Lecture Notes: Key Topics in Psychopharmacology

Key Concepts

• Beta Delta Fibers: Symbols will be used in representations.
• Off-label Medication: Focus on FDA-approved medications for treatment guidance.
• Brain Areas and Functions: Emphasis on specific areas related to anxiety, pain, and sleep-wake regulation.

Brain Areas in Anxiety and Sleep

• Amygdala and Hippocampus: Involved in mood and emotions, especially anxiety.
• Parrachial Nucleus and Periaqueductal Gray: Key roles in sleep regulation.
• Pineal Gland: Mainly associated with sleep through melatonin release.

Anxiety Types

• Amygdala-Driven Anxiety: Physical symptoms such as fear, panic, and phobias.
• CSTC-Driven Anxiety: Mental symptoms like worry and rumination.
• Treatment Implications: Different approaches for physical vs. mental anxiety symptoms.

Medication-Related Issues

• Overdose Concerns:
  • TCAs and Benzodiazepines: High risk for overdose.
  • Antidotes: Narcan for opiates, Flumazenil for benzodiazepines.
• Contraindications:
  • Elderly, Respiratory Disorders, Liver Disease: Caution with benzodiazepine use.
  • Substance Abuse History: Avoid benzodiazepines.

Benzodiazepines

• High Potency & Short Half-life: Higher risk of misuse and withdrawal.
• Preferred Benzos for Liver Issues: Lorazepam due to multiple administration options.

Sleep Medications

• Going to Sleep vs. Staying Asleep:
  • Sonata: Helps go to sleep (short half-life).
  • Lunesta and Ambien: Help stay asleep.
• Important Advisories:
  • Risk of complex sleep-related behaviors.
  • Avoid alcohol and high-fat meals.

Non-Benzo Sleep Aids

• Ramelteon (Rozerem): Good for onset sleep issues.
• Trazodone: Useful for staying asleep, monitor for priapism.
• Doxepin, Melatonin: Options for substance abuse histories.

Wakefulness Medications

• Orexin Role: Stabilizes wakefulness.
• DORA Drugs: Inhibit orexin to decrease wakefulness.

Pain Management

• Gabapentin vs. Lyrica: Similar mechanisms; Lyrica more potent.
• Chronic Pain: Involves central sensitization.

Study and Examination Tips

• Exam Details: 48 questions, opens Tuesday 8 a.m., closes Friday 8 a.m.
• Preparation Advice: Focus on emphasized lecture content and main drug classes discussed.