NEUROBIOLOGIC THEORY AND PSYCHOPHARMACOLOGY

A. The Nervous System and How it works

The CNS:
• Brain
• Spinal Cord
• Associated Nerves that control voluntary acts.

Anatomy and Physiology

 Mental Illness is centered around the brain

Division of t he Brain Structure:

• Cerebrum– Divided into 2 hemispheres.
 Corpus Callosum- a pathway connecting the 2 hemispheres and
coordinates their functions.
- LEFT Hemisphere controls the RIGHT side of the body and is the
center for logical reasoning and analytic functions example READING,
WRITING and MATHEMATICAL tasks.
- RIGHT Hemisphere controls the LEFT side of the body and is the
center for CREATIVE THINKING, INTUITION, and ARTISTIC
abilities. •
• Cerebellum– Located below the Cerebrum.
- Center for COORDINATION OF MOVEMENTS and POSTURAL
ADJUSTMENTS.
- RECEIVES and INTEGRATES information from all areas of the body
ei. The muscle, joints, organs and other components of the CNS.

• Brain Stem– Includes: midbrain, pons, and medulla oblongata.

- THE MEDULLA OBLONGATA – Located at the top of the spinal cord.

- Contains VITAL CENTERS for RESPIRATION and
CARDIOVASCULAR functions.
- THE PONS – Located above the medulla oblongata and in front of the
cerebrum, bridges the gap both functionally and structural, as a PRIMARY
MOTOR PATHWAY.
- Measures L: 0.8 inches (2cm), includes most of the RETICULAR
ACTIVATING(RAS) and the EXTRAPYRAMIDAL system (EPS). - The
 RAS influences MOTOR ACTIVITY, SLEEP, CONSCIOUSNESS and
AWARENESS.
- The EPS relays information about MOVEMENT and COORDINATION
from the brain to the spinal nerves.
- The LOCUS CERULEUS, a small group of norepinephrine producing
neurons in the brain stem, is associated with STRESS, ANXIETY, and
IMPULSIVE BEHAVIOR.
- THE MIDBRAIN - includes most of the reticular activating and
extrapyramidal system
- Reticular Activating System - influences motor activity, sleep,
consciousness and awareness.
- Extrapyramidal System - relays information about movement and
coordination from the brain to the spinal nerves
Limbic System– Located above the brain stem, that includes: Hypothalamus,
Thalamus, Amygdala, and Hippocampus.

o The THALAMUS– Regulates ACTIVITY, SENSATION and EMOTION.

o The HYPOTHALAMUS– Involved in TEMPERATURE REGULATION,
APPETITE CONTROL, ENDOCRINE FUNCTION, SEXUAL DRIVE, and
IMPULSIVE BEHAVIOR associated with feelings of ANGER, RAGE or
EXCITEMENT.
o The HIPPOCAMPUS and AMYGDALA– Involved in EMOTIONAL
AROUSAL and MEMORY.

 Disturbances in the Limbic System have been implicated in a variety of Mental

Illnesses, ei. Memory Loss that accompanies DEMENTIA and that of poorly
controlled emotions and impulses manifested with PSYCHOTIC or MANIC
BEHAVIOR.
o LOBES
 FRONTAL LOBES.
 Control the organization of THOUGHT, BODY MOVEMENT,
MEMORIES, EMOTIONS and MORAL BEHAVIOR.
 INTEGRATION of all this information regulates AROUSAL, FOCUSES
ATTENTION, and enables PROBLEM SOLVING and DECISION
MAKING.
 ABNORMALITIES are associated with SCHIZOPHRENIA, ADHD and
DEMENTIA.
 THE PARIETAL LOBE.
 Interprets SENSATIONS of TASTE and TOUCH and assist in spatial
orientation.
 THE TEMPORAL LOBE.
 Center for the senses of SMELL and HEARING, and for MEMORY and
EMOTIONAL EXPRESSION.
 THE OCCIPITAL LOBE.
  Assist in coordinating LANGUAGE GENERATION and VISUAL
INTERPRETATION, such as DEPTH PERCEPTION.

