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Pharmacology E5 > Antidepressants and Antipsychotics > Flashcards

Antidepressants and Antipsychotics Flashcards

1
Q

What type of medication has a side effect of Bruxism due to extrapyramidal effects?

A

SSRIs

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2
Q

You should take Epi with caution when taking these two types of meds:

A

tricyclics and MAOIs

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3
Q

What is lithium primarily used for?

A

tx of bipolar disorder

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4
Q

What type of mild/moderate pain reliever would you give a pt who is taking lithium: aleve, aspirin, Advil or Tylenol?

A

Tylenol (acetaminophen) b/c lithium is contraindicated with NSAIDS (COX-2) as they inhibit renal excretion of lithium

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5
Q

What are the 4 types of drug interactions associated with lithium?

A
  1. Diuretics
  2. NSAIDS
  3. anticonvulsants
  4. antihypertensives
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6
Q

What are the 3 effects produced by benzos?

A
  1. behavior
  2. anticonvulsant
  3. muscle relaxation
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7
Q

What type of changes in behavior do benzos produce at high vs. low doses?

A

High doses: drowsiness, depressions, anterograde amnesia (surgery)

Low doses: reduction in anxiety, aggression, hostility

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8
Q

T/F benzos can only prevent seizure activity, they cannot arrest an ongoing seizure

A

False - benzos can prevent or arrest generalized seizure activity produced by electric shock or analeptic agents

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9
Q

What are the 2 drugs of choice used to prevent/arrest local anesthetic induced seizures in dentistry?

A

diazepam (Valium)

midazolam (Versed)

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10
Q

Diazepam (Valium) and cholrdiazepoxide (Librium) are two potent benzos that are used to produce what effect(s)?

A

muscle relaxation

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11
Q

Muscle relaxation produced by benzos is ______ mediated, requires an intact ___________ and can depress motor nerve and function in both ________ persons and in patients with ________________ disorders.

A

centrally mediated
intact spinal cord
healthy persons
skeletal muscle disorders

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12
Q

What is the MOA of benzos?

A

enhances inhibitory effects of GABA causing hyperpolarization and neuronal stabilization

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13
Q

T/F GABA receptors in neuronal plasma membranes can bind both GABA and Benzos

A

True

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14
Q

T/F The binding of Benzos is reduced by the presence of GABA

A

False - the presence of GABA enhances the binding of benzos

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15
Q

Why is it important to reduce apprehension prior to surgery?

A

apprehension may reduce anesthesia effects

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16
Q

Name 5 uses of benzos in medicine

A
  1. anti-anxiety
  2. skeletal m. relaxation
  3. hypnotic to tx insomnia
  4. tx alcoholism withdrawls
  5. pre-op apprehension reduction
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17
Q

Name the main uses of benzos in dentistry

A
  1. dec. pre-op anxiety
  2. IV sedative and amnesic
  3. EM seizure intervention
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18
Q

What benzo drug is a good choice for dental use b/c it is rapidly metabolized to inactive compounds therefore does not have significant accumulation?

A

Lorazepam (Ativan)

19
Q

If a patient is on benzos and perscribe an opiate for pain how should your dosage differ than if the patient was not on a benzo?

A

reduce the opiate dosage by 1/3 of normal dose to counteract CNS effects

20
Q

Which benzo has a very long half-life?

A

Lorazepam (Ativan)

21
Q

Which benzo is referred to as “dazzle”?

A

midazolam (Versed)

22
Q

What is the MOA of buspirone (BuSpar)?

A

binds Serotonin receptors w/o affecting GABA receptors

23
Q

What are the drug interactions associated with BuSpar?

A
  1. ciprofloxiacin
  2. clarithromycin
  3. erythromycin
  4. doxycyline
24
Q

What is the MOA of tranquilizers (antipsychotics)?

A

D2 dopa receptor antagonists

25
Q

What is the major side effect(s) of tranquilizers?

A

movement disorders or resting tremors

26
Q

Where is the primary site for dopaminergic neurons?

A

striatum

27
Q

T/F effective doses (potency) are indirectly proportional to tranquillizers D2 antatonism

A

False - Effective doses (potency) are directly proportional to their D2 antagonism

28
Q

T/F all tranquilizers have a high therapeutic index and similar efficacy

A

True

29
Q

What drug is used for pts with severe nausea/vomiting due to chemo b/c it’s effective dose is not directly proportional to it’s antagonism?

A

Clozapine (Clozaril) = low D2 antagonism

30
Q

Where does the antipsychotic action of tranquilizers primarily take effect?

A

prefrontal cortex

limbic areas

31
Q

Where do the extrapyramidal side effects of tranquilizers primarily take effect?

A

basal ganglia

32
Q

Where does the antiemetic effects of tranquilizers primarily take effect?

A

chemo receptor trigger zone in medulla

33
Q

What does the Dopaminergic hypothesis of Schizophrenia state?

A

Schizo is doe to overactivity of dopaminergic system

34
Q

T/F Tranquilizers block receptors within hours of administration but therapeutic activity begins immediately

A

False: receptors are blocked within 2-4 hours after drug administration but therapeutic activity requires several weeks of treatment to achieve full effect

35
Q

T/F Schizos have alterations in their prefrontal cortex and limbic system neuronal structures

A

True - Drugs help to recover normal cell morphology

after drugs are discontinued morphological abnormalities come back and symptoms of disease return

36
Q

What are the major extrapyramidal effects of tranquilizers?

A 
Parkinsonism
Akinesia (difficulty initiating movement) 
Tremor 
Rigidity 
Akathisia (restless leg syndrome) 
Dystonia (sustained m. contraction)
Tardive Dyskinesia 
Bruxism
37
Q

What type of drugs can be administered to tx extrapyramidial effects of tranquilizers?

A

anti-cholinergic drugs

38
Q

What causes the sedation and autonomic of side effects of tranquilizers?

A

blockade of histamine, cholinergic and adrenergic receptors

39
Q

What potential CV effects are pts taking tranquilizers at risk for?

A

altered QT interval

40
Q

What are the drug interactions associated with lithium?

A
  1. potentiate CNS effects of sedatives, analgesics, antihistamines
  2. potentiate respiratory depression caused by opioids
  3. antacids: dec. absorption of antipsychotics
  4. anticonvulsants: dec plasma levels of antipsychotics
  5. may alter antihypertensive meds
41
Q

What is typical antipsychotic used for tx of nausea and vomiting during chemo?

A

promethazine (Phenadoz, Phenergan, Promethegan)

42
Q

What is the atypical antipsychotics used as cross over tx for bipolar disorders?

A

aripiprazole (Abilify)

43
Q

What type of atypical antipsychotic is most commonly used for older people?

A

risperdone (Risperdal)

44
Q

What are the indications for use of antipsychotics?

A 
psychotic disorders
acute delirium and dementia 
manic episodes during induction of lithium 
movement disorders 
intractable hiccups 
severe nausea and vomiting

Pharmacology E5 (3 decks)

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