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Drugs & Individual Behavior Class Notes Week 5

by: McKenna Keck

Drugs & Individual Behavior Class Notes Week 5 PSYCH 3102

Marketplace > University of Northern Iowa > Psychology > PSYCH 3102 > Drugs Individual Behavior Class Notes Week 5
McKenna Keck
GPA 3.71

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About this Document

These notes cover what we've gone over in class this week including finishing up the benzodiazepines, and beginning to cover alcohol.
Drugs and Individual Behavior
Dr. Linda Walsh
Class Notes
alcohol, benzodiazepines, Drugs, social, work, UNI
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This 7 page Class Notes was uploaded by McKenna Keck on Thursday September 22, 2016. The Class Notes belongs to PSYCH 3102 at University of Northern Iowa taught by Dr. Linda Walsh in Fall 2016. Since its upload, it has received 13 views. For similar materials see Drugs and Individual Behavior in Psychology at University of Northern Iowa.

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Date Created: 09/22/16
Drugs & Individual Behavior Week 5 Tuesday, September 20, 2016 Continued from families of CNS Depressants ○ Non­Barbiturate Sedative­Hypnotics ■ Called then non­barbiturates b/c there were so many problems w/  the barbs that they wanted to come up w/ something better ■ Several drugs were released claiming to be big improvements over  the barbs (but they turned out not to be better) ■ Examples: ● methadone (Quaalude) ● meprobamate (Miltown) ● It just wasn’t the improvement they claimed it was. ○ It’s really not until drugs have been  out for a long time that you know what it’s really like. ■ Turned out not to be significant improvements & one after another  have been removed from the legal market ○ Benzodiazepines ■ “Minor Tranquilizers” or “Anxiolytics” ■ 15 different benzos currently available, main difference is half­ life/time course (just like for barbs) ● Examples: diazepam (Valium), alprazolam (Xanax), chlordiazepoxide (Librium) ■ Act via benzodiazepine receptor on GABA receptor, increasing the calming effects of GABA (they are sometimes called BZRAs: benzodiazepine receptor  agonists) ■ Very commonly prescribed ● Several benzos are in the top drugs prescribed ■ Why might you want a short acting benzo? ● You need a sleep aid but don’t want to wake up  groggy ■ Why might you want a long acting benzo? ● If you have epilepsy ● If you have muscle spasms ● If you’re going through alcohol detox ● If you have an anxiety disorder that bothers you all  the time ■ Benzo benefits ● Somewhat more selective than barbs ● Wide safety margin (high LD) as long as other  depressants aren’t used ● 2 antidotes for overdose are available: ○ Antagonist flumazenil (Romazicon)  (short half­life, must be re­administered) ■ Misplaces the benzo  from the receptor they attach to so they can’t have an effect any  more ■ Short half­life, so they might have to give it more than once if you overdose on something long­acting ○ NEW!: narcotic antagonist Narcan  (naloxone) that’s used for opiate overdoses can also help in benzo  overdose! (but not good if person is opiate­dependent) ● Less tolerance & dependence than barbs ● Less dangerous withdrawal (can be delayed several  days & leaves more gradually due to longer half­life) ● Sleep somewhat more normal than w/ barbs (but  still REM suppression) ■ After their introduction in the 1960s, benzodiazepines became  THE most widely prescribed psychotherapeutic drugs until nearly the 1990s. ● Doctors got a little trigger happy on their  prescribing. ■ Benzo Problems ● Great for short term use, but dependency & abuse  still possible (Schedule IV) ● Significant cognitive/memory storage impairment ○ Sometimes used specifically for that  reason, like for colonoscopies ● Driving impaired, interacts w/ alcohol; (low dose  Xanax = like BAC .15) ● Dangerous interactions ○ Should never be paired w/ other CNS depressants  or opioids ● Some increased risk of birth defects ● Over­response in elderly common; idiosyncratic  responses like agitation & rage possible ■ Benzo Withdrawal: Rebound Hyperexcitability ● Not as dangerous as barb withdrawal because it is  naturally more gradual ● But rebound insomnia, anxiety, restlessness,  agitation, & irritability making quitting difficult for dependent users. Taper dose  over months to get the least withdrawal symptoms. ● In rare cases can get DTs (delirium tremens ­ a  delirious state) & seizure like barbs ● Even after withdrawal users are prone to relapse  (like alcoholics) ■ Rohypnol ­ a “date­rape drug” ● “Roofies” contain