamines formerly used as s▯mulant treatment for ge▯ng pa▯ents who Oded on sleeping pills to breathe again ◦ Amphetamines became more ▯ghtly controlled • 1970s restric▯ons passed to limit manufacture • Many look-alikes appeared • Some users switched back to cocaine • Illicit manufacture of methamphetamine grew • Amphetamine used medically: ◦ Asthma - dilator of nasal & bronchial passages ◦ Narcolepsy - disorder where brain is over-excited & prepares itself to fall asleep/shut down PSY 320 Drugs & Behavior ◦ Hyperac▯vity in children ◦ Appe▯te suppressant ◦ S▯mulant Names & Forms/Manufacture Forms of Cocaine • Leaves ◦ Slow absorp▯on ◦ Slow onset of eﬀects • Coca Paste ◦ Crude extract created during manufacture of cocaine ◦ Coca leaves mixed w/ organic solvent (kerosene or gasoline) ◦ Soaked/mixed/mashed & then excess liquid ﬁltered out to form coca paste de k oms y l nom m o C • Rapid & brief eﬀects • Cocaine Hydrochloride ◦ Most common form ◦ Stable water-soluble salt ◦ Typically intra-nasal use • Snor▯ng • Rapid absorp▯on • Up to 15 min un▯l onset of eﬀects ◦ Can be injected • Rapid & brief eﬀects (peak 3 min) ◦ Can be used topically (rubbing on gums, numbing eﬀect) • Freebase/Crack Rock ◦ Lumps of dried smokable cocaine ◦ Produced by mixing cocaine w/ baking soda & water Amphetamines • Methylphenidate (Ritalin) ◦ One of the oldest of the s▯mulant medica▯ons used in the treatment of a▯en▯on & concentra▯on problems ◦ Generally well tolerated & works well to increase concentra▯on & a▯en▯on while decreasing hyperac▯vity ◦ Works about 80% of the ▯me to reduce up to 80% of the symptoms a person is experiencing ◦ Side eﬀects: • Decreased appe▯te, decrease/disturbance of sleep, some▯mes headaches & gastrointes▯nal pains • At ▯mes motor or vocal ▯cs emerge • Problems w/ mood instability & irritability • Overdose: psycho▯c symptoms or delirium ◦ Problems can also arise from short half-life • Crystal Meth ◦ Made from household products ◦ OTC medica▯on pseudoephedrine mixed w/ iodine, phosphorus, organic solvents, drano, paint thinner, an▯freeze, etc. • Mixed amphetamine salts ◦ Available for many years in treatment of a▯en▯on & concentra▯on for many years ◦ Currently available of Adderall & AdderallXR Marke▯ng PSY 320 Drugs & Behavior Crack • Inexpensive form of smokable cocaine became available 0 1$ - ◦ 5 $ ◦ Gets you high much faster ◦ Much higher poten▯al for abuse • Legal controls ◦ Media & poli▯cians focused on crack use among urban black ppl • Associated w/ violence & dependency • Coke & Marijuana: ◦ Reagan presidency & Bush vice presidency • Focused on limi▯ng/controlling inﬂux of marijuana by smugglers • Smugglers shi▯ed to impor▯ng cocaine ▪ Government indirectly contributed to growth of cocaine importa▯on & cheaper forms like crack ◦ An▯-drug abuse acts of 1986 & 1988 • Penal▯es for sale of crack cocaine signiﬁcantly more severe than penal▯es for powder cocaine • Tougher penal▯es for ﬁrst ▯me users of crack • Dispropor▯onately aﬀects black community Amphetamines • Limited amphetamine availability increased # of illicit laboratories making methamphetamine • Manufacture of meth is dangerous & associated w/ toxic fumes & residue ◦ Ice or crystal meth ◦ Smokable • Abuse began in Western US & now spread east • Now considered a club drug • Abuse mainly remains concentrated in mid-west US • Beneﬁcial uses: ◦ Weight control • Widely used to reduce food intake & body weight • Eﬀect real, but small • Combina▯on of fenﬂuramine & phentermine associated w/ heart valve damage & lung disease in some individuals ◦ Narcolepsy • S▯mulants keep pa▯ents awake during day • Newer drug modaﬁnil (Provigil) promotes wakefulness • Increases ac▯vity of norepinephrine & dopamine • Low abuse poten▯al • Doesn't induce tolerance ◦ ADHD • S▯mulant medica▯ons can reverse catecholamine-associated deﬁcits underlying ADHD • Side eﬀects & concerns lead to use of other treatments for ADHD being studied • Longitudinal studies suggest majority of children/adolescents w/ ADHD display symptoms into adulthood • Manifesta▯on of symptoms change over ▯me ◦ Treatment op▯ons in ADHD: • Psychoeduca▯on for pa▯ent & family members ▪ Support groups ▪ Coaching • Behavioral ▪ Psychotherapy ▪ Cogni▯ve behavioral therapy PSY 320 Drugs & Behavior • Pharmacologic ▪ Pharmacotherapeu▯c interven▯ons ▪ S▯mulants ▪ Non-s▯mulants ▪ Treatment typically requires mul▯modal approach tailored to meet needs of the individual ◦ Some▯mes used as adjunc▯ve therapy for depression ◦ An▯depressant eﬀects work within days Mechanism of Ac▯on Cocaine • Binds diﬀeren▯ally to dopamine, serotonin, & norepinephrine proteins • Binds to DAT1 transporter, inhibi▯ng reuptake w/ more eﬃcacy than methamphetamines ◦ Directly prevents reuptake of dopamine, serotonin, & norepinephrine into pre-synap▯c neurons • Inhibi▯on of re-uptake subsequently elevates synap▯c concentra▯ons of each of these neurotransmi▯ers ◦ Prolongs eﬀects of these neurotransmi▯ers ◦ Also produces number of indirect ac▯ons • Alters other neuromodulatory systems • Opiodergic, glutamatergic, GABAergic systems • **Behavioral eﬀects based upon interac▯on of mul▯ple neurotransmi▯ers ◦ Some may be allergic & die on ﬁrst-▯me use ◦ In consump▯on w/ alcohol, combine in the liver to form cocaethylene - more euphorigenic & higher CV toxicity • Absorp▯on: ◦ Chewing/sucking leaves - slow absorp▯on thru mucous membranes ◦ Snor▯ng powder - rapid absorp▯on into the brain ◦ Intravenous injec▯on - rapid/brief onset, high concentra▯on in the brain ◦ Smoking crack - equally fast onset of eﬀects • Ac▯on: ◦ Cocaine molecules metabolized by enzymes in blood & liver • Elimina▯on: ◦ Metabolized by enzymes in the blood & liver ◦ Half-life of ~an hour • Considerable variability depending on method of administra▯on Amphetamines • Chemical structure similar to catecholamine neurotransmi▯ers ◦ Less than 15% of users become addicted • Structure allows it to more easily cross blood-brain barrier ◦ Structurally similar to molecules of dopamine & norepinephrine (catecholamine neurotransmi▯ers) ◦ Ephedrine & PPA less able to cross barrier & produce more peripheral than central nervous system eﬀects • Causes increased ac▯vity of monoamine neurotransmi▯ers (dopamine, norepinephrine, serotonin) by s▯mula▯ng their release • Amphetamines cause an increase in synap▯c dopamine levels thru 2 mechanisms: 1. Amphetamines expel dopamine from the neuron thru dopamine membrane transporters • S▯mulate release • Cause a reversal in the direc▯on of the dopamine transporter 2. @ high doses amphetamines prevent dopamine storage • Enter dopamine storage vesicles thru vesicular transporter & displace dopamine from the vesicle • S▯mula▯on of dopamine pathways create euphoria & increase motor ac▯vity • Increased doses produce repe▯▯ve movements that could lead to psycho▯c reac▯ons PSY 320 Drugs & Behavior • Absorp▯on: ◦ Consumed orally, intranasally, intravenously, & thru smoking ◦ Peak eﬀects: • 1.5 hours a▯er oral inges▯on • 15-30 minutes a▯er intranasal administra▯on • 5-10 minutes