Exam 5: Anti-Anxiety, Anti-Psychotics Flashcards Preview

Pharmacology > Exam 5: Anti-Anxiety, Anti-Psychotics > Flashcards

Flashcards in Exam 5: Anti-Anxiety, Anti-Psychotics Deck (90):
1

What is the drug of choice for Bi-Polar disorder? What are 2 brand names?

Litium: Eska-lith (no, not Eskimo) & Lith-o-bid (I'd bid on Lithium at an auction!)

2

Lithium-Prevents release of ___________.

Neurotransmitters

3

Lithium-Increases uptake of serotonin precursor
_________.

tryptophan

4

Lithium-Decreases rate of ________ synthesis

serotonin

5

Lithium-Inhibits serotonergic and adrenergic receptor-mediated activation of ______ and second messenger cascades

cAMP

6

Lithium-Administered _______ in form of a salt

ORALLY

7

Lithium-Peaks in blood within ____ hours after
administration

2 hours

8

Lithium-Half-life = ___-36 hours

24-36 hours

9

Lithium-Improvement in condition occurs over several ______ of treatment

WEEKS

10

Lithium-Very ____ therapeutic index = level in blood is monitored WEEKLY

LOW

11

Lithium-Drug is often taken in _____ doses several times per day to minimize toxicity

small

12

Lithium-Produces serious side effects = affects patient _______

compliance!

13

What happens with a drug interaction involving lithium?

The drug will INCREASE lithium levels in the blood and cause toxicity

14

What are the 4 types of drugs that have drug interactions with Lithium?

1.Diuretics 2.NSAIDs 3.Anticonvulsants 4.Antihypertensives

15

NSAIDs are contraindicated with Lithium because NSAIDs inhibit the ______ of lithium. SO we will use ________ instead.

renal EXCRETION....acetaminophen

16

What are the two synonyms for anti-anxiety medications?

sedative hyponotics (sedatives) and minor tranquilizers

17

What is the class of anti-anxiety drugs that is among the most widely used in medicine?

Benzodiazepines

18

_______ (______)* and ________ (_______) account for 75% of 100 million prescriptions written for sedatives/tranquilizers!!!!

diazepam (Valium)....chlordiazepoxide (Librium)

19

All benzodiazepines (BDZ) have same basic structure: _______ AND ________.

2 nitrogens “diazo”....Benzene ring = binds to GABA receptors

20

LETS GET IT!!! What are the 5 Benzodiazepines that Dr. S wants us to know?

1. di-az-ep-am (Valium) 2.lor-az-ep-am (Ativan) 3.al-pr-az-ol-am (Xanax) 4.tri-az-ol-am (Hal-see-on) 5. mid-az-ol-am (Ver-sed)

21

What is the primary pre-op sedative and inducer of general anesthesia in dentistry?

mid-az-ol-am (Versed)

22

It is NOW known that Benzodiazepines are HIGHLY _______! Does tolerance come into play?

addictive...yes tolerance is involved

23

What are the two schedules for Benzodiazepines?

IV and V

24

What are the 3 distinct effects of Benzodiazepines???

1.Effects on behavior 2. Anticonvulsant effects 3.Muscle Relaxation

25

Benzodiazepines- Effects on Behavior....Reduces _______ and hostility.

aggresion

26

Benzodiazepines- Effects on Behavior....Reduces anxiety at _____ doses.

low

27

Benzodiazepines- Effects on Behavior...causes ______ at high doses.

drowsiness

28

Benzodiazepines- Anticonvulsant Effects...Benzo's can prevent or arrest generalized seizure produced by _______ or ________.

electric shock or analeptic agents (dental anesthetic!!!!)

29

Benzodiazepines- Anticonvulsant Effects... SO, were in the clinic and suddenly a patient starts to seize shortly after receiving local anesthetic. WHAT TWO drugs can we use to arrest the seizure? How would they be administered?

1. diaz-ep-am (Valium) and 2.mid-azo-lam (Versed).... slowly through IV

30

Benzodiazepines- Muscle Realxation Effects..._______ (_____) and ________ (______) = most potent

diazepam (Valium) and chlordiazepoxide (Librium) ((75% of all sedatives!!))

31

Benzodiazepines- Muscle Realxation Effects...Centrally-mediated and requires intact _______

spinal cord

32

Benzodiazepines- Muscle Realxation Effects...Depresses ________ and muscle function in BOTH healthy persons and in patients suffering from skeletal muscle disorders.

motor nerve

33

Mechanism of Action of BDZs-Receptor sites for BDZ are found in the _____.

CNS

34

Mechanism of Action of BDZs-BDZ affect the concentration of most neurotransmitters, including _____.