THE NEURON
▪ 100 B approximated number of brain cells forming groups of neurons or nerve
cells, arranged in networks.

o Neurotransmission- a process whereby neurons communicates information

by sending electrochemical messages from neuron to neuron.
o Neotransurmitters- chemical messengers that enables messages to cross the
synapses between neurons.
• Aids in transmission of information throughout the body.
- Either EXCITE or STIMULATE an action in the cells (EXCITATORY) or stop an
action (INHIBITORY)

THE MAJOR NEUROTRANSMITTERS

Type Mech. of Physiologic Effects Psyche Implications

Action
Dopamine Excitatory Controls complex Implicated in schizophrenia and
movements, motivation, other psychoses as well as
cognition, regulates movement in Parkinson’s disease
emotional response

Epinephrine Excitatory Controls flight or fight

(adrenaline) response
Norepinephrine Excitatory Causes changes in attention, Excess has been implicated in
(Noradrenal ine) learning and memory, sleep several anxiety; Deficits may
and wakefulness, mood contribute to memory loss, social
withdrawal and depression

Serotonin (slows Inhibitory Controls food intake, sleep or Plays an important role in
or stops the wakefulness, temp, anxiety and mood disorders in
action) regulation, pain control, schizophrenia. Contributes to
sexual behavior, regulation of delusions, hallucinations, and
emotions withdrawn behaviors seen in
schizophrenia

Histamine Neuromodul Controls alertness, gastric Some psychotropic drugs blocks

ator secretions, cardiac histamine, resulting in wt. gain,
stimulations, peripheral sedation, hypotension
allergic response
Acetylcholine Excitatory or Controls sleep Alzheimer’s disease have
inhibitory

A. DOPAMINE.
a. Located primarily in the brain stem.
b. Excitatory and is synthesized by Tyrosine.
c. Implicated in Schizophrenia and other Psychoses, as well as movement disorders ei.
Parkinson’s Disease.
B. NOREPINEPHRINE (NORADRENALINE).
a. Located primarily in the brain stem.
b. Most prevalent neurotransmitter in the nervous system.
c. Derivative epinephrine.
d. Excess, implicated with several anxiety disorder.
e. Deficit, memory loss, social withdrawal, and depression
C. SEROTONIN.
a. NT found only in the brain
b. Derived from tryptophan (a dietary aminoacid)
c. Plays an important role in anxiety and mood disorders and schizophrenia
d. Contributes to delusions, hallucinations and withdrawal behavior (schizo).
e. Some antidepressants block serotonin reuptake, leaving it effective longer in the
synapse, thus results to mood improvement.
D. HISTAMINE.
a. Role in mental illness still investigated.
b. Involved in peripheral allergic response.
c. Some psychotropic drug block histamine, resulting to weight gain, sedation and
hypotension.
E. ACETYLCHOLINE.
a. NT found in the brain, spinal cord and peripheral nervous system particularly at the
neuromuscular junction of the of skeletal muscle.
b. Derived from dietary choline found in red meat and vegetables, affecting sleep-wake
cycle and signals muscle to become active.
c. Alzheimer’s Disease have decreased acetylcholine secreting hormone, and those with
Myasthenia Gravis have reduced acetylcholine receptors (muscle disorder whereby
impulses fail to pass the myoneural junction, thus causing muscle weakness).
F. GLUTAMATE.
a. Excitatory amino acid that at high level can have major neurotoxic effect.
b. Implicated with brain damage caused by stroke, hypoglycemia, sustained hypoxia or
ischemia, and other degenerative diseases ei. Huntington’s or Alzheimer’s.
G. GAMMA- AMINOBUTYRIC ACID.
a. Major inhibitory NT in the brain.
b. Found to modulate other NTs rather than provision of direct stimulus.

B. Brain Imaging Techniques

1. Computed Tomography (CT) or Computed Axial Tomography (CAT)
1. gives serial x-rays of the brain
 2. shows structural images
3. Schizophrenia have large ventricles on the brain

2. Magnetic Resonance Imaging (MRI)

- radio waves from brain detected from magnet
- shows structural images
- reduction of cortical thickness in schizophrenia
3. Positron Emission Tomography (PET)
- a radioactive tracer injected to the bloodstream and monitored
- gives the functional
- Schizophrenia demonstrates decreased blood flow

C. Nero-biologic Causes of Mental illness

NEUROBIOLOGIC CAUSES OF MENTAL ILLNESS

• Current theories and studies indicate that several mental disorders may be linked to a
specific gene or combination of genes but that the source is not solely genetic;
nongenetic factors also play important roles.
• Two genetic links to Alzheimer’s disease are chromosomes 14 and 21.
• Stress and the Immune system (Psychoimmunology)
• Infection as a possible cause