following injec▯on, intranasal, or smoking • Rapid tolerance (tachyphylaxis) can occur a▯er high doses Harms Cocaine • Acute cocaine toxicity causes profound CNS s▯mula▯on ◦ Can lead to convulsions, respiratory or cardiac arrest • Signiﬁcant individual varia▯on in the uptake & metabolism of cocaine ◦ Diﬃcult to es▯mate size of a lethal dose • Rare, severe, unpredictable reac▯ons can cause cardiac failure s e i g r e l ◦l A • Risks of regularly snor▯ng: ◦ Damage to nasal septum • Suscep▯bility to infec▯on • May erode a hole btwn septal passages ◦ Paranoid psychosis • O▯en results from not sleeping • Irritability, restlessness, paranoia ◦ Damage to heart muscle • Reproduc▯ve eﬀects: ◦ Suppresses appe▯te, will eﬀect nutri▯on of mother & baby • Infant will not develop properly ◦ Increased risk of miscarriage & torn placenta • "Crack Baby" phenomenon ◦ Babies born w/ severe developmental abnormali▯es ◦ More due to insuﬃciency of nutri▯on than direct contact w/ cocaine ◦ Studies: • Longitudinal study following "crack babies" & re-assessing them every 5 years • Individuals/adults 30 years later seem to have "caught up" • Now func▯on more or less typically • Cocaine & alcohol ◦ Combina▯on in the body forms cocaethylene ◦ Shown to be more toxic than cocaine in mice ◦ Tho less potent than cocaine in humans Crystal Meth • Ini▯al eﬀects pleasurable to many users ◦ Euphoria, conﬁdence, wakefulness • Ini▯al high bloods brain w/ dopamine, feels very pleasurable, use con▯nues despite severity of nega▯ve consequences • Nega▯ve eﬀects include: s s en s s e l pe e l s f o s do i r ep dedne t ◦ x E ◦ Paranoia, anxiety, agita▯on ◦ Violent mood swings ◦ Increased HR & BP • Acute toxicity: ◦ Increases in feelings of power, suspicion, paranoia PSY 320 Drugs & Behavior ◦ Poten▯al risk of violent behavior • Very high doses may destroy catecholamine neurons • Contaminants formed during manufacture of illicit methamphetamine may have toxic eﬀects on brain cells • Under study: Risk of developing movement disorders like Parkinson's disease • High dose use: ◦ Higher risk among those who inject ◦ Compulsive & repe▯▯ve stereotyped ac▯ons • I.E. Spending a night coun▯ng corn ﬂakes • Chronic toxicity: ◦ Development of paranoid psychosis Dependence & Treatment Cocaine Chronic toxicity/Dependence • Animal & human studies show it is a powerfully reinforcing drug ◦ Animals will readily self-administer the drug by lever-pressing • A▯er binge use, many experience withdrawal symptoms: ◦ Craving, irritability, anxiety, depressed mood, increased appe▯te, fa▯gue 3 main withdrawal stages: 1. Crash ◦ Ini▯al abs▯nence a▯er binge consis▯ng of depression, agita▯on, suicidal thoughts, fa▯gue 2. Withdrawal ◦ Mood swings, craving, anhedonia, obsession w/ drug-seeking ▯▯E ◦ Normal pleasure returns, cues trigger craving & mood swings Treatment • Medica▯ons ◦ Beta-andrenergic blocking drugs for irregular heart rate & blood pressure g u r d c ▯oh c y s p - ▯◦n A halperidol controls psycho▯c symptoms ◦ An▯-depressant drug despramine helps promote abs▯nence • Behavioral Approaches ◦ Con▯ngency approaches ◦ Relapse preven▯on ◦ Group support Amphetamines • Dependence ◦ O▯en no obvious withdrawal symptoms ◦ Produce psychological dependence ◦ Capable of producing dependence as deﬁned by DSM criteria ◦ Potent reinforcer Current Use & Future Trends • Surveys indicate ~ 1% of adults currently use cocaine (2012 data) ◦ Down from peak of 12% in the 1980s • Usage rates of cocaine & amphetamine tend to cycle in opposi▯on to each other ◦ When cocaine use decreases, amphetamine use may increase • Len Bias ◦ 22 y/old college basketball player ◦ Dra▯ed to the NBA ◦ Died from trying coke his ﬁrst ▯me, probably had allergies ◦ Followed 8 days later by coke-related death of Cleveland Browns player Don Rogers PSY 320 Drugs & Behavior Ar▯cle - Misuse of Prescrip▯on S▯mulants Among College Students ◦ Systema▯c literature review of research done on misuse of prescrip▯on s▯mulants ◦ Collec▯on of psych data from 2003 to present ◦ 22 studies meta-analyzed • ADHD symptoms aﬀect approx. 2-4% of college students ◦ Majority males ◦ Male students tend to misuse at higher rates than female students • S▯mulant medica▯ons among the most frequently prescribed treatments for college students w/ ADHD • 2009 - 50% of students surveyed agreed that prescrip▯on s▯mulants are easily accessible on campus ◦ Illicit recrea▯onal use among college students ranges from 5.3 - 34% • Main reasons students report misusing prescrip▯on s▯mulants: ◦ Improve academic performance ◦ Help w/ concentra▯on & focusing ◦ Improve test performance ◦ For recrea▯onal purposes • Students par▯cipa▯ng in Greek life more likely to misuse • Both children & adults with or w/o the disorder show posi▯ve cogni▯ve behavioral responses to s▯mulant medica▯ons ◦ Improves response inhibi▯on & working memory ◦ Improves convergent thinking ◦ Improves test performance in children w/ ADHD ◦ Normalizes brain ac▯vity pa▯erns in individuals w/ ADHD to equivalency of those without • Physical eﬀects: ◦ Cerebellar vermis signiﬁcantly smaller in children w/ ADHD who take s▯mulants than for children who don't ◦ Greater cor▯cal thinning in adolescents w/ ADHD on medica▯on than for children who don't • Tho thinning may result more rapidly in individuals w/ ADHD who don't take medica▯ons ◦ Pa▯ents treated w/ MPH display signiﬁcantly higher ac▯va▯on in the dorsolateral prefrontal cortex ◦ Normalizes previously reduced blood ﬂow in children's brains ◦ 12 months of MPH treatment showed decreases in dopamine levels & decreases in associated ADHD symptoms ◦ Oxida▯ve damage in rat brains • Synap▯c altera▯ons of thalamic nuclei & GABA transmission • 34% of the na▯onal sample reported misusing ADHD medica▯ons in their life▯me ◦ Majority btwn 12 - 25 yrs/old ◦ Students most likely to misuse are male Greek-aﬃliated students PSY 320 Drugs & Behavior Depressants Chapter 7 Depressants • Class of drugs that decrease/slow CNS ac▯vity & have widespread eﬀects on the brain • Group name: Seda▯ve-Hypno▯cs ◦ Include prescrip▯on drugs trea▯ng anxiety (seda▯ves) & insomnia (hypno▯cs) ◦ Seda▯ves - calming, Hypno▯cs - sleep inducing • Alcohol most widely used depressant • Benzodiazepines most widely prescribed depressants • Grouped on the basis of: ◦ Time of onset & dura▯on of ac▯vity ◦ Short-ac▯ng & rapid onset: Used to induce sleep & o▯en prescribed in high doses (hypno▯c drug) • Short-ac▯ng (pentobarbital, secobarbital) • Rapid onset • 2-3 hrs dura▯on of ac▯on ◦ Intermediate-ac▯ng (amobarbital, butabarbital) • 30 min onset ▯me • 5-6 hrs dura▯on of ac▯on ◦ Long-ac▯ng & delayed onset: Used to reduce anxiety & o▯en prescribed in low doses (seda▯ve drug) • Later onset ▯me (1 hr) • 6-10 hrs dura▯on of ac▯on History • Choral Hydrate ◦ "Knockout drops," "Mickey Finn" • Mickey Finn - Famous Chicago bartender who'd slip CH into customers' drinks before accomplices robbed them ◦ Synthesized in 1832, used clinically in 1870 ◦ Induces sleep in less than an hr • Rapidly metabolized to tri-choroethanol ◦ Abuse leads to gastric irrita▯on ◦ Ppl o▯en slipped them into drinks like rooﬁes to make individuals pass out • Paraldehyde ◦ Synthesized in 1829, used clinically in 1882 ◦ Eﬀec▯ve CNS depressant w/ a wide safety margin ◦ Noxious taste & odor, causes bad breath ◦ Widespread use in mental hospitals before 1950s • Bromides ◦ Widely used as sleep agent in patent medicines ◦ Appeared in OTC drugs thru the 1960s ◦ Can accumulate in the body & cause toxic eﬀects over several days of regular use • Any of these drugs in combina▯on w/ alcohol induced comas or death ◦ Pulled oﬀ the market • Late 1800s search for new drug replacement f o y r e v o c s ◦i D Barbiturates - Chemical group of seda▯ve-hypno▯cs ◦ First CNS depressant prescrip▯on medica▯ons to be widely used & abused ◦ Grouped according to dura▯on of ac▯on • 1903 - Barbital (Veronal) ﬁrst barbiturate to be used clinically ◦ Used for calming over-ac▯vity in the brain • 1912 - Phenobarbital (Luminal) introduced, s▯ll used today PSY 320 Drugs & Behavior • Harms: ◦ Overdose deaths • Both inten▯onal & accidental • Caused by respiratory depression e c nedneped & e s u◦b A • Reinforcing eﬀects related to rapidity of drug's onset of eﬀects • Short-ac▯ng drugs more likely to lead to psychological dependence • Concerns led to search for safer medica▯ons • 1950s: 2W f o d◦ n E ◦ Research turned to iden▯fying less addic▯ng drugs • Meprobamate ◦ Introduced in the 1950s ◦ First modern an▯anxiety (anxioly▯c) agent ◦ Produce psychological/physical dependence like barbiturates ◦ Made a Schedule 4 drug in 1970 ◦ S▯ll available as prescrip▯on drug, tho largely replaced by benzodiazepines • Methaqualone ('ludes) (Quaalude, Sopor) ◦ Primarily a CNS depressant, eﬀects include sexual arousal & paresthesias (numbing of ﬁngers, light ▯ngling) ◦ Introduced to the USA in 1965 ◦ No ini▯al monitoring, no perceived abuse poten▯al • Package insert read "Addic▯on poten▯al not established" ◦ Overprescribed, thinking drug was a safe alterna▯ve to previous barbiturates • Prescribed to reduce stress • "Stress clinics" opened up for ppl to visit & get prescrip▯on drugs ◦ Quickly became widely misused & abused • 1960s Germany & Japan both experienced high rates of abuse & suicide due to methaqualone • Placed ▯ght restric▯ons on prescrip▯ons to reduce overdoses ◦ One of the top selling drugs 1960s-70s • Major party drug of 70s disco era • "Disco biscuits" • Many ppl overdosed & abused, combined w/ alcohol ▪ DUI incidences, overdoses, date rape etc. ◦ 1973 made a Schedule 2 drug ◦ Movement to withdraw from the market for safer alterna▯ve drugs ◦ Pharmaceu▯cal companies agreed to stop manufacturing around 1980s ◦ 1985 no longer made available as prescrip▯on drug, listed as Schedule 1 drug ◦ Large demand remained • Illicit manufacturing of bootleg Quaaludes • Became more diﬃcult as manufacturers stopped producing ac▯ve ingredients • Pills w/ other ingredients s▯ll circula▯ng • Diazepam - Valium (contained huge doses) ▪ Ppl overdosed not by dying but for sleeping 3 days & then waking up Benzodiazepines • 1960 introduc▯on of chlordiazepoxide (Librium) • FIRST commercially marketed benzodiazepine in 1960s ◦ Reduces anxiety w/o inducing sleep ◦ Much larger safety margin than barbiturates • Much more rare cases of OD, usually just when combined w/ other depressants ◦ Physical dependence rare PSY 320 Drugs & Behavior • 1970s: Diazepam (Valium) ◦ Low-dose benzodiazepine ◦ Became best seller among prescrip▯on drugs for a ▯me ◦ One of the most frequently men▯oned