Anti-anxiety Drugs; Antidepressants; Antipsychotics Flashcards
What is the clinical signs and symptoms of depression in adolescents and adults?
1) sleep disturbances
■ adults= insomnia
■ children= sleep all day
2) women are twice as more likely to experience depression as men
3) Know signs of depression- pretty straight up
NOTE: Cannot take St. John’s wort with any perscription antidepressants!
What are the differences between primary (endogenous) & secondary (exogenous) depression?
Primary depression (ENDOgenous):
1) Absence of clearly identifiable factors leading to secondary affective state
2) “Chemical imbalance”
3) Responds to antidepressant medications
Secondary depression (EXOgenous):
1) Chronologically occurs w/ pre existing non affective disorders; develops because of non affective disorders
2) Disease, trauma, chronic pain
3) Completely alleviated by treatment of non affective disorder
What is the characteristics of bipolar disorder (manic depressive disorder)?
1) Characterized by recurrent wide swings in mood from depression to mania
2) Treated w/ lithium
What is the biogenic amine hypothesis for affective disorders, and its limitations?
1) Depression related to decreased levels of synaptically released norepinephrine and/or serotonin in the brain
2) Mania is a result of an excess of these transmitters
3) Limitations:
■ Antidepressants increase extracellular levels of neurotransmitters almost immediately
■ However, their therapeutic effects are seen only after several weeks of treatment
■ An additional theory: antidepressants produce compensatory changes in levels and/or functioning of many receptors =
■ Improve receptor function
● alpha1, alpha2, beta-adrenergic, & serotonergic
What are the 3 primary functions of serotonin?
1) Elevates mood
2) Helps you fall asleep and have good quality sleep
3) Acs on satiety center in brain to help you feel full after eating
What are the mechanisms of action of antidepressant medications?
1) INCREASE the amount of neurotransmitter in the synaptic cleft
■ inhibition of reuptake
■ enzymatic degradation
2) Tricyclics = INCREASE synaptic serotonin and norepinephrine
3) Tetracyclics = INCREASE synaptic norepinephrine
4) MAOIs = BLOCK the degradation of norepinephrine, dopamine and serotonin
5) SSRIs = INCREASE synaptic serotonin
What is the indications for use and common brand names of popular antidepressant medications like MAOIs?
○ Monoamine Oxidase Inhibitors (MAOI):
■ OLD drugs used in OLD people
■ Atypical, non-endogenous or neurotic depression
■ Depression associated w/ Parkinson’s disease
■ Investigational for ADHD, Alzheimer’s, Schizophrenia
■ PTSD
■ EXAMPLES: ● isocarboxazid (Marplan) ● phenelzine (Nardil) ● selegiline (Atapryl, Eldepryl, Selpak) ● tranylcypromine (Parnate)
■ Side effects: Cause release of endogenous catecholamines, can result in hyperadrenergic crisis (severe hypertension, fever, arrhythmias). AVOID tyramine containing foods
What is the indications for use and common brand names of popular antidepressant medications, like SSRIs?
○ Selective Serotonin Reuptake Inhibitors (SSRIs):
■ INCREASE extracellular concentration of serotonin
■ Approved indications: depression, geriatric depression, generalized anxiety disorder, social phobias, social anxiety disorders, diabetic neuropathies, anorexia, bulimia, premenstrual syndrome, OCD, panic attacks
■ EXAMPLES: ● citalopram (Celexa) ● escitalopram oxalate (Lexapro) ● fluoxetine (Prozac, Sarafem) ● fluvoxamine (Luvox) ● paroxetine (Paxil) ● sertraline (Zoloft)
■ Side effects: agitation, anxiety, hostility, aggression, serotonin syndrome
What is the indications for use and common brand names of popular antidepressant medications, like SNRIs?
○ Serotonin/Norepinephrine Reuptake Inhibitors (SNRI):
EXAMPLES: ● desvenlafaxine (Pristiq) ● duloxetine (Cymbalta) ● milnacipran (Savella) ● venlafaxine (Effexor XR) a. Treats major depressive disorder, generalized anxiety, social anxiety, panic, investigational for OCD, hot flashes, neuropathic pain, ADHD
■ CAUTION w/ epinephrine; increases blood pressure and heart rate
What is the indications for use and common brand names of popular antidepressant medications, like tetracyclics?
○ Tetracyclics:
■ maprotiline (Ludiomil)
● INHIBITS reuptake of norepinephrine
● TREATS depression, anxiety with depression (causes sedative effect), dsythymic disorder
● Investigational: bulima, enuresis, pain, panic attacks, tension headache, cocaine withdrawal
What is the indications for use and common brand names of popular antidepressant medications, including the tricyclics, tetracyclics, MAOIs, SSRIs and SNRIs.
○ Tricyclics:
■ BLOCKS reuptake of norepinephrine & serotonin
■ TREATS severe anxiety, panic attacks, phobias, OCD, bulimia, chronic fatigue, sleep apnea
■ Adjunctive therapy for CHRONIC pain, peripheral neuropathies = exhibits analgesic properties
■ Investigational for substance abuse-related disorders, ADHD
■ Take BP on patients prior to local anesthesia, caution with epinephrine
■ BLOCKERS of both norepinephrine & serotonin
● amitryptyline (Elavil)
● imipramine (Tofranil)
■ Selective norepinephrine reuptake BLOCKERS
● desipramine (Norpramin)
● nortriptline (Pamelor)
What is the indications for use of the dopamine-reuptake inhibitor bupropion (Wellbutrin, Zyban), and how this drug can be used in dentistry?
○ Smoking cessation
What is the side effects/risks associated w/ using bupropion?
1) INCREASED risk for SEIZURES
2) risk for emergent hypertension with concurrent nicotine patch use
What is the drug interaction of epinephrine with tricyclic and MAOI antidepressants?
1) INCREASED blood pressure
2) Caution w/ epinephrine = especially with tricyclics and monoamine oxidase inhibitors (MAOIs)
3) Taking medications together results in rapid heartbeat, seizures, or hallucinations.
Why is bruxism as a side effect of SSRIs?
■ Due to INCREASED extrapyramidal effects (EPS-drug induced movement disorders)
■ Excessive serotonergic action on meso-cortical neurons arising from the ventral segmental area.
■ This action leads to a dopaminergic deficit, which causes a specific form of akathisia & akathisia-like movement of the jaw muscles, thereby leading to bruxism