Three types of studies are commonly conducted to investigate the genetic basis of
mental illness:
1. Twin studies are used to compare the rates of certain mental illnesses or traits in
monozygotic (identical) twins, who have an identical genetic makeup, and
dizygotic (fraternal) twins, who have a different genetic makeup. Fraternal twins
have the same genetic similarities and differences as nontwin siblings.
2. Adoption studies are used to determine a trait among biologic versus adoptive
family members.
3. Family studies are used to compare whether a trait is more common among first-
degree relatives (parents, siblings, and children) than among more distant relatives
or the general population.

D. Psychopharmacology

 PSYCHOPHARMACOLOGY- The study of the effects of drugs on mood, behavior,

and mental processes.
 Efficacy: The extent to which a drug produces the desired therapeutic effects in
clinical trials or real-world use.
 Half-life: The time it takes for the concentration of a drug in the bloodstream to
decrease by half, indicating how long the drug remains active in the body.
 Potency: The strength or effectiveness of a drug in producing a particular effect.
 Off-label use: The use of a medication for purposes other than those approved by
regulatory agencies based on clinical judgment and evidence.
 Black box warning: The most serious type of warning issued by the FDA, indicating
that a medication carries a significant risk of serious or life-threatening adverse
effects.
 Rebound: The worsening of symptoms following the discontinuation of a
medication, often observed with drugs that affect mood or behavior.
 Withdrawal: The onset of symptoms when a person stops using a drug to which
they have developed dependence, often characterized by physical and
psychological symptoms.
 Depot injection: A long-acting injection of medication that is slowly released into
the bloodstream over time, providing sustained therapeutic effects.
 Post Injection delirium/sedation syndrome: A rare adverse reaction characterized
by confusion, agitation, and sedation following the administration of certain
antipsychotic medications.
o Antipsychotic or Neuroleptics
 Used to treat the symptoms of psychosis such as delusions and hallucinations
seen in schizophrenia, schizoaffective disorder, manic phases of bipolar
disorder.
 do not cure the underlying disease but they may permit the psychotic patient
to function. It treat only the symptoms of psychosis.
 It block muscarinic, alpha adrenergic and histamine receptors
 MOA : older neuroleptic drugs “Typical Antipsychotics” are competitive
blockers of dopamine receptors (D2)
 MOA : newer agents “Atypical Antipsychotics” are blockers of serotonin
receptors (5HT2A) and to a lesser extent dopamine receptors (D2)
 Conventional or Typical Antipsychotic Drugs
o First Generation Agents (Low Potency)
 Chlorpromazine – Prototype
 Prochlorperizine (Compazine)
 Thioridazine (Mellaril)
 Perphenazine (Trilafon)
 Mesoridazine (Serentil)
 Trifluoperazine (Stelazine
o First Generation Agents (High Potency)
 Fluphenaine (Prolixin)
 Haloperidol (Haldol)
 Thiothixene (Navane)
 Atypical Antipsychotics Drug
o Second Generation Antipsychotic Agents
 Clozapine (Clozaril)
  Clozapine ( Clozaril )
 Risperidone ( Resperdal )
 Olanzapine ( Zyprexa)
 Quetiapine (Seroquel)
 Ziprasidone (Geodone)
 Aripiprazole (Abilify) – New Generation antipsychotic
 All reduce “positive” symptoms hallucinations and agitation by blocking dopamine
receptors
 First generation most effective against “positive” Symptoms.
 Newer (atypical) agents are arguably more effective in treating “negative”
symptoms
 The antipsychotic effects take several weeks to be effective
 Calming effect (“Tranquilizers”)
 Used to handle agitated and disruptive behavior
 parenteral administration for acute agitation
 Reduce spontaneous physical movement
 DSM-V
o Positive symptoms- delusions, hallucinations, disorganized speech/
thought, catatonic behavior, bizarre behaviors
o Negative symptoms- (neurovegetative)- flat affect, poor eye contact and
lack of goal-directed activity.
o Most patients exhibit both types of symptoms
 Side Effects: Extrapyramidal symptoms (EPSs): Movement disorders
