13. Anxiolytics/Anti-depressants

Question 1

Side effects of tricyclic antidepressants (like amitriptyline)

Answer 1

1. Sedation
2. Weight gain
3. Orthostatic hypotension
4. Arrhythmias
5. Decreased libido
6. Pregnancy category: D

Question 2

Tricyclic antidepressant contraindications (amitriptyline) (3)

Answer 2

1. Seizures
2. Ischemic heart disease
3. Pregnancy

Question 3

Tricyclic antidepressants (amitriptyline) dental concerns (3)

Answer 3

1. Xerostomia
2. Dental chair syncope
3. Pressor effect w/ vasoconstrictor (increases epidemic effect x2)

Question 4

SSRI (citalopram) general adverse effects (4)

Answer 4

1. Dizziness
2. Fatigue
3. Headache
4. Decreased libido

Question 5

SSRI (citalopram) dental concerns (2)

Answer 5

1. Xerostomia

2. Bruxism ~10% of cases leading to increased risk of dental implant failures (12% up from 3%)

Question 6

Monoamine oxidase inhibitors (isocarboxazid) - dental concerns (1)

• General precaution

Answer 6

Xerostomia

2. Hypertensive crisis with consumption of tyramine

Question 7

Benzodiazepine (midazolam) - disrupts GABA binding - Adverse general and dental effects (5 and 1)

Answer 7

1. Dependance
2. Ataxia
3. Sedation
4. Disrupts stage 3 sleep
5. Pregnancy cat: D-X
6. Xerostomia

Question 8

Benzodiazepine contraindications (5)

Answer 8

1. Pregnancy
2. Severe liver disease
3. Myasthenia gravis/ataxia
4. Obstructive sleep apnea
5. Glaucoma

Question 9

Benzodiazepine (reversal agent)

Answer 9

Flumazenil

Question 10

Which med is known to lower seizure thresholds?

- Chloral hydrate, amitriptyline, clonazepam, or sertraline

Answer 10

Amitriptyline (tricyclic antidepressant)

Chloral hydrate (barbiturate)
Clonazepam (benzo)
Sertraline (SSRI?)

Question 11

Which med induces bruxism

- Notriptyline, lorazepam, duloxetine, citalopram

Answer 11

Citalopram (SSRI)

Notriptyline (tricyclic antidepressant - seizures)
Lorazepam (benzo - flumazenil is the reversal agent)
duloxetine (SNRI)

Question 12

Which listed benzodiazepine has the shortest half ife?

- Triazolam, diazepam, praia-am, flurazepam

Answer 12

Triazolam (Triazolam, midazolam, and estazolam are short acting benzo’s - rapidly excreted and <24 hour half life)

Question 13

Which med aggravates OSA?

- Sertraline, protriptyline, diazepam, diphenhydramine

Answer 13

Diazepam (benzo)

Sertraline (SSRI - bruxism)
Protriptyline (TCA - seizures)
Diphenhydramine (antihistamine)