Transcript Introduction to Pharmacology

Introduction to Pharmacology
October 3, 2006
Schedule of Drugs
Developed in 1970 by the DEA to aid in the regulation
of controlled substances.
Drugs are placed on 1 of 5 “schedules” in accordance
with 1) accepted medical use and 2) abuse /
addiction potential.
A schedule 1 drug (crack, heroin, marijuana) has no
accepted medical use and is considered to have a
high abuse / addiction potential. Whereas a schedule
5 drug (cough syrup) is widely accepted for medical
use and is considered to have a little to no abuse /
addiction potential.
Schedule 2 and 3 drugs are ones typically used to
treat psychosis and mood disorders. For these
drugs, you need a prescription to have then in your
possession.
Blood / Brain Barrier
BBB is semi-permeable
Protects the brain from “foreign
substances” in the blood that may injure
the brain.
Protects the brain from hormones in the
rest of the body.
Maintains a constant environment for
the brain.
CNS
Neurotransmitters
4 Main Classes
Acetylcholine (excitation)
Monoamines*** (inhibition)
Norepinephrine
Dopamine
Serotonin
Amino Acids (excitation / inhibition)
GABA
Glycine
Glutamate
Aspartate
Peptides (excitation)
Substance P
Enkephalins
***Monoamines are implicated in mood disorders, psychosis and anxiety.
These neurotransmitters are found in the limbic system, a part of the brain
associated with the the regulation of sleep, appetite, and emotional
responses.
Mood Disorders
There are two major types of mood
disorders: Depressive Disorders and
Bipolar Disorders
Depression affects females
approximately 2x more than males
Most common psychological disorder in
the U.S.
What Defines Depression?
AFFECTIVE – depressed mood, feelings
of sadness, dejection, and
excessive/prolonged mourning, feelings of
worthlessness, and a loss of joy for living
BEHAVIORAL – social withdrawal,
lowered work productivity, low energy
levels is the dominant behavioral symptom
…continued
COGNITIVE – feelings of futility, emptiness,
and hopelessness, profound pessimistic
beliefs about the future, disinterest,
decreased energy, and motivation towards
work and life in general
PHYSIOLOGICAL – change of appetite,
weight change, constipation, sleep
disturbance, menstrual abnormalities, and
lack of libido
Medications
3 classes of meds for depression
Tricyclics - effect norepinephrine - include
Elavil, Emitrip, Pertofrane, and Janimine
MAO inhibitors - effect norepinephrine include Marplan, Nardil, Parnate
2nd Generation of medications (including
SSRIs) - effect seretonin - include
Wellbutrin, Prozac (SSRI), Zoloft (SSRI),
and Paxil (SSRI)
How they work
Tricyclics and SSRI work the same, but for a
different monoamine (norepinephrine and
serotonin respectively). Each 1) prevents the
reuptake in the synapse allowing the
neurotransmitter more time to be absorbed
into the second neuron and 2) increases the
number of receptor cites the neurotransmitter
can be absorbed through.
MAO inhibitors prevent the MAO enzyme
from breaking norepinephrine down; allowing
it to remain in the synapse.
Why was there a need for a new
generation?
Tricyclics can cause dry mouth, excessive sweat,
blurred vision, sexual dysfunction.
MAO inhibitors have less effects, but can damage the
liver, cause severe low blood pressure, or be fatal.
So they are not prescribed nearly as much as
tricyclics.
SSRI can cause a person to become nervous, angry,
or weak; however the side effects last a shorter
amount of time.
SSRI usually take 2 weeks to build up effective levels
whereas tricyclics and MAO inhibitors take approx. 4
weeks. Furthermore the side effects of SSRIs usually
last a shorter time.
Vocational Implications
Client exhibits decreased motivation for work
productivity
Client exhibits decreased energy
Both lead to employee loss of time at work
Sleep disturbance can also cause
absenteeism
Cognitive difficulties, i.e. concentration,
memory, decision-making
Can be associated with other illnesses
(cancer, diabetes, cardiac problems)
Side effects from medication
ACCOMMODATIONS FOR
DEPRESSIVE DISORDER
Flexibility in work schedule
Time for treatment
(medical/psychological)
Reduction of workload during active
stage of disorder
Bipolar Disorder
Affects approximately 1.2% of the
population.
Characterized by mood shifts from
depression to mania.
Bipolar
Symptoms for a manic episode include
elevated persistence, irritability, grandiosity,
decreased need for sleep, distractibility, and
social/occupational impairment
Usually accompanied by:
psychosis – altered mental state
(auditory and visual hallucinations)
delusions – believing something about
yourself that is not true (ability to fly)
Bipolar
Bipolar can easily be misdiagnosed as
schizophrenia and depression because of the
similar symptoms one can have.
Remember a person with bipolar disorder is
unlikely to seek treatment while in the manic
phase unless Baker Acted (committed).
A typical cycle for Bipolar ranges from several
weeks to a several months. No one is
depressed, then manic in one or two days.
Medications for Bipolar
People with bipolar usually take a medication
to even out their mood.
Lamictal and Tegretol are most commonly
used. Lithium is the old “standby”
medication, but not that common anymore.
Why would med compliance be more difficult
in a person who is in a manic phase of his
disorder?