drugs in DAWN reports (almost always in combina▯on w/ other depressants) ◦ Alprazolam now currently most widely prescribed from this drug class • Benzodiazepines: *many end in "pam" or "lam" ) n i pono l K ( ma pe z ano◦ l C ) na v▯A ( m ape z a r◦ o L )mu i l aV ( mape z a◦i D ◦ Alprazolam (Xanax) ) l i r o t s eR ( m ape z am ◦e T ) no i c l aH ( ma l o z a i ◦ r T • Rohypnol (ﬂunitrazepam ) ◦ Date-rape drug ◦ Hypno▯c ◦ 1990s version of "Mickey Finn" ◦ Produce profound intoxica▯on in combina▯on w/ alcohol • Changes in laws & formula▯on of pills have reduced abuse • 1997 manufacturers changed formula▯on to produce characteris▯c color when dissolved in drinks Benzodiazepine Hypno▯cs: • Temazepam (Restoril) ◦ For pa▯ents ini▯ally seeking treatment for short term insomnia & naïve to prescrip▯on sleep aids • Nonbenzodiazepine hypno▯cs ◦ Concerns about use as sleeping agents: • Hypno▯cs may induce tolerance, dependence, rebound insomnia, "hangover" eﬀects ◦ A▯er 1976, benzodiazepines displaced barbiturates in the sleeping-pill market Nonbenzodiazepine Hypno▯cs • Diﬀerent chemical structure than BZs, same eﬀects • 1993 Zolpidem (Ambien) introduced ◦ One of the most widely prescribed hypno▯cs for a ▯me ◦ Rapid onset, short dura▯on of acton • Followed by Zaleplon (Sonata) & Eszoplicone (Lunesta) • Reports of withdrawal symptoms & complica▯ons • Listed as Schedule 4 drugs PSY 320 Drugs & Behavior Inhalants • Vola▯le solvents inhaled for intoxica▯ng purposes: ◦ Gasoline, glue, paint, paint thinner, lighter ﬂuid, nail polish, etc. • Aerosols, propellants, gases: ◦ Butane, propane, spray paint, hair spray, lighters, whipped cream • Anesthe▯cs: ◦ Nitrous oxide, ether, current & former medical anesthe▯cs • High dose exposure: ◦ Intoxica▯on, slurred speech, trouble walking, similar to drunkenness Vola▯le Solvent s • 1959 reports of glue inhaled to induce similar intoxica▯on eﬀects to alcohol • Reports describing methods led to increased rates around Colorado ◦ Overly informa▯ve news ar▯cles/educa▯on programs actually demonstrated how to abuse vola▯le solvents • Inhalant use more common among low-income popula▯ons & young ppl w/o access to alcohol ◦ Abuse tends to occur as localized fads • Harms: ◦ Kidney damage, brain damage, peripheral nerve damage ◦ Irrita▯on of respiratory tract & headaches ◦ Severe headache ◦ Suﬀoca▯on in the bags • Gaseous Anesthe▯cs y r e g r u s & en i c i dem r o f de◦s U ◦ Abused by physicians & individuals w/ access s 00◦ 8 1 Nitrous Oxide (laughing gas) ﬁrst used • S▯ll used as a light anesthesia, usually by den▯sts • Used as propellant for commercial & home whipping-cream dispensers (whippets) • Pure inhala▯on may result in suﬀoca▯on from lack of oxygen • Isoamyl, isobutyl • Liquid that releases gases • "Locker room," "rush," "poppers" • Mid 1800s Amyl Nitrite introduced as treatment for chest pain • Nitrites ◦ Relaxes blood vessels, increases blood ﬂow, reduces blood pressure • Reduces blood pressure in the brain • Can trigger faintness or unconsciousness • Unpleasant odor ◦ 1960s recrea▯onal use of "poppers" - small glass vials crushed & vapors inhaled • Increased warmth & blood ﬂow links use to aphrodisiac ◦ Late 1970s linked to men ge▯ng high before sex ◦ 1980s sta▯s▯cal correla▯on w/ HIV infec▯on ◦ 1988 An▯-Drug Abuse Act listed nitrites as controlled substances & limited manufacturer produc▯on ◦ Consumer Product Safety Commission taking steps to remove poppers/other nitrites from the market GHB - Gamma Hydroxybutyric Acid • Used