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Pharmacology 1 > E5 > Flashcards

E5 Flashcards

1
Q

What is the drug of choice for bipolar disorder?

A

Lithium

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2
Q

How long does it take to see improvement with lithium?

A

Several weeks

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3
Q

What is the spectrum of lithium? (Narrow/wide)

A

narrow

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4
Q

What are the pharmacological effects of lithium? (4)

A

Prevents release of NT.
Increases uptake of serotonin precursor tryptophan.
Decreases rate of serotonin synthesis.
Inhibits serotonergic and andronergic receptor mediated acting of cAMP and second messenger cascades.

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5
Q

What are the side effects of lithium?

A

CV; CNS: blackouts, coma, seizures, sedation, slurred speech, vertigo, fatigue; hypothyroidism; diabetes insipidus; GI: nausea, vomiting, diarrhea; Neuromuscular: tics, hand tremors, muscular weakness, restlessness; Vision problems; Polyuria - renal damage; Thinning of hair, sking rash, acne; Sexual dysfunction

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6
Q

What are the important drug interactions in dentistry with lithium?

A

Diuretics; NSAIDS; Anticonvulsants, Antihypertensives

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7
Q

Why are NSAIDS contraindicated with lithium?

A

Inhibit renal excretion of lithium (use acetaminophen instead)

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8
Q

What are the three (3) distinct effects produced by benzodiazepines?

A

Effects on behavior.
Anticonvulsant effects.
Muscle relaxation.

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9
Q

What are the behavior effects of benzodiazepines (BDZ)?

A

Reduces aggression and hostility.
Anxiety reduction at low doses.
Drowsiness/depression at high doses.
Anterograde amnesia - forgetful after surgery

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10
Q

Which drug causes anterograde amnesia and is known as a rape drug?

A

BDZ

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11
Q

What are the anticonvulsant effects of BDZ?

A

Prevent/arrest generalized seizure activity produced by electric shock or analeptic agents.
Diazepam (valium) and midazolam (Versed) prevents and arrests local anesthetic-induced seizures in dentistry

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12
Q

Where are the receptor sites of BDZ?

A

CNS

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13
Q

What is the effect of BDZ on GABA (nt)?

A

Enhances the inhibitory effect of GABA on neuronal excitability –> hyperpolarization and neuronal stabilization.
Acts on GABA in spinal cord and other brain regions at low doses.

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14
Q

What can the GABA receptor embedded in neuronal plasma membranes bind?

A

Both GABA and BDZs

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15
Q

What are the uses of benzos in medicine?

A

Antianxiety. Skeletal muscle relaxation. Hypnotic to treat insomnia –> promotes sleep. Treat w/drawal symptoms of alcoholism. Pre-op medication to reduce apprehension (Valium)

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16
Q

What is the effect of apprehension on anesthesia?

A

May reduce anesthesia effects, so benzos such as Valium are given to get properly anesthesized

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17
Q

What are the uses of benzos in dentistry?

A

Reduce pre-op anxiety. IV sedation and amnesiac. Emergency intervention for seizures.

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18
Q

Why is lorazepam (Ativan), a benzo, a good choice for denstistry?

A

Rapidly metabolized to inactive compounds - no significant accumulation

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19
Q

What is the effect of benzos on the CNS?

A

CNS depression: fatigue, drowsiness, muscle weakness, ataxia

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20
Q

What are the effects of parenteral administration of benzos?

A

Acute hypotension, muscle weakness, apnea and cardiac arrest

21
Q

Which pts are more likely to have acute effects to parenteral administration of benzos?

A

Pts receiving opiates, sedatives (barbiturates), and/or alcohol

22
Q

T/F Benzos can cause xerostomia with long term use

A

T

23
Q

T/F Benzos can have an additive effect with other CNS depressants

A

T. Reduce opiates by 1/3 of normal dose if benzo is added to counteract CNS effect

24
Q

Why should pts taking benzos avoid alcohol?

A

Can result in respiratory depression

25
Q

What are the popular benzos?

A

diazepam, chlordiazepoxide, lorazepam, alprazolam, oxazepam, triazolam, midazolam. DCLAOTM

26
Q

Is buspirone (BuSpar) a benzo?

A

No, but it is used to treat anxiety. Binds serotonin receptors w/out affecting GABA receptors

27
Q

What is the mechanism of action of major tranquilizers?

A

Reduce dopaminergic activity by blocking D2 receptors

28
Q

What are the major side effects of tranquilizers?

A

Movement disorders/resting tremors

29
Q

Tranquilizers are antagonistic to what receptors?

A

Dopaminergic, alpha 1 & 2 adrenergic, serotonergic, muscarinic, H1 histamine, sigma opioid

30
Q

Where is the primary site of dopaminergic neurons where tranquilizers work?

A

Striatum, limbic system, and prefrontal cortex

31
Q

What is the therapeutic index of all tranquilizers (high/low?

A

high TI

32
Q

Which tranquilizer is the exception in its potency (low, while most higher potency)?

A

clozapine (Clozaril) is a low D2 antagonis

33
Q

Effective doses (potency) are directly proportional to what?

A

Their D2 antagonism (w/ the exception of clozapine)

34
Q

T/F tranquilizers are great for chemo pts with severe nausea and vomiting

A

T

35
Q

Where do tranquilizers exert their receptor blockade?

A

Prefrontal cortex and limbic areas. Extrapyramidal side effects (movement disorders); Blockade basal ganglia.

36
Q

T/F Tranquilizers are antiemetic

A

T. They they block the chemoreceptor trigger zone of medulla

37
Q

What is the dopaminergic hypothesis of Schizophrenia?

A

Overactivity of dopaminergic system: antipsychotics reduce dopaminergic activity by blocking D2 receptors

38
Q

What are the limitations of the dopaminergic hypothesis of Schizophrenia?

A

Receptors are blocked within 2-4 hours but therapeutic effects don’t materialize for several weeks of tx.

39
Q

What is the therapeutic effect related to in the dopaminergic hypothesis of Schizophrenia?

A

Slow developing depolarization block of dopaminergic neurons

40
Q

With the dopaminergic hypothesis of Schizophrenia, drugs help to recover normal cell morphology. What happens when drug is discontinued?

A

Morphological abnormalities come back and symptoms of disease return

41
Q

What are the major side effects of antipsychotics (tranquilizers)?

A 
Extrapyramidal (movement).
Sedation and autonomic effects.
Hematologic disturbances (WBC count).
Altered QT interval.
42
Q

Antipsychotics potentiate CNS effects of what three classes of drugs?

A

Sedatives, analgesics, antihistamines

43
Q

What is the interaction effect of opioids with antiphychs?

A

Respiratory depression

44
Q

What is the interaction effect of antacids with antiphychs?

A

decrease absorption of antipsychs

45
Q

What is the interaction effect of anticonvulsants with antiphychs?

A

decrease plasma levels of antipsychs

46
Q

What is the interaction effect of antihypertensives (lisinopril) with antiphychs?

A

Alters efficacy (lowers?)

47
Q

What are the typical major antipsychs?

A 
chlorpromazine (Thorazine).
haloperidol (Haldol).
prochlorperazine (Compro, Compazine).
fluphenazine (Prolixin).
pimozide (Orap).
promethazine (Phenadoz, Phenergan, Promethegan)
(used for nausea and vomiting in chemo).
thiothixene (Navane).
48
Q

What are the ATYPICAL major antