Psychotropics Flashcards
(44 cards)
1
Q
what are antipsychotics used for
A
- also called neuroleptics
- the treatment of psychoses such as schizophrenia
2
Q
what are mood stabilizing agents used for
A
- the treatment of manic or bipolar disorder
3
Q
what are anxiolytic drugs used for
A
- treatment of anxiety disorders
4
Q
what are benzodiazepines and barbiturates used for
A
- reduction of anxiety or the induction of sleep
5
Q
what are adverse effects of psychotropic medications
A
- xerostomia, which may cause caries, PD
6
Q
what is schizophrenia
A
- type of psychosis
- caused by too much dopamine in the brain
- extra dopamine overexcites the dopamine receptors
- the more potent a medication is in blocking dopamine receptors the more potent it is as an antipsychotic
7
Q
what are positive and negative symptoms
A
- positive: additive, symptoms that wouldn’t normally occur without the condition
- negative: taken away, ie emotional and social withdrawal where it should be normal
8
Q
what are positive symptoms of schizophrenia
A
- hallucinations, delusions, paranoia, and suspiciousness
9
Q
what are negative symptoms of schizophrenia
A
- emotional and social withdrawal and lack of interest
10
Q
what are the 2 types of antipsychotics
A
- typical or conventional antipsychotics
- atypical antipsychotics
- both act by attaching to dopamine receptors and preventing dopamine from attaching -> decrease in psychotic behaviour
11
Q
what are typical antipsychotics
A
- older drugs
- treat positive symptoms not negative
- examples: largactil, haldol
12
Q
what are some adverse effects associated with typical antipsychotic drugs
A
- dry mouth, urine retention
- extrapyramidal symptoms (dystonia, acute akathisia, Parkinsonism)
sedation, drowsiness - cardiac safety of concern: tachycardia. orthostatic hypotension, precautions when administering epi
13
Q
what are atypical/novel antipsychotics
A
- newer antipsychotics
- reduce both positive and negative symptoms
- function primarily through dopamine, serotonin and alpha-adrenergic blockade
- lower incidence of side effects
- ex: risperdal, seroquel
14
Q
what are some adverse effects associated with atypical antipsychotics
A
- tardive dyskinesia (difficult to manage dental patient)
- sedation and weight gain
- seizures
- diabetes
- high triglycerides
- orthostatic hypotension
15
Q
what are some dental drug interactions we may see with antipsychotics
A
- epic containing local anesthetics may cause hypotension and tachycardia
- administer cautiously, monitor vitals
- max number of epi is 2 of 1:100,000 epi
- avoid levonordefrin containing local anesthetics
16
Q
what are some anticholinergic side effects of antipsychotics
A
- monitor for xerostomia, root caries and oral candidiasis
- Monitor patient for orthostatic hypotension: patient should remain in upright position in the dental chair before standing up
- greater incidence of hyperglycaemia in patient with schizophrenia: monitor pt for PD
- traduce dyskinesia: dental management may be difficult due to abnormal muscle movements
17
Q
what are mood disorders
A
- includes major depressive disorder and bipolar disorder
18
Q
what are symptoms of major depression and what must occur for diagnosis
A
- at least 5 symptoms must be present every day for at least 2 weeks
1. depressed mood
2. markedly diminished interest or pleasure in activities
3. eating more or eating less
4. sleep changes
5. feelings of worthlessness or guilt
6. poor concentration
7. fatigue or loss of energy
8. thoughts of death
19
Q
how do antidepressants work
A
- depression is caused by decreased levels of NE and/or serotonin in the brain
- antidepressant meds work by increasing concentration of NE or serotonin by inhibiting or blocking the reuptake into synaptic terminals on the neuron OR inhibiting the enzyme MAO that breaks down NE
20
Q
what are the 3 classifications of antidepressants
A
- monoamine oxidase inhibitors: ex: phenelzine
- tricyclic antidepressants: ex: amitriptypline
- selective serotonin reuptake inhibitors (SSRIs): ex: paroxetine
21
Q
what are monoamine oxidase inhibitors
A
- MOAs
- inhibit the actions of MAO, resulting in increased activity of norepinephrine within the brain and other places in the body
- avoid tyramine-containing foods (May cause hypertensive episode, includes beer, wine and aged cheese)
- no dental drug interactions
22
Q
what are tricyclic antidepressants
A
- inhibit reuptake of NE and/or serotonin from the synapse
- resulting in elevated levels of NE and serotonin -> improve depression
23
Q
what are some dental uses of tricyclic antidepressants (not for depression in this case)
A
- nocturnal bruxism
- chronic orofacial pain
24
Q
what are some side effects of tricyclic antidepressants
A
- nonselective blocking of receptors: cause many side effects
- dental side effects: xerostomia
- dental drug interactions: epi, limit use of epi to 0.04 mg (2 cartridges of 1:100,000)
25
what are selective serotonin reuptake inhibitors (SSRI)
- better side effect profile because selectively binds to serotonin receptors
- a 'serotonin syndrome' can occur due to elevated serotonin blood levels, which are potentially very dangerous and Fatal: caused by a combination of 2 or more drugs, one of which is a SSRI and the other is a MAOI
26
what are atypical antidepressants
- similar action to the SSRI but are classified as atypical antidepressants
- also have activity on dopamine
- ex: venlafaxine, bupropion
27
what are some interactions of antidepressants with epi
- accumulation of epi: causes cardiac arythmias, hypertension
- use epi with caution in patients taking antidepressants: 2 cartridges of 1:100,000 epi
- avoid levonordefrin
- note: no interaction occurs between EPI and SSRIs, mechanism of action of SSRIs not involved in NE reuptake pump, no need to discontinue with EPI
28
what are manic episodes of bipolar disorder like
- an abnormally elevated or irritable mood
- aggressiveness
- happy
- euphoric
- impulsive behaviour
- decreased sleep
- increased activity
- and grandiosity (exaggerated sense of self-importance)
29
how can someone be diagnosed with bipolar
- manic: must have symptoms for at least 1 week
| - depressive: at least 2 weeks with 5 or more symptoms most of the day/nearly every day
30
what are hypomanic episodes
- not full blown mania
- milder form that does not interfere with an individuals daily functioning
- at least 4 days of 3 or more symptoms
31
what are depressive episodes of bipolar like
- feeling sad
- decrease interest
- low self esteem
- sleep disturbances
- an appetite disturbance
32
what are mixed episodes of bipolar
- mixed episodes are characterized by both mania and depression over a one week period
33
what are the phases of treatment of bipolar disorders
- acute therapy: treatment of the acute episode of the manic and depressed state
and
- maintenance therapy: prevention of the relapse of these episodes
34
what is bipolar therapy (pharmacotherapy)
- mood stabilizers to treat the mania exert their effects by 'stabilizing from above'
and
- antidepressant to treat the depression exert their effects by 'stabilizing from below'
35
how do we treat the acute case of mania and what are some dental drug interactions to watch out for
- mono therapy or combination therapy depending on the severity
- can use lithium: the 'gold standard' mood stabilizer. narrow therapeutic index (get blood levels--avoid toxicity)
- can also use antipsychotics
- many side effects: tongue movements, xerostomia
- dental drug interactions: NSAIDs, metronidazole antibiotic
36
what are special dental considerations for patients being treated for bipolar disorders
- can decrease salivary flow: potential for caries, PD and oral cadidiasis
- causes orthostatic hypotension: monitor vitals, Pte must remain seated in dental chair for a few minutes before standing up
37
how do we treat the depressive episodes of bipolar disorder
- more difficult to treat than the manic
- difficult to recognize if depression is due to bipolar or major depressive disorder
- antidepressant mono therapy is NOT recommended due to the chance of starting a manic episode
- combine SSRI with antipsychotic
38
what is the maintenance like for bipolar disorder
- once the acute crisis is over, ptes may remain at particularly high risk for relapse for up to 6 months
- continuation treatment is aimed at preventing recurrences of mood episodes (depression, mania, hypomania, mixed episodes)
- use antipsychotics or lithium
39
what are anxiety disorders
- most common type of psychiatric disorder
- only 30% of people will seek tx
- includes: generalized anxiety disorder, panic disorder, phobias, PTSD, OCD
40
what are benzodiazepines
- drug of choice in the pharmacologic tx of GAD
- also called minor tranquillizers or sedatives
- bind to gaba receptors to stimulate or activate them
- used to reduce anxiety in dental patient
- rapid onset and short acting
- ex: diazepam, midazolam
41
what are side effects of benzodiazepines
- xerostomia
| - tolerance does occur within 3-14 days
42
what are barbiturates
- formerly used in the tx of anxiety but no longer because of risk of od and fatality
- uses: hypnotics, short term (2 weeks) for insomnia; anticonvulsants in the tx of seizures; preoperatively to relieve anxiety and provide sedation
- ex: secobarbital
43
what are some other CNS depressants
- chloral hydrate: sedation in children in dental office, low therapeutic index -> high incidence of toxicity and OD, not used much anymore
- other non barb/non benzodiazepines CNS depressants: zopiclone
44
what is the use of psychotropic drugs in dental office for
- apprehensive dental patients
- bruxism
- orofacial pain