recrea▯onally as a depressant • Occurs naturally in the brain & body • Similar structure to GABA • Sold for a while as a dietary supplement for athletes & bodybuilders ◦ May also be used as anesthe▯c, date rape drug, etc. • Combina▯on w/ alcohol yields similar eﬀects as other depressants • Behavioral eﬀects similar to alcohol PSY 320 Drugs & Behavior ◦ Slurred speech, lack of coordina▯on • 1990 banned inclusion from dietary supplements • 2000 listed as Schedule 1 substance • 2002 oral solu▯on of GHB known as Xyrem approved for treatment of narcolepsy ◦ Reduces cataplexy - muscular weakness or paralysis resul▯ng from episodes of narcolepsy ◦ Available by prescrip▯on as Schedule 2 drug Anxioly▯cs • Beneﬁts of anxioly▯cs: ◦ Anxiety reducers ◦ Seda▯ves o▯en prescribed to reduce anxiety ◦ 4 benzodiazepines among top 100 most commonly prescribed meds in the US • Alprazolam (Xanax) • Lorazepam (A▯van) • Clonazepam (Klonopin) • Diazepam (Valium) • Anxioly▯c Drugs: ◦ Anxioly▯cs - Literally “Anxiety dissolving;” Drugs used in the treatment of anxiety disorders ◦ Most commonly prescribed psychotropic drugs ◦ Psychiatrists write less than 20% of US prescrip▯ons ◦ Prescribed most commonly by general prac▯▯oners, family physicians, internal medicine MDs y l k c i uq y r e v k r◦ oW ◦ Elderly o▯en abuse, have reduced ability to metabolize long ac▯ng BZs • Concerns: ◦ Some anxiety disorders respond to anxioly▯cs while others seem treated more eﬀec▯vely by an▯depressants or behavior therapy ◦ Pa▯ents may take drugs for long periods ◦ May be overprescribed - Is pa▯ent taking the drug to treat a disorder or to feel be▯er in a general way? • Anxioly▯cs as an▯convulsants: ◦ Barbiturates & benzodiazepines in low doses or combined w/ other an▯convulsants may be prescribed for seizure disorders (epilepsies) • Poten▯al problems: ◦ Tolerance & ﬁnding a dose that is eﬀec▯ve but doesn't cause excessive drowsiness ◦ Abrupt withdrawal likely to cause seizures • As sleeping pills/hypno▯cs: ◦ Taking a large enough dose of a hypno▯c drug helps individuals sleep quickly ◦ Insomnia a common complaint, although ppl some▯mes overes▯mate severity ◦ Today fewer hypno▯cs are prescribed than in the past & taken only for a few nights at a ▯me • Insomnia: ◦ Persistent diﬃculty ini▯a▯ng/maintaining sleep ◦ Do not wake feeling refreshed ◦ Decline in social or occupa▯onal func▯oning • Insomnia's eﬀects: s s en i pe e l s em▯y◦a D eu g▯◦ a F ◦ Cogni▯ve impairment ◦ Decline in work performance de s s im s y ad k r◦ oW ◦ Depression/anxiety • Insomnia therapies: ◦ Pharmacologic PSY 320 Drugs & Behavior • Melatonin • An▯-depressants • An▯-histamines • Benzodiazepines • Non-benzodiazepine hypno▯cs • An▯psycho▯cs ◦ Non-pharmacologic • CBTi (cogni▯ve behavioral therapy for insomnia) • S▯mulus control therapy • Sleep restric▯on therapy • Relaxa▯on training • Cogni▯ve therapy • Sleep hygiene educa▯on ▪ Beneﬁts are long-las▯ng, even a▯er therapy ends ▪ Rela▯vely free of medical risks ▪ No signiﬁcant interac▯ons w/ other medical treatments • Monetary costs (repeated visits to providers) • Improvement may not occur for several weeks • Requires ▯me & mo▯va▯on • Day▯me sleepiness during sleep restric▯on • Lack of access to a trained therapist • Lack of therapist exper▯se ◦ Both have strong evidence to support their use Mechanism of Ac▯on • Benzodiazepine & Barbiturates ◦ Bond w/ brain receptors ◦ Enhance inhibitory eﬀects of GABA ◦ A▯ach to receptors • Nonbenzodiazepine hypno▯cs ◦ Selec▯vely target GABA-A receptor ◦ Bind to