Side Effects of Bipolar Medications
Headache
Fatigue
Drowsiness
Dizziness
Blurred vision
Joint aches
Vocational Implications
Very similar to depression, but during
stages of mania:
Work relationship difficulties
Concentration difficulties
Lack of focus or attention
Side effects to medication
Accommodations
Similar modifications for a person with
depressive disorders
Schizophrenia
Group of disorders characterized by
severely impaired cognitive processes,
personality disintegration, affective
disturbances, and social withdrawal
4 main types of schizophrenia: paranoid,
disorganized, catatonic, and residual
Approximately 1% of the population
Not a result of poor parenting, the brain
just develops differently
Is NOT Multiple Personality Disorder
Schizophrenia
Paranoid Schizophrenia – extreme
suspicion, persecution, or grandiosity, or
a combination of these feelings
Disorganized Schizophrenia –
incoherent speech and thought, but may
not have delusions
Schizophrenia
Catatonic Schizophrenia – withdrawal,
mute, negative, and often assumes
unusual body positions
Residual Schizophrenia – no longer
experiences delusions or hallucinations,
but no longer has motivation in life
“Positive Symptoms”
Delusions
Delusions of Grandeur- belief that one is a famous or powerful
person
Delusions of Control- belief that other people, animals, or
objects are trying to control of one
Delusions of Thought Broadcasting- belief that one can hear the
thoughts of the individual
Delusions of Persecution- belief that others are plotting against
one, maybe trying to kill one
Delusions of Reference- belief that one is always the center of
attention, or all things revolve around oneself
Thought Withdrawal- belief that one’s thoughts are being
removed from one’s mind
“Positive Symptoms”
Hallucinations (occurs for all senses)
Loosening of Associations- cognitive
slippage and neologisms
“Negative Symptoms”
Anhedonia - inability to feel pleasure
Avolition - inability to take action or
become goal-oriented
Alogia - a lack of meaningful speech
Flat Affect- little or no in situations where
strong reactions are expected
Medications
Medications- Haldol, Thorazine, Zyprexa,
Clozaril, and other neuroleptics
Effect the dopamine and serotonin levels
Side effects can occur from these meds, such as
Parkinson-like symptoms, blurred vision, weight
gain, skin problems, dystonia (muscle
contraction), ticks, and tremors
Leads to taking Parkinson’s meds or treatment
for Tardive Dyskinesia (except Clozapine)

http://www.ninds.nih.gov/disorders/tardive/tardive.htm
Vocational Implications
Confused thinking or strange, grandiose
ideas
Heightened anxieties, fears, anger, or
suspicions
Blaming others
Social withdrawal, diminished
friendliness, and increased selfcenteredness
Vocational Implications
Denial of obvious problems and strong
resistance to offers of help
Substance abuse
Side effects from the meds for treatment
Accommodations
Flexible scheduling
Additional time to learn new responsibilities or self-paced
workload
Reduced distractions and/or stimulus in workplace
Allowed use of “white noise”, or environmental sound machine
Increased natural lighting (artificial lighting is no good!)
Daily to-do list
Allow employee to tape record meetings and other important
information
Sensitivity training for the other employees
Limit change in the workplace: KEEP THINGS STRUCTURED
Anxiety
Generalized Anxiety Disorder (GAD)
GAD is characterized by excessive,
unrealistic worry that lasts six months or
more; in adults, the anxiety may focus on
issues such as health, money, or career. In
addition to chronic worry, GAD symptoms
include, excessive sweating, muscular aches,
jumpiness, insomnia, abdominal upsets,
dizziness, and irritability.
Anxiety
Panic Attacks
People with panic disorder suffer severe attacks
of panic-which may make them feel like they are
having a heart attack or are going crazy-for no
apparent reason. Symptoms include heart
palpitations, chest pain or discomfort, sweating,
trembling, tingling sensations, feeling of choking,
fear of dying, fear of losing control, and feelings
of unreality. Panic disorder often occurs with
agoraphobia, in which people are afraid of
having a panic attack in a place from which
escape would be difficult, so they avoid these
places.
Anxiety
Social Anxiety Disorder
Social Anxiety Disorder (SAD) is
characterized by extreme anxiety about being
judged by others or behaving in a way that
might cause embarrassment or ridicule. This
intense anxiety may lead to avoidance
behavior. Physical symptoms associated with
this disorder include heart palpitations,
faintness, blushing and profuse sweating.
Medications for Anxiety
Most anti-depressant meds are also
used to treat anxiety (especially SSRIs)
In addition to the these medications,
benzodiazepines, including Valium
(GAD) and Xanax (panic disorder) are
used to treat anxiety.
Side Effects
High-potency benzodiazepines relieve
symptoms quickly and have few side
effects, although drowsiness can be a
problem. Because people can develop a
tolerance to them and would have to
continue increasing the dosage to get
the same effect, benzodiazepines are
generally prescribed only for short
periods of time.
Vocational Limitations
Job seeking
New tasks tend to be problematic
Avoiding “highly charged” work environments
Depending on the type of anxiety disorder,
certain work places and / or functions are
limited. (i.e. someone with social anxiety
would be uncomfortable doing public
speaking)
Accommodations
Scheduled weekly visits with supervisor
Provide space enclosures or a private office
Divide large assignments into smaller tasks
and goals
Allow telephone calls during work hours to
doctors and others for needed support
Provide praise and positive reinforcement
Provide a self-paced work load and flexible
hours
As a counselor…
Do not tell an employer or anyone else at the
client’s job the person’s diagnosis. When you
talk to an employer you can tell him or her
that your client has certain limitations.
Empower the client to make his or her own
choices about whom he or she discloses
information to.
Be careful how you reinforce medication
compliance. Be sure to reinforce the fact that
the person has taken the responsibility to
take his or her meds.