Chapter 20

Psychotropic Medications, Alcohol,

and Drug Abuse

Edited by Dr. Ryan Lambert-Bellacov, chiropractor for Back in the Game in West Linn, OR

2

Psychotropic Medications

• Substance affecting the brain

• Therapeutic effect on mental processes

• Classifications– CNS stimulants– Antidepressants– Anxiolytics– Antipsychotic

Edited by Dr. Ryan Lambert-Bellacov, chiropractor for Back in the Game in West Linn, OR

CNS Stimulants

• Promote CNS functioning

• Uses

• Side effects

• Contraindications or precautions

• Pediatric precautions

• Patient education

Edited by Dr. Ryan Lambert-Bellacov, chiropractor for Back in the Game in West Linn, OR

4

Antidepressants

• Depression– Chemical imbalance

• Neurotransmitters– Dopamine, serotonin, and

norepinephrine

Edited by Dr. Ryan Lambert-Bellacov, chiropractor for Back in the Game in West Linn, OR

Antidepressants

• Categories– Tricyclics– Monamine oxidase inhibitors– Selective serotonin reuptake inhibitors– Heterocyclic antidepressants

Edited by Dr. Ryan Lambert-Bellacov, chiropractor for Back in the Game in West Linn, OR

Tricyclics

• Improve effect of norepinephrine and serotonin by blocking their reuptake pre-synaptically

• Strong anticholinergic activity

• Delayed action

• Frequently given at bedtime

Edited by Dr. Ryan Lambert-Bellacov, chiropractor for Back in the Game in West Linn, OR

Tricyclics

• Side effects

• Contraindications or extreme caution

• Interactions

Edited by Dr. Ryan Lambert-Bellacov, chiropractor for Back in the Game in West Linn, OR

Monamine Oxidase Inhibitors (MAOIs)

• Increase concentrations of serotonin, norepinephrine, and dopamine

• Inhibit monamine oxidase enzyme

• Rarely used today

• Given two weeks after tricyclics have been discontinued

Edited by Dr. Ryan Lambert-Bellacov, chiropractor for Back in the Game in West Linn, OR

9

MAOIs

• Side effects

• Contraindications

• Interactions

10

Selective Serotonin Reuptake Inhibitors (SSRIs)

• First-line treatment of depression

• Fewer side effects

• Greater safety

• Increased patient compliance

• Block reabsorption of serotonin

11

SSRIs

• Side effects

• Caution

• Interactions

12

Selective Norepinephrine Reuptake Inhibitors (SNRIs)

• Nonstimulant– Attention-deficit hyperactivity disorder

(ADHD)

• Non-controlled

• Side effects

• Contraindications and precautions

• Interactions

13

Heterocyclic Antidepressants

• Uses

• Side effects

• Interactions

• Precautions

• Interactions

14

Antimanic Agents

• Lithium

• Bipolar disorders (manic-depression)

• Side effects

• Signs of lithium toxicity

• Precautions

• Interactions

15

Anxiolytics

• Antianxiety medications

• Uses

• Side effects

• Contraindication or extreme caution

• Interactions

16

Preoperative Medications

• Relieve anxiety

• Provide sedation

• Light anesthesia

• Amnesia of operative events

• Anxiolytic effects

• Conscious sedation

• Side effects

17

Preoperative Medications

• Side effects

• Precautions

• Contraindications

• Interactions

18

Antipsychotic Medications and Major Tranquilizers

• Relieve symptoms of psychoses

• Relieve nausea and vomiting

• Potentiation of analgesics

• Side effects– Extrapyramidal reactions– Abnormal involuntary movement scale

19

Antipsychotic Medications and Major Tranquilizers

• Contraindications

• Precautions

• Interactions

• Patient education

20

Alcohol

• Ethyl alcohol, ethanol

• Psychotropic drug and CNS depressant

• Number one drug problem in the United States

• Alcohol poisoning

21

Alcohol

• Fetal Alcohol Syndrome (FAS)

• Treatment

• Chronic Alcoholism

22

Drug Abuse

• Use of drugs without therapeutic purpose

• Drug addiction– Tolerance– Psychological dependence– Physical dependence– Physiological withdrawal effects

23

Drug Abuse

• Habituation

• Chemical dependency

• Health care workers have access to prescription drugs – Can get involved in illegal use of

psychotropic drugs

24

Amphetamines

• Produced and prescribed legally

• Can be produced in illegal labs

• Symptoms of chronic abuse

• Symptoms of acute toxicity

• Treatment

25

Marijuana

• Tetrahydrocannabinol (THC)

• Classified as CNS depressant

• Euphoriant, sedative, and hallucinogen

• Treatment

• Side effects

Edited by Dr. Ryan Lambert-Bellacov, chiropractor for Back in the Game in West Linn, OR

26

Cocaine

• CNS stimulant

• Euphoriant and increased expenditure of energy

• Medical use is local anesthetic

• Highly addictive

• Side effects

Edited by Dr. Ryan Lambert-Bellacov, chiropractor for Back in the Game in West Linn, OR

27

Hallucinogens

• Lysergic acid diethylamide (LSD)

• Phencyclidine (PCP)

• Side effects

• Flunitrazepam (Rohypnol)– Roofies– Date-rape drug (induces amnesia)

Edited by Dr. Ryan Lambert-Bellacov, chiropractor for Back in the Game in West Linn, OR

28

Role of Medical Personnel

• Thorough knowledge

• Education

• Competent care

• Complete and accurate record keeping

• Report drug abuse

• Resources for medical personnel with addiction problems

Edited by Dr. Ryan Lambert-Bellacov, chiropractor for Back in the Game in West Linn, OR

29

• Back in the Game Sports Medicine is a clinic dedicated to the treatment of physical injuries to the body. Caring for an injured body involves more than making the diagnosis; it's about understanding and treating the cause to prevent future injuries. The clinic addresses variety of injuries to the body whether it be from a car accident to over-use trauma. When injuries occur, it is no longer enough for people to "take it easy for awhile" or "work through it."

• PHYSICIAL THERAPYWe believe that the true goal of physical therapy involves restoration of function through neuromuscular re-education and specialized manual techniques. These techniques restore movement, balance and quality of life. At Back in the Game, we go a step further and instruct people how to keep their bodies stronger and healthier. We do this by teaching proper body mechanics and developing personalized exercises that will help prevent re-injury.

• At Back In The Game, it's all about you. You're the reason we're here. The entire visit is centered around giving you an experience uncommon in today's impersonal medical world. We recognize that you are a unique human being with specific needs which require talented people who truly care and we strive to deliver this care in a professional, yet comfortable environment. Dr. Lambert, a state licensed Chiropractic Physician, who has training in sports medicine, heads Back In The Game.