sub-types of GABA receptors speciﬁcally modula▯ng sleep ◦ Thought to have less unwanted side eﬀects ◦ Tolerance & abuse not a major concern ◦ Shorter dura▯on of ac▯on than most benzos, less likely to cause next day seda▯on ◦ Seem to work be▯er as sleeping pills than as an▯anxiety drugs ◦ Drowsiness, dizziness, unsteadiness of gait, rebound insomnia, memory impairment ◦ Include zolpidem (Ambien), zaleplon (Sonata), eszopiclone (Lunesta) Beneﬁts vs/ Harms of BZs • Beneﬁts ◦ Good medicinal uses ◦ Enhance sleep (hypno▯c) ◦ Decrease anxiety (anxioly▯c) ◦ Muscle relaxant ◦ An▯-convulsant • Harms nwod uo y swo l s , no▯ade s em▯y◦a D ◦ Decreased reac▯on ▯me ◦ Unsteadiness of gait may cause falls *esp in elderly ◦ Cogni▯ve impairments & memory problems PSY 320 Drugs & Behavior ◦ Risk of tolerance ◦ Risk of withdrawal & rebound insomnia ◦ Risk of abuse ◦ Short-ac▯ng drugs more likely to produce withdrawal symptoms • Dependence & overdose can occur • Dosage & ▯me course are cri▯cal factors ◦ Overdose deaths more likely for drugs sold in higher doses ◦ Psychological dependence more likely w/ drugs that have rapid onset of eﬀects ◦ Physical dependence more likely w/ drugs having a shorter dura▯on of ac▯on • More diﬀerences among barbiturates & among benzodiazepines than there are btwn the 2 classes of drugs Depressants & concerns: • Dependence ◦ Psychological dependence: • Esp associated w/ short-ac▯ng barbiturates ◦ Physical dependence: • Poten▯ally life-threatening withdrawal syndrome linked to large doses of seda▯ve-hypno▯cs • Withdrawal symptoms similar to & longer las▯ng than alcohol withdrawal ◦ Barbiturate withdrawal: • Anxiety, insomnia, weakness, nausea, vomi▯ng, seizures, disorienta▯on, agita▯on, delusions, visual & auditory hallucina▯ons ◦ Benzodiazepine withdrawal: • Less severe, anxiety, irritability, insomnia : e c nednepe d - s s o◦ r C • Occurs among barbiturates, benzodiazepines, alcohol • Toxicity ◦ Behavioral: • Alcohol-like intoxica▯on w/ impaired judgment & coordina▯on • Increased risk of injury while driving or engaging in ac▯vi▯es • Addi▯ve eﬀects if combined w/ alcohol ◦ Physiological: • Respiratory depression, death • Esp dangerous if combined w/ alcohol • Pa▯erns of abuse: ◦ Most abuse associated w/ oral use of legally manufactured products ◦ Two types of typical abusers: • Older adults using prescrip▯on drug, tolerance develops, dose increases • Younger ppl who obtain drugs to get high, may take high doses/mix w/ alcohol Benzodiazepines during pregnancy: • Associa▯on remains unclear btwn BZDs & cle▯ palate, birth defects • No conclusive data regarding possible behavioral teratogenicity • Exposure late in pregnancy: ◦ Delivery complica▯ons, withdrawal symptoms in baby, convulsions Ar▯cle - Increasing Benzodiazepine Prescrip▯ons & Overdose Mortality in the US 1996-2013 • Describes trends in benzodiazepine prescrip▯ons & OD mortality among US adults ◦ Data examined from Medical Expenditure Panel Survey & caue-of-death data from Centers for Disease Control & Preven▯on • From 1996 - 2013: ◦ Adults ﬁling for benzodiazepine prescrip▯ons increased from 4.1% to 5.6% PSY 320 Drugs & Behavior ◦ Quan▯ty of BZs ﬁlled increased from 1.1% to 3.6% ◦ OD death rate increased from 0.58% to 3.07% • Rate con▯nued to increase for: ◦ Adults 65 + ◦ Black & Hispanic par▯cipants • Prevalence of long-term use increased w/ age • Rate of OD deaths involved BZs have stabilized ◦ Remains over 5x the rate from the beginning
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