caused by dysfunction of the extrapyramidal system, often associated with the
use of antipsychotic medications.
o blockade of D2receptors in the midbrain region of the brain stem
 Pseudoparkinsonism: A condition characterized by symptoms
resembling Parkinson's disease, such as bradykinesia (slow moving, tremor,
rigidity), stiff, stooped posture, drooling of saliva, Decreased arm swing,
Mask-like faces, Coarse pill-rolling movements of the thumbs and fingers
while at rest.
o Treatment
1. Discontinue or change antipsychotic medication that has lower
incidence of EPS
2. Adding an anti-cholinergic agent (Akineton) or Amantadine.
 Acute Dystonia: A movement disorder characterized by involuntary
muscle contractions, leading to repetitive or twisting movements and
abnormal postures. It includes torticollis, Opisthotonus , acute muscular
rigidity and cramping ,Stiff or thick tongue , Difficulty swallowing ,
Laryngospasm Respiratory difficulties
o Treatment
1. Intramuscular Benztropine mesylate (Cogentin)
 2. IM or IV Diphenhydramine (Benadryl)
 Akathisia: A movement disorder characterized by a subjective feeling of
restlessness and an inability to sit still, often accompanied by
involuntary movements such as pacing or rocking
o Treatment
1. Lowering the dose of antipsychotic drugs, switch to lower
potency FGA, or switching to an SGA other than risperidone and
aripiprazole.
2. Beta-blockers such as propranolol
3. Anticholinergic agents such as benztropine (Cogentin) may be
utilized if concomitant pseudoparkinsonism is present.
4. Benzodiazepine
 Tardive dyskinesia (TD): A movement disorder characterized by
involuntary, repetitive movements of the face, tongue, and other body
parts, often caused by long-term use of antipsychotic medications. It
includes stereotyped, repetitive oral facial dyskinesia, of limbs. (May be
irreversible ) , Involuntary movements of the body.
o Treatment
1. Valbenazine
2. Deutetrabenazine
3. Progression can be arrested by decreasing the antipsychotic
medication
 Neuroleptic malignant syndrome (NMS): A potentially life-threatening
neurological disorder characterized by high fever, altered mental status,
muscle rigidity, and autonomic instability such as unstable BP, diaphoresis,
and pallor and delirium, elevated CPK enzymes often associated with the use
of antipsychotic medication
 Treatment
1. Immediate discontinuance of antipsychotics
2. treat dehydration and hyperthermia
3. Stool softeners
4. Calorie-free beverages
5. Adequate fluid intake
6. Inclusion of grains and fruits in the diet
 Agranulocytosis
 fatal side effect of atypical such as clozapine
 produces suddenly and is characterized by fever, malaise, ulcerative sore
throat and leukopenia
 Clients should have a baseline WBC count and differential before
initiation of treatment
 WBC count every week throughout treatment and for 4 weeks after
discontinuation of clozapine
o Antidepressant
 Antidepressant drugs are used to restore mentally depressed patients to an
improved mental status.
 Primarily used in the treatment of: Major depressive illness, Anxiety
disorders , Depressed phase of bipolar disorder and psychotic depression
 Types of Antidepressant Drugs
1. Tricyclic Antidepressant (TCA)
2. Selective Serotonin Reuptake Inhibitors (SSRI)
3. Monoamine Oxidase Inhibitors (MAOI)
 Tricyclic Antidepressant Drugs (TCA)
 blocks the reuptake of norepinephrine primarily and serotonin to some
degree
 may take 4 to 6 weeks for effectiveness
 Tricyclic antidepressants (TCAs) were one of the original first-generation
antidepressants.
 The tricyclic antidepressants are the most effective drugs presently
available for the treatment of depression.
 TCAs are now more commonly used to treat neuropathic pain and
insomnia.
 Nursing Alert
o Potentially lethal if taken in an overdose.
o Depressed or impulsive clients who are taking these drugs need to
have prescriptions and refills in limited amounts to decrease the risk.
 The Food and Drug Administration (FDA) approved these tricyclic
antidepressants to treat depression:
o Amitriptyline (Elavil)
o Amoxapine (Ascendin)
o Desipramine (Norpramin)
o Doxepin (Sinequan)
o Imipramine (Tofranil)