a high potency bezo not marketed in the US, but similar to Halcion ● Actually any combination of alcohol + sufficient  benzo could produce similar effects ● Impairs consciousness & memory of victim ● DAWN reports about 15,000/yr cases of such  “intentional poisonings,” ⅔ in females, about 60% via tainted drinks ● There are products now to check if your drink has  been tainted (there’s even a nail polish that’ll change colors if you dip it in your  drink & it’s tainted). ● GABA­related Club Drug Gamma­hydroxybutyrate  (GHB) ○ Not a benzo, but worth mentioning  here. ○ A non benzo that that’s sometimes  used as a date­rape drug. ○ Potent depressant used as a general  anesthetic in some countries & as date­rape or club drug in others ○ Found in the CNS ­ some GABA is  converted into GHB ○ Overdose can be deadly ­ nausea,  vomiting, loss of consciousness, respiratory depression, possible seizures ○ DAWN reports 3,400­5,000  overdoses per year, 72 fatal ○ Now a Schedule I drug & a Schedule III drug for improving nighttime sleep/decreasing daytime sleepiness in  narcolepsy ○ When you get a drug on the street  there’s really no way of knowing exactly what it is, how potent it is, etc. ■ Alternatives to Benzos & Barbs ● The Trend in Drug Development: Even More  Selective Drugs ○ More “selective” drugs affect only a  subgroup of receptors ○ Non­benzodiazepine selective  BZRAs ­ the Z’s ■ zolpidem (Ambien)  Mostly hypnotic & amnesic effects w/ little anti­anxiety,  anticonvulsant, or muscle relaxing effects. More normal sleep, less  insomnia rebound. Half­life 2 hrs; short­term use only. ■ zaleplon (Sonata) ­  half­life > 1 hr, so can be taken in middle of night (about 4 hour  effect) ■ eszopiclone (Lunesta) half­life about 6 hrs ­ approved for use up to 6 months  ■ Take these at bedtime  only; DO NOT DRIVE, may increase bizarre sleepwalking, sleep  eating in some w/ no memory of event ■ Approved v. Off­Label Uses of a Drug: ● If a drug company wants to list a particular use for a drug in their materials and/or advertise their drugs for that use, the FDA require  that they conduct & submit the extensive research necessary to demonstrate the  drug is safe & effective for that use (approved). ○ It takes many years… Usually more  than a decade. ○ When you research a drug you can  see what a drug is actually approved for. ● But doctors aren’t limited to prescribing for these  “approved” uses. You should always check (off­label). ○ Did the FDA approve this drug for  this use? If not, what research suggests it would be useful? ○ What alternatives are there? ● Brand name companies that produce Halcion,  Restoril & Dalmane did the years of research necessary to get FDA approval to  market their drugs as hypnotics & list this use in their package insert. This is a   FDA approved use of these drugs. ● If doctors prescribe other benzos to promote sleep  (ones that didn’t submit research related to sleep to the FDA), use for that purpose would be “off­label” (those drugs can’t be marketed for that use & can’t list that  use on their label or package insert). In this case, any benzo can make you sleepy,  but sometimes “off­label” use is really experimental. ■ Drug Abuse Warning Network (DAWN) ● Network of metropolitan hospitals w/ ER  departments ● From ER medical records glean how many visits are associated w/ different drugs ● It’s not perfect information, because they don’t do  blood tests to check to see if it’s the drug. They just go off of mentions. Thursday, September 22, 2016 Continued from Benzodiazepines…  ■ Benzos may be following the barbs out of widespread popular use ● Benzos are being replaced by safer, more selective  drugs for many, if not most, of their therapeutic uses ● Use for anxiety now being replaced by  antidepressants & other drugs ­ more than 50% decrease in benzo prescriptions ● Use for insomnia decreasing as well ● BUT: Swing to new drugs may be going too far ● Benzos still have their place & new drugs have their own problems. ○ Anti­epileptics or “Anticonvulsants” Besides the Barbs & the Benzos ■ The majority of the many drugs used to control seizures work on  the same transmitter­enhancing the calming action of GABA. ■ We’ll come back to a few of the anticonvulsants being used as  psychotherapeutic drugs later in the semester. ○ General Anesthetics ■ Exert dose­dependent CNS depressant effects ■ Additional complication of inhaled anesthetics ­ decrease/displace  the inhalation of oxygen. Except in the hands of a trained anesthesiologist there is a very  real risk of hypoxia & brain damage. ■ We won’t cover individual anesthetics except nitrous