GABA

35

Mechanism of Action of BDZs-Enhances the inhibitory effect on _____ on neuronal excitability....Causes _________ (a less excitable state) and neuronal stabilization.

GABA...hyperpolarization

36

Mechanism of Action of BDZs-BDZs enhance presynaptic GABA-mediated _______ in spinal cord and other brain regions at low doses...Remember that GABA is _______ = decreases excitation in brain

INHIBITION...INHIBITORY

37

Mechanism of Action of BDZs- the GABA receptor is embedded in neuronal _________ located at the _______ = binds BOTH _____ & _____.

plasma membranes...synapse...GABA & BDZ

38

Mechanism of Action of BDZs- Presence of GABA _______ binding of BDZ!! Is this action reversible? Is it fast or slow?

ENHANCES....reversible and quick

39

Pharmokinetics of Benzo's---most have ______ half lives and are metabolized to _________....therefore repeated dosing results in ________ of the drug in the body.

VERY LONG...active compounds...accumulation

40

Pharmokinetics of Benzo's--- ________ (______) BREAKS the common Benzo mold and is metabolized RAPIDLY to INACTIVE compounds so there is no significant accumulation! IT is a GOOD CHOICE FOR DENTISTRY!!!

lor-az-e-pam (Ativan)

41

Uses of Benzo's in Medicine, Relief of ______....Skeletal muscle ______ = muscle strains....________ to treat insomnia

anxiety...relaxation...hypnotic

42

Uses of Benzo's in Medicine...can help withdrawal symptoms of _______!

alcoholism!

43

Uses of Benzo's in Medicine, it's a great _______ medication to decrease apprehension. But be careful it may decrease the effects of anesthesia!

pre-operative

44

Uses of Benzo's in DENTISTRY! To reduce pre-operative anxiety, you can prescribe one of these 4 Benzo's...WHICH one is preferred c/o half life and onset time???

1.diazepam (Valium), 2. lorazepam (Ativan) 3.al-praz-olam (Xanax) 4.tri-az-olam (Halcion)...triazolam (Halcion) has a rapid onset of 15-30 min and has the shortests half life, and its orally adinistered

45

Uses of Benzo's in DENTISTRY! IV ______ and Anterograde _______.

Sedation...amnesia

46

Uses of Benzo's in DENTISTRY! EMERGENCY intervention for ______.

seizures

47

Adverse Effects of BenZOdiAZapines- _____ depression leading to fatigue, drowsiness, muscle weakness, ataxia
(failure of muscle coordination)

CNS

48

Adverse Effects of BenZOdiAZapines- ________ administration = acute hypotension, muscle weakness, apnea and cardiac arrest

Parenteral

49

Adverse Effects of BenZOdiAZapines- Heres a DENTAL related adverse effect:_______!!

Xerostomia!!

50

Adverse Effects of BenZOdiAZapines- It has ________ effects with other CNS depressants, ESPECIALLY ______, so reduce dose of opiates by ____ of normal dose when a BDZ is added (diazepam)

ADDITIVE....alcohol....1/3

51

Adverse Effects of BenZOdiAZapines-What can be the end result of mixing EtOH and Benzo's?

Significant Respiratory Depression

52

Our first Miscellaneous Anti-anxiety agent-buspirone: What is the mechanism of action?... Hey this is cool- it binds to ______ receptors without affecting BZD-GABA receptors!

The mechanism of action is UNKNOWN....serotonoin

53

YAY full circle!!! What 5 antimicrobials have drug interactions with our new friend bus-pir-one?

1.cipro-flox-acin 2.clar-ithro-mycin 3.erythro-mycin 4.de-oxy-cycline 5.systemic antifungals

54

Oral health considerations with anti-anxiety drugs: ______ is a major cause of cavities and gingivitis.

xerostomia

55

Oral health considerations with anti-anxiety drugs: Pt's get a LACK of interest in ______.

Oral Hygiene

56

Oral health considerations with anti-anxiety/anti-depression drugs: CAUTION with EPINEPHRINE, especially in the anti-depressants _______ and ______.

tricyclics and MAOIs

57

Oral health considerations with anti-anxiety/anti-depression drugs: did you know? _____ CAUSE BRUXISM and increased EXTRAPYRAMIDAL effects!

SSRIs

58

Major Tranquilizers are aka _________ meds.

anti-psychotic

59

What is the primary indication for major tranquilizers?

Schizophrenia

60

Major Tranquilizers can be used for ________ disorders like Huntington’s disease, Tourette’s syndrome, ballismus.

movement

61

What is a secondary indication for the use of major tranquilizers that pt's on Chemo therapy can use them for?

to help curve severe nausea and vomiting

62

Major Tranquilizers-Individual drugs bind to a variety of receptors and act as __________.

ANTAGONISTS

63

Major Tranquilizers- Blockade of __________ transmission in various areas of brain is thought to be responsible for their major effects.

dopaminergic

64

Major Tranquilizers-________ action = blockage in prefrontal cortex and limbic areas

Antipsychotic

65

Major Tranquilizers- __________ side effects = blockade in basal ganglia

Extrapyramidal

66

Major Tranquilizers- ________ effects = blockade in chemoreceptor trigger zone of the medulla

Antiemetic

67

Major Tranquilizers- One hypothesis: Schizophrenia = overactivity of __________ system, SO antipsychotic medications reduce this activity by blocking ____ receptors!

dopaminergic...D2

68

What is the ONLY major tranquilizer that has LOW D2 antagonism and there for the effective dose is lower then expected...FOR EXAMPLE-Most drugs work in striatum (primary site for dopaminergic neurons)...Antipsychotics occupy >___% of striatal D2 sites...THIS DRUG occupies only ____%

CLOZE the DOOR...cloz-a-pine (Cloz-ariL)...70%....30%

69

Whats wrong with the dopaminergic hypothesis?-Receptors are blocked within 2-4 hours after drug administration, but therapeutic activity requires several ______ of treatment to achieve full effect...Therapeutic effects is related to slow- developing depolarization ______ of dopaminergic neurons

WEEKS..blocks

70

Hypothesis-Schizophrenia is a sccociated with a change in ________ of neurons and drugs help to recover this!

morphology

71

Pharmacokinetics of tha MAJOR tranq's---Administered ______ or by _____.

orally or IM

72

Pharmacokinetics of tha MAJOR tranq's--- Maximal concentration in blood is achieved __-4 hours after oral administration and within ___-40 minutes after IM....Half-life = ___-40 hours..._____ time daily dosing

2...30min..18...one time

73

Pharmacokinetics of tha MAJOR tranq's--- All drugs have similar ______.

efficacy (except for cloz-a-pine)

74

Major Tranq's-Side Effects> Are they addictive??

Not addictive

75

Major Tranq's-Side Effects> Extrapyramidal side effects:
movement disorders...________– akinesia (difficulties in initiating movement), tremor, rigidity..This is caused by the block of ____ receptors in the ______ ganglia.

Parkinsonism!!...D2...basal ganglia

76

Major Tranq's-Side Effects> ______ = jimmy legs/restless leg syndrome can occur

A-kath-isia (so your pt will be moving during tx)

77

Major Tranq's-Side Effects> _______ – sustained muscular contraction

Dys-tonia

78

Major Tranq's-Side Effects> ________ – abnormal movements, particularly of FACE and TONGUE, but may also be of trunk and limbs...Noticeable after at least ___ months of chronic treatment

Tardive Dyskinesia...6 (think it will be easy to work on these patients???)

79

Major Tranq's-Side Effects> YAY! Even more meds!!! Most extrapyramidal side effects are treatable with __________ drugs

anti-cholenergic (makes sense, stop movement=stop Ach)

80

Major Tranq's-Side Effects>Sedation and autonomic side effects are caused by blockade of _______, ________ and ________ receptors

histamine, cholinergic, and adrenergic

81

Major Tranq's-Side Effects>Take home message-it aint ______ to be on these meds.

easy

82

Anti-Psych DRUG INTERACTIONS!! Antipsychotics ________ CNS effects of: sedatives, analgesics, antihistamines

POTENTIATE

83

Anti-Psych DRUG INTERACTIONS!! Antipsychotics potentiate the respiratory depression caused by _______

OPIOIDS

84

Anti-Psych DRUG INTERACTIONS!! Antacids = decrease ______ of antipsychotics

absorption

85

Anti-Psych DRUG INTERACTIONS!! Anticonvulsants = decrease ______ levels of antipsychotics

plasma

86

Anti-Psych DRUG INTERACTIONS!! Antipsychotics may alter ______ of antihypertensive medications

efficacy

87

What are the 6 anti-psychotic's Dr. S wanted us to know?

1. HALO-per-id-ol (Haldol) 2.Pro-Chlor-per-az-ine (Compro) 3.ProMETHazine (Phenadoz) (WEEEZY BABY) 4.Ari-pip-ra-zole (Abilify) 5.Ris-per-DONE (Risperdal) 6.CLOZ-a-pine (Clozaril)

88

Critical Points for DENTISTS Re: AntiPsychotics---May cause ________ disturbances = check white blood cell counts

hematologic

89

Critical Points for DENTISTS Re: AntiPsychotics---May alter ________ of heart, so caution with ________, and there is a risk for ________.

QT interval... epinephrine... arrhythmias

90

Critical Points for DENTISTS Re: AntiPsychotics--- Cause extrapyramidal effects (movement disorders)....LIKE ________ and _________.

Bruxism AND Tardive dyskinesia