o Nortriptyline (Pamelor)
o Protriptyline (Vivactyl)
o Trimipramine (Sumontil)
o Clomipramine (anafranil)
 Side Effects: Dry mouth, Constipation, Urinary retention, Dry nasal
passages, Blurred vision, Orthostatic hypotension, Sedation, Weight gain,
Tachycardia, Sexual dysfunction, Agitation
 Indications: TCAs are used to treat depression, neuropathic pain, and
insomnia.
 Nursing Considerations:
1. TCAs are often administered at bedtime due to sedating effects and are
contraindicated with MAOIs.
2. Geriatric patients are particularly sensitive to the anticholinergic side
effects of tricyclic antidepressants
 Selective Serotonin Reuptake Inhibitor
 MOA: blocks reuptake of serotonin
 Selective Serotonin Reuptake Inhibitors (SSRIs) are a second-generation
antidepressant and have fewer side effects than TCAs and MAOIs.
Fluoxetine and citalopram are commonly used SSRIs
 Replaced the tricyclic drugs as the first choice in treating depression
because they equaling efficacy and produce fewer side effects
 Effective in the treatment of obsessive-compulsive disorder
 Safest drug to give during panic attack
 Indications: SSRIs are primarily used to treat depression, but are also used
to treat obsessive compulsive disorder, bulimia, panic disorder,
posttraumatic stress disorder, other forms of anxiety, premenstrual
syndrome, and migraines.
 Drugs:
1. Fluvoxamine (Luvox)
2. Paroxetine (Paxil)
3. Sertraline (Zoloft)
4. Citalopram (Celexa)
5. Escitalopram (Lexapro)
 Side Effect:
1. Agitation
2. Akathisia
3. Nausea
4. Insomnia
5. Sexual dysfunction
6. Weight gain (less)
7. Sedation
8. Sweating
9. Headaches
 Nursing Considerations:
1. The onset of fluoxetine’s antidepressant effect develops slowly for up
to 12 weeks.
2. Use with caution in patients who are taking other CNS medications or
who have liver dysfunction.
3. This drug is contraindicated with MAOIs.
4. Monitor for increased suicide ideation in all populations, as well as for
the development of serotonin syndrome.
5. Patients should avoid grapefruit juice due to its effect on the CYP3A4
enzyme that affects the bioavailability of the medication.
 Adverse Effect:
 Symptoms of serotonin syndrome may include mental status changes
(e.g., agitation, hallucinations, coma), autonomic instability (e.g.,
tachycardia, labile blood pressure, hyperthermia), neuromuscular
 aberrations (e.g., hyperreflexia, incoordination), and/or gastrointestinal
symptoms (e.g., nausea, vomiting, diarrhea).
 Monoamine Oxidase Inhibitor
 MAOIs are a first-generation antidepressant
 A significant disadvantage to MAOIs is their potential to cause a
hypertensive crisis when taken with stimulant medications or foods
containing tyramine
 Major interaction is on the monoamine neurotransmitter particularly
norepinephrine and serotonin, has little effect in dopamine
 These drugs are less effective and produce more side effects than the
tricyclic antidepressants. For example, they lower blood pressure and were
at one time used to treat hypertension
 Drugs
1. Phenelzine (Nardil)
2. Tranylcypromine (Parnate)
3. lsocarboxazid (Marplan)
 Side Effects
1. Daytime sedation
2. Insomnia
3. Weight gain
4. Dry mouth
5. Orthostatic hypotension
6. Sexual dysfunction
 Nursing Considerations:
1. Avoid tyramine foods
2. No mature or aged cheeses or dishes made with cheese, such as
lasagna, pizza (except cottage cheese. cream cheese, ricotta cheese,
and processed cheese slices)
3. No aged meats such as pepperoni, salami, mortadella, summer
sausage, beef logs, and similar products.
4. No Italian broad beans (fava) pods or banana peel. Banana pulp and
all other fruits and vegetables are permitted
5. Avoid all tap beers and microbrewery beer. Drink no more than two
cans or bottles of beer (including nonalcoholic beer) or 4 ounces of
wine per day
 Adverse Effects: Use with caution due to the risks of hypertensive crisis,
serotonin syndrome, and increased suicidality. Hypertensive crisis is
defined by severe hypertension (blood pressure greater than 180/120 mm
Hg) with evidence of organ dysfunction. Symptoms may include occipital
headache (which may radiate frontally), palpitations, neck stiffness or