oxide &  GHB as substances of abuse. ● Alternatives to CNS Depressants/Sedatives/Hypnotics ○ You might not want to prescribe a CNS Depressant b/c of substance abuse,  alcohol use, recovery, etc. ○ Antihistamines (for sedative/hypnotic effects) ■ diphenhydramine (Benadryl) (OTC) ● The sedating antihistamine that’s in “PM” drugs  (like Tylenol PM) ■ hydroxyzine (Atarax, Vistaril) ­ prescription only ■ promethazine (Phenergan) ­ prescription only ○ Melatonin (OTC supp) or a melatonin agonist (prescription) Rozerem (ramelteon) to help one fall asleep ○ Beta­blockers (decrease body signs of anxiety) ■ propranolol (Inderal), atenolol (Tenormin), metoprolol (Lopressor) ○ Antidepressants ■ trazodone (Desyrel), amitriptyline (Elavil), mirtazapine (Remeron)  & doxepin (Sinequan) used for sleep ■ SSRIs now used for most anxiety disorders ­ we’ll cover these later in the semester ○ Anti­Anxiety Drug Not Working on GABA ■ Selective 5HT­1A agonist buspirone (Buspar) (antianxiety but not  CNS depressant) ● Delayed (2­4 weeks) antianxiety action without  sedation, incoordination, memory problems, depressant interactions, dependency  (good for those w/ abuse risk or drinking problem). May not be as effective for  panic disorder. ● Side effects: headache, dizziness, nausea Alcohols ● Different Kinds ○ Beverage alcohol = ethanol or ethyl alcohol ○ Rubbing alcohol = isopropyl alcohol (also in antiseptics, aftershave, window  washer fluid) ○ Methanol or Methyl alcohol = common industrial/chemical form of alcohol  (antifreeze, Sterno, solvents, duplicating fluid) ○ All 3 are toxic to your body, but ethanol is the least toxic. ● Ethanol ○ Produced by the action of yeast on a sugary mixture (“fermentation”) ■ Or you could start w/ a starchy mixture that can be turned into  sugar ■ Fermentation can only go up to (at max) a solution that’s 15%  alcohol. Once it gets that high the alcohol itself kills off the yeast. ■ Distillation must be used to produce stronger spirits ● Alcohol boils at a lower temp than water. If you  boil it off, the alcohol will evaporate 1st, collect the vapors, stopping before the  temp where the water would boil off, & get a more concentrated alcohol. ● Distilled spirits can get up to 40% ● “Proof” is 2x the % ○ A lot of people use alcohol to ease their pain for a while, some people are totally  against it, etc. ○ BAC (Blood Alcohol Concentrations) are how you measure the dose response for  ethanol ■ .08% is considered the legal limit ○ Alcohol absorption ■ Fat & water soluble molecule easily gets into all tissues; no  digestion necessary ■ Provides calories but no nutrients ● Alcoholics often have a lot of vitamin deficiencies ■ About 20% absorbed from stomach, 80% from intestines ■ Stomach contents, alcohol concentration, carbonation (speeds),  gender, drug interactions (aspirin, anti­ulcer, etc), all affect absorption ■ Other factors influencing intoxication: speed of consumption,  individual sensitivity, expectancy ● Alcohol Expectancy Effects ○ Males who expect to get alcohol: ■ Act drunker ■ Show more subjective arousal & sexual disinhibition whether or not they get alcohol ○ Typical Effects on the Body ■ Dilation of blood vessels in skin leading to a warm surface flush  (but drop in core body temp) ● If that happens every day, like to an alcoholic, those blood vessels can break ● So, the St. Bernard bringing whiskey to people lost  in avalanches, actually probably not a good idea. ■ Decreased Antidiuretic Hormone (ADH) leading to increased  urination & dehydration ● Antidiuretic hormone tells your body to save water ● You’ll end up losing more water than you drink ■ In moderate doses, increased HDLs (good) & lowered LDLs (bad)  except in smokers ■ Gastric irritation ○ Actions of Alcohol on the Brain (Multiple Actions) ■ Produces most depressant actions by enhancing the inhibitory  effects of GABA ● A drug (RO 15­4513) which keeps alcohol from  binding to GABA receptor acts as a “sober­up” drug. It actually forced alcohol off the alcohol binding site on the GABA receptor. ● Didn’t get marketed, because it didn’t reverse  depression of respiration, & you can’t depend on people to take it appropriately.  Full of chances of lawsuits. ■ Alcohol blocks excitatory effect of glutamate (like barbs) so is  “extra­depressant” in its effects ■ These actions, in turn, lead to the release of 5HT, DA, endorphin & anandamide producing rewarding/mood elevating effects *Some lines of notes copied directly from slides in order to maintain testing accuracy. Most is of the lecture &  discussion, not found on slides.


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