morgayn Flashcards
(19 cards)
What type of drug is fluoxetine
SSRI
What is the mechanism of action of fluoxetine?
Selectively bind to serotonin reuptake transporters, inhibiting the reuptake of serotonin into the presynaptic neuron, increasing serotonin at the synapse to help improve mood and reduce anxiety
How can fluoxetine affect oral health
- causes xerostomia, increasing risk of caries, gingivitis, and oral infections
- may contribute to bruxism (teeth grinding)
- potential for delayed healing and increased bleeding due to serotonergic effects on platelet function
- can cause reflux: erosion
What advice should OHTs give to help a pt manage oral side effects of fluoxetine?
- Frequent sips of water, sugar-free gum, saliva substitutes to stimulate saliva flow
- Maintain oral hygiene and schedule regular dental visits
- nighttime mouthguard if needed
- recommend paracetamol for pain management (interacts with codeiene and NSAIDS)
Why may pts taking an SSRI have increased bleeding risk and what does this mean
serotonin plays an important role in platelet aggregation, and NSAIDs also impair this so may cause more extreme bleeding
What is the mechanism of action of levodopa (l-dopa) and carbidopa in the treatment of parkinson’s disease?
-L-dopa is a precursor to dopamine: it crosses the BBB where it is converted into dopamine to increase neuronal dopamine levels and improve motor control
- carbidopa prevents the conversion of L-dopa to dopamine in the periphery (by inhibiting dopa decarboxylase): this increases the amount of L-dopa and therefore dopamine in the brain, and reduces peripheral side effects
How can parkinson’s disease and its treatments affect oral health?
- can impair motor function, making oral hygiene tasks more difficult, leading to increased plaque, gingivitis, and caries risk
- Additionally, patients can experience increased drooling due to dysphasia and teeth grinding
- Medications eg L-dopa can also cause dry mouth, contributing to decay
What are the key neurochemical changes involved in parkinson’s disease?
- involves a deficiency of dopamine
- primarily due to degeneration of dopaminergic neurons in the substantia nigra
- leading to impaired motor control
What are the key neurochemical changes involved in schizophrenia?
- Associated with dopamine dysregulation
- Elevated dopamine levels in the nucleus accumbens, contributing to the positive symptoms of schizophrenia eg. hallucinations and delusions
- Dopamine hypoactivity in the prefrontal cortex contributes to the negative symptoms of schizophrenia eg apathy, social withdrawl, inactivity
What is the most common therapeutic option for parkinson’s disease and it’s mechanism of action
- L-dopa and carbidopa
- L-dopa is the precursor to dopamine, it crosses the BBB where it is converted to dopamine to increase neuronal dopamine levels and improve motor control
- carbidopa prevents L-dopa being broken down before it reaches the brain, ie it prevents the conversion of L-dopa to dopamine in the periphery (by inhibiting dopa decarboxylase). this increases the amount of L-dopa and therefore dopamine in the brain and also reduces peripheral side effects
What are the common therapeutic option for schizophrenia and it’s mechanism of action
- antipsychotic medications
- antagonists for dopamine receptors
- atypical antipsychotics also antagonise serotonin (5-HT2) receptors to further reduce dopamine levels
How does Parkinson’s disease and its associated treatments impact oral health?
- motor symptoms (tremors, rigidity) impair manual dexterity, making oral hygiene more difficult
- Patients may experience drooling, tooth grinding, difficulty swallowing, and xerostomia due to medication, increasing the risk of plaque accumulation, caries, and oral infections
How does schizophrenia and its assoicated treatments impact oral health
- poor motivation and self-neglect can lead to inadequate oral hygiene
- schizophrenic patients are more likely to be smokers and have poor diets
- antipsychotic medications often cause dry mouth, increasing the risk of dental decay and periodontal disease
Describe the mechanism of action of propanolol
MOA:
- non-selective antagonist for B1 and B2 adrenergic receptors
- reduces physiological symptoms of anxiety (HR, tremors, sweating)
- does not directly affect psychological feelings of anxiety but is useful for managing performance or situational anxiety
Describe the oral health implications of midazolam
- Dry mouth (xerostomia): can increase caries risk
- Orthostatic hypotension: May cause dizziness or fainting when a patient is reclines or repositioned quickly in the dental chair
- Interaction caution: with LA containing adrenaline as there may be a risk of hypertensive reaction
Describe MOA of Midazolam
- Short acting benzodiazepine
- Positive allosteric modulator of the GABAa receptor
- meaning it has no effect itself but acts to enhance the inhibitory effect of GABA at the GABAa receptor
- Enhanced GABA activity results in sedation, anxiolysis, muscle relaxation and amnesia
Describe oral health implications of midazolam
- used for conscious sedation for dental procedures
- monitor cardiorespiratory effects during sedation
- post-tx drowsiness and motor incoordination
- pts may forget post-operative instruction so make sure they are clearly written down
- may reduce saliva production temporarily, affecting speech and comfort
- valuable for highly anxious pts during invasive or lengthy procedures
Describe MOA of fluoxetine
- Selectively inhibits the reuptake of serotonin (5-HT) in the presynaptic neurons, increasing serotonin levels at the synaptic cleft, leading to improved mood and reduced anxiety, but takes weeks to produce an effect
- used in the long term management of generalized anxiety disorder, depression, and other mood disorders
Describe oral health implications of fluoxetine
- Xerostomia: chronic dry mouth is a common side effect, increasing the risk of caries, candidiasis, periodontal disease
- Bruxism: involuntary grinding or clenching of teeth, especially at night, may be exacerbated
- Delayed healing: some evidence suggests SSRIs may affect platelet aggregation, leading to increased bleeding risk and slower wound healing
- caution with NSAIDs (increased risk of gastrointestinal bleeding) and codeine.