soreness, nausea or vomiting, sweating, dilated pupils, photophobia,
shortness of breath, or confusion.
o Mood Stabilizing Drugs
 used to treat bipolar by stabilizing the client’s mood and treating acute episodes
of mania.
 Functions:
 Stabilize client's mood
 Preventing or minimizing the highs and lows that characterize bipolar
illness
 Treat acute episodes of mania
 Lithium: is the most established mood stabilizer; this normalizes the reuptake of
serotonin, NE, acetylcholine & dopamine.
 Available in tablets, capsules, liquid sustained-released form.
 No parenteral forms
 Normal level: 0.5 — 1.5 mEq/L
 Therapeutic level: 0.6 – 1.2 mEq/L
 Common side effects:
1. Mild nausea/diarrhea
2. Anorexia
3. Fine hand tremor
4. Polydipsia
5. Polyuria
6. Metallic taste in the mouth
7. Fatigue
8. Lethargy
 Toxic Effects
1. Severe diarrhea
2. Severe vomiting
3. Muscle weakness
4. Lack of coordination
 If left untreated, symptoms may worsen and can lead to renal failure, coma and
death
 Lithium levels exceed 3.0 mEq/L = Dialysis
 Nursing Alert:
1. Valproic acid can cause hepatic failure in fatality
2. Carbamazepine can cause aplastic anemia and agranulocytosis
3. Lamotrigine can cause Steven-Johnsons Syndrome
 Valproic Acid (Depakote, Depakene) and Topiramate (Anticonvulsant)
o are known to increase levels of GABA
o Stabilizes mood by inhibiting the kindling process.
o A snow-ball like effect seen with minor seizure activity
o can cause hepatic failure resulting to fatality.
o Liver Function test must be performed before therapy and for the 1 st 6
months
 Carbamazepine (Tegretol)
o Can cause aplastic anemia and agranulocytosis at a rate of 5 to 8 times
greater
 Lamotrigine (Lamictal)
o cause serious rashes requiring hospitalization called toxic epidermal
necrolysis
o Anxiolytics (anti-anxiety drugs)
 Anxiolytics (anti-anxiety drugs)
o used to treat anxiety and anxiety disorders, Insomnia. OCD, Depression,
Post-traumatic stress disorder, Alcohol withdrawal
 Benzodiazepines have proved to be most effective in relieving anxiety
o Alprazolam (Xanax)
o Chlordiazepoxide (Librium)
o Clonazepam (Klonopin)
o Diazepam (Valium)
o Flurazepam (Dalmane)
o Lorazepam (Ativan)
o Oxazepam (Serax)
o Temazepam (Restoril)
o Triazolam (Halcion)
o Proven to be the most effective to relieve anxiety mediate the actions of the
amino acid GABA, the major inhibitory neurotransmitter in the brain.
o Common side effects: sedation, drowsiness, poor coordination and clouded
sensorium
o Serious side effect: tendency to cause physical dependence; strongly
potentiate the effects of alcohol, one drink may have the effect of 3 drinks.
 Nonbenzodiazepines
o Buspirone (BuSpar)
o Nursing Considerations
1. It is important for clients to know that antianxiety agents are aimed at
relieving symptoms, such as anxiety or insomnia; it does not treat the
underlying problems that cause the anxiety.
2. Benzodiazepines strongly potentiate the effects of alcohol
3. One drink may have the effect of three drinks (alcohol)
4. Avoid driving (drowsiness)
5. Benzodiazepine withdrawal can be fatal: once a course of therapy has
been started, benzodiazepines should never be discontinued abruptly
without the supervision of the physician.
6. Take anxiolytic drugs only as prescribed.
o proven to be the most effective to relieve anxiety
 o mediate the actions of the amino acid GABA, the major inhibitory
neurotransmitter in the brain.
o Common side effects: sedation, drowsiness, poor coordination and clouded
sensorium
o Serious side effect
o tendency to cause physical dependence; strongly potentiate the effects of
alcohol, one drink may have the effect of 3 drinks.
o Disulferam (Antabuse)
o is a sensitizing that causes an adverse reaction when mixed with alchol.
o used to deter client from drinking alcohol
o inhibits the enzymes aldehyde dehydrogenase, which is involved in
metabolism with ethanol
o s/e: fatigue, drowsiness, halitosis, tremors, and impotence
o Herbal Medicines
o St John’s Wort – treat depression
o Kava – treat anxiety potentiate the effect of alcohol
o Valerian – helps produce sleep, used to relieve stress and anxiety.
o Gingko biloba – improve memory also taken for fatigue, anxiety and
depression.