Introduction to Pharmacology

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					   Introduction to
  September 14, 2004
              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
               CNS Neurotransmitters
4 Main Classes
• Acetylcholine (excitation)
• Monoamines*** (inhibition)
• Amino Acids (excitation / inhibition)
• Peptides (excitation)
    Substance P
***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
• BEHAVIORAL – social withdrawal,
  lowered work productivity, low energy
  levels is the dominant behavioral
• 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
• 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
              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
• 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
  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
• Cognitive difficulties, i.e. concentration,
  memory, decision-making
• Can be associated with other illnesses
  (cancer, diabetes, cardiac problems)
• Side effects from medication
• Flexibility in work schedule
• Time for treatment
• Reduction of workload during active
  stage of disorder
           Bipolar Disorder

• Affects approximately 1.2% of the
• Characterized by mood shifts from
  depression to mania.
• Symptoms for a manic episode include
  elevated persistence, irritability,
  grandiosity, decreased need for sleep,
  distractibility, and social/occupational
• Usually accompanied by:
  psychosis – altered mental state
     (auditory and visual hallucinations)
  delusions – believing something about
     yourself that is not true (ability to fly)
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
A typical cycle for Bipolar ranges from
  several weeks to a several months. No one
  is depressed, then manic in one or two
      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

• Similar modifications for a person
  with depressive disorders
• 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
• Paranoid Schizophrenia – extreme
  suspicion, persecution, or grandiosity,
  or a combination of these feelings

• Disorganized Schizophrenia –
  incoherent speech and thought, but
  may not have delusions
• 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- 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 Tardives Dyskinesia (except Clozapine)
     Vocational Implications
• Confused thinking or strange,
  grandiose ideas
• Heightened anxieties, fears, anger, or
• Blaming others
• Social withdrawal, diminished
  friendliness, and increased self-
     Vocational Implications
• Denial of obvious problems and strong
  resistance to offers of help
• Substance abuse
• Side effects from the meds for
• Flexible scheduling
• Additional time to learn new responsibilities or self-paced
• 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
• Sensitivity training for the other employees
• Limit change in the workplace: KEEP THINGS STRUCTURED
• 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.
• 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.
• 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
            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
• 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
• Scheduled weekly visits with supervisor
• Provide space enclosures or a private office
• Divide large assignments into smaller tasks and
• 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 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.

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