Central Nervous System Drugs Flashcards
Diazepam is preferred to barbiturates as an anti-anxiety agent because diazepam: Produces no sedation Is a very short acting drug Is substantially less expensive Does not potentiate CNS depressants Has less addiction potential
Has less addiction potential
A patient with grand mal epilepsy would likely be under treatment with Meprobamate Trimethadione Phenytoin Pentobarbital Ethosuximide
Phenytoin
Haloperidol (Haldol)
Class: Dopamine Antagonists; Typical Antipsychotics
Mechanism of action: Binds to receptors in all central dopamine pathways
Indication: Schizophrenia
Effect: Alleviate positive symptoms, hallucinations, delusions
No effect on: interpersonal withdrawal, loss of drive, flattened affect
Pharmacological effects:
How this drug might effect dental treatment of patient
oAdverse effects you have to consider:
-Binds to D2 receptors in the basal ganglia–>extrapyramidal side effects
oDystonia-dyskinetic movements due to disordered tonicity of muscle
oAkinesia-absence or poverty of movement
oTardive dyskinesia -continual chewing motions with intermittent darting movements of the tongue, facial grimacing, nose twitching
-Pituitary Gland
o↑ Prolactin secretion
oAmenorrhea
oFalse + pregnancy test
oGynecomastia
o↓libido
-Antagonism of peripheral muscarinic receptors
oAnticholinergic effects
oDry mouth
oConstipation
oDifficulty urinating
oOrthostatic hypotension
oContraindicated drugs:
oWhich analgesic can the patient take:
Clozapine (Clozaril)
Class: Dopamine Antagonist: Atypical Antipsychotic
Mechanism of action: Binds to receptors in mesolimbic and mesocortical dopaminergic pathways– more selective than older drugs; Greater affinity for dopamine receptor subtypes found in these areas, D4 and D3
Indication: Schizophrenia
-Fewer extrapyramidal side effects
Alleviates positive and negative symptoms
Binds to serotonin receptor—negative effects of schizophrenia
Pharmacological effects:
How this drug might effect dental treatment of patient oAdverse effects you have to consider: -Weight gain- leads to non-compliance -Anticholinergic effects -Hyper-salivation -1% of patients develop agranulocytosis -Blood counts every 2 weeks -Interact with any drug that causes CNS depression like benzos, opiates, ethanol, antihistamines -Prolong QT interval
oContraindicated drugs:
oWhich analgesic can the patient take:
Olanzapine (Zyprexa)
Risperidone (Risperdal)
Quetiapine (Seroquel)
Class: Dopamine Antagonist; Atypical Antipsychotic
Mechanism of action: (Same as Clozaril)Binds to receptors in mesolimbic and mesocortical dopaminergic pathways– more selective than older drugs; Greater affinity for dopamine receptor subtypes found in these areas, D4 and D3
Indication: Schizophrenia
Pharmacological effects:
How this drug might effect dental treatment of patient
oAdverse effects you have to consider:
-Weight gain- leads to non-compliance
-Anticholinergic effect
Zyprexa:
-Patients 10 times more likely to develop diabetes
-Exacerbation of diabetes
-700 million dollar settlement
-Interact with any drug that causes CNS depression like benzos, opiates, ethanol, antihistamines
-Prolong QT interval
oContraindicated drugs:
oWhich analgesic can the patient take:
Aripiprazole (Abilify)
Class: Atypical Antipsychotic
Mechanism of action: Partial agonist activity at dopamine and serotonin 5-HT 1A receptors and antagonist activity at 5-HT2A receptors
Indication: Schizophrenia, Bi-polar disorder, Depression
Pharmacological effects:
How this drug might effect dental treatment of patient
oAdverse effects you have to consider:
-Interact with any drug that causes CNS depression like benzos, opiates, ethanol, antihistamines
-Prolong QT interval
oContraindicated drugs:
oWhich analgesic can the patient take:
Ropinirole (Requip)
Class: Dopamine Receptor Agonist
Mechanism of action: Potent D2 receptor agonist
Indication: Parkinson’s disease
Pharmacological effects:
How this drug might effect dental treatment of patient
oAdverse effects you have to consider:
-Abnormal involuntary movements, confusion, psychosis and dry mouth
-Compulsive behavior ?? Spending sprees, gambling
oContraindicated drugs:
oWhich analgesic can the patient take:
Inhibitors of Dopmine Metabolism
Rasagiline (Azilect): inhibits MAO-B
Entacapone (Comtan) and Tolcapone (Tasmar): inhibits COMT
- Drugs work together to increase Dopamine in the brain
- Indicated for Parkinson’s disease
Rasagiline (Azilect)
Class: Inhibitors of Dopamine Metabolism; Monoamine Oxidase Inhibitor B (MAO-B)
Mechanism of action: Inhibits MAO-B (causing an increase in dopamine levels); Approved doses of 0.5-1 mg daily should not inhibit type-A MAO; Nonselective MAO inhibition at higher doses and/or in certain sensitive individuals
Indication: Parkinson’s Disease
Pharmacological effects:
How this drug might effect dental treatment of patient
oAdverse effects you have to consider:
Avoid use of vasoconstrictors due to possibility of hypertensive episodes
oContraindicated drugs: Dental drug interactions–meperidine, methadone, tramadol
oWhich analgesic can the patient take:
Carbidopa/Levodopa (Sinemet)
Class: Dopamine Precursor
Mechanism of action:
(-Levodopa crosses the BBB and is decarboxylated to dopamine by carbidopa; Dopamine is then able to stimulate dopaminergic receptors)
Indication: unlabeled use is Restless Leg Syndrome; Parkinson’s Disease
Pharmacological effects:
How this drug might effect dental treatment of patient
oAdverse effects you have to consider:
-Abnormal involuntary movements of the orofacial muscles
•Abnormal mouth movements
•Protrusion and retraction of the tongue
•Chewing motions
•Facial grimacing
-Oral problems: inflammation, damage to oral structures, movement of anterior teeth and difficulty wearing dentures.
-Dry mouth
oContraindicated drugs:
oWhich analgesic can the patient take:
Selegiline (Ensam)
Class: Monoamine Oxidase Inhibitors (MAOI) Type B; Norepinephrine and Serotonin Drugs
Mechanism of action: Inhibit MAO in the brain (MAO-B) for antidepressant effect; Preserving MAO-A in the digestive tract to break down tyramine
Indication: Depression
Pharmacological effects:
-6 mg/24 hr patch
oInhibit MAO in the brain (MAO-B) for antidepressant effect
oPreserving MAO-A in the digestive tract to break down tyramine
-9 mg/24 hr patch and the 12 mg/24 hr patch
oDietary modifications are required
How this drug might effect dental treatment of patient
oAdverse effects you have to consider:
- Dietary modifications are required
- Dry mouth
- Orthostatic
oContraindicated drugs:
oWhich analgesic can the patient take:
Amitriptyline (Elavil)
Class: Tricyclic Antidepressant; Norepinephrine and Serotonin Drugs
Mechanism of action: NE and serotonin reuptake inhibitors (If NE reuptake is inhibited, so is E reuptake; may be ok but not for someone with heart condition); Also block muscarinic receptors and α1 adrenergic receptors
Indication: Depression, anxiety, obsessive-compulsive disorder (OCD)
Pharmacological effects:
How this drug might effect dental treatment of patient
oAdverse effects you have to consider:
-Drugs take 3 weeks to have an effect
-Overdose leads to cardiotoxicity–arrhythmias, MIs
-Severely depressed patients have been known to commit suicide with TCAs
oContraindicated drugs: Increased effects of direct acting sympathomimetics, like epinephrine
oWhich analgesic can the patient take:
Fluoxetine (Prozac) Sertraline (Zoloft) Paroxetine (Paxil) Citalopram (Celexa) Escitalopram (Lexapro)
Class: Selective Serotonin Reuptake Inhibitors (SSRIs)
Mechanism of action:
Indication: Depression, bulimia, obsessive-compulsive disorder, social anxiety disorder, panic disorder, posttraumatic stress disorder
Pharmacological effects: No significant toxicity with overdose
How this drug might effect dental treatment of patient
oAdverse effects you have to consider:
-Prolonged QT interval: unknown what effect vasoconstrictors have
-Bruxism and Xerostomia
-May impair platelet aggregation: Aspirin and NSAIDs
oPlatelets and Serotonin
•Platelets obtain serotonin from plasma
•Uptake blockage affects platelets ability to capture and secrete serotonin
•Down regulation of cell surface markers responsible for aggregation
•Can cause bleeding in patients that are on SSRIs
oContraindicated drugs:
oWhich analgesic can the patient take:
Venlafaxine (Effexor)
Duloxetine (Cymbalta)
Bupropion (Wellbutrin)
Class: Serotonin-Norepinephrine Reuptake Inhibitors
Mechanism of Action: Duloxetine (Cymbalta)–Blocks both serotonin and norepi reuptake; Bupropion (Wellbutrin)–Block norepi and dopamine reuptake; Weakly blocks serotonin reuptake
Indication:
- Depression
- Neuropathic Pain (Cymbalta)
- Nicotine Withdrawal (Wellbutrin)
Pharmacological effects:
How this drug might effect dental treatment of patient oAdverse effects you have to consider: -Dry mouth oVenlafaxine (Effexor) 12-22 % oDuloxetine (Cymbalta) 5-15 % oBupropion (Wellbutrin) 17-26 % -Blocks Norepi oVasoconstrictor administered with caution oXerostomia and taste perversion oMay impair platelet aggregation •Aspirin and NSAIDs
oContraindicated drugs:
oWhich analgesic can the patient take:
Trazodone (Desyrel)
Class: Serotonin antagonist/reuptake inhibitor (SARI)
Mechanism of action:
Indication: Used for depression that causes sleep disturbances; Weak antidepressant effect
Pharmacological effects: Not given alone; usually given at night
How this drug might effect dental treatment of patient
oAdverse effects you have to consider: Orthostatic hypotension
oContraindicated drugs:
oWhich analgesic can the patient take:
