Antidepressants and Antipsychotics Flashcards
What type of medication has a side effect of Bruxism due to extrapyramidal effects?
SSRIs
You should take Epi with caution when taking these two types of meds:
tricyclics and MAOIs
What is lithium primarily used for?
tx of bipolar disorder
What type of mild/moderate pain reliever would you give a pt who is taking lithium: aleve, aspirin, Advil or Tylenol?
Tylenol (acetaminophen) b/c lithium is contraindicated with NSAIDS (COX-2) as they inhibit renal excretion of lithium
What are the 4 types of drug interactions associated with lithium?
- Diuretics
- NSAIDS
- anticonvulsants
- antihypertensives
What are the 3 effects produced by benzos?
- behavior
- anticonvulsant
- muscle relaxation
What type of changes in behavior do benzos produce at high vs. low doses?
High doses: drowsiness, depressions, anterograde amnesia (surgery)
Low doses: reduction in anxiety, aggression, hostility
T/F benzos can only prevent seizure activity, they cannot arrest an ongoing seizure
False - benzos can prevent or arrest generalized seizure activity produced by electric shock or analeptic agents
What are the 2 drugs of choice used to prevent/arrest local anesthetic induced seizures in dentistry?
diazepam (Valium)
midazolam (Versed)
Diazepam (Valium) and cholrdiazepoxide (Librium) are two potent benzos that are used to produce what effect(s)?
muscle relaxation
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.
centrally mediated
intact spinal cord
healthy persons
skeletal muscle disorders
What is the MOA of benzos?
enhances inhibitory effects of GABA causing hyperpolarization and neuronal stabilization
T/F GABA receptors in neuronal plasma membranes can bind both GABA and Benzos
True
T/F The binding of Benzos is reduced by the presence of GABA
False - the presence of GABA enhances the binding of benzos
Why is it important to reduce apprehension prior to surgery?
apprehension may reduce anesthesia effects
Name 5 uses of benzos in medicine
- anti-anxiety
- skeletal m. relaxation
- hypnotic to tx insomnia
- tx alcoholism withdrawls
- pre-op apprehension reduction
Name the main uses of benzos in dentistry
- dec. pre-op anxiety
- IV sedative and amnesic
- EM seizure intervention
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?
Lorazepam (Ativan)
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?
reduce the opiate dosage by 1/3 of normal dose to counteract CNS effects
Which benzo has a very long half-life?
Lorazepam (Ativan)
Which benzo is referred to as “dazzle”?
midazolam (Versed)
What is the MOA of buspirone (BuSpar)?
binds Serotonin receptors w/o affecting GABA receptors
What are the drug interactions associated with BuSpar?
- ciprofloxiacin
- clarithromycin
- erythromycin
- doxycyline
What is the MOA of tranquilizers (antipsychotics)?
D2 dopa receptor antagonists
What is the major side effect(s) of tranquilizers?
movement disorders or resting tremors
Where is the primary site for dopaminergic neurons?
striatum
T/F effective doses (potency) are indirectly proportional to tranquillizers D2 antatonism
False - Effective doses (potency) are directly proportional to their D2 antagonism
T/F all tranquilizers have a high therapeutic index and similar efficacy
True
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?
Clozapine (Clozaril) = low D2 antagonism
Where does the antipsychotic action of tranquilizers primarily take effect?
prefrontal cortex
limbic areas
Where do the extrapyramidal side effects of tranquilizers primarily take effect?
basal ganglia
Where does the antiemetic effects of tranquilizers primarily take effect?
chemo receptor trigger zone in medulla
What does the Dopaminergic hypothesis of Schizophrenia state?
Schizo is doe to overactivity of dopaminergic system
T/F Tranquilizers block receptors within hours of administration but therapeutic activity begins immediately
False: receptors are blocked within 2-4 hours after drug administration but therapeutic activity requires several weeks of treatment to achieve full effect
T/F Schizos have alterations in their prefrontal cortex and limbic system neuronal structures
True - Drugs help to recover normal cell morphology
after drugs are discontinued morphological abnormalities come back and symptoms of disease return
What are the major extrapyramidal effects of tranquilizers?
Parkinsonism Akinesia (difficulty initiating movement) Tremor Rigidity Akathisia (restless leg syndrome) Dystonia (sustained m. contraction) Tardive Dyskinesia Bruxism
What type of drugs can be administered to tx extrapyramidial effects of tranquilizers?
anti-cholinergic drugs
What causes the sedation and autonomic of side effects of tranquilizers?
blockade of histamine, cholinergic and adrenergic receptors
What potential CV effects are pts taking tranquilizers at risk for?
altered QT interval
What are the drug interactions associated with lithium?
- potentiate CNS effects of sedatives, analgesics, antihistamines
- potentiate respiratory depression caused by opioids
- antacids: dec. absorption of antipsychotics
- anticonvulsants: dec plasma levels of antipsychotics
- may alter antihypertensive meds
What is typical antipsychotic used for tx of nausea and vomiting during chemo?
promethazine (Phenadoz, Phenergan, Promethegan)
What is the atypical antipsychotics used as cross over tx for bipolar disorders?
aripiprazole (Abilify)
What type of atypical antipsychotic is most commonly used for older people?
risperdone (Risperdal)
What are the indications for use of antipsychotics?
psychotic disorders acute delirium and dementia manic episodes during induction of lithium movement disorders intractable hiccups severe nausea and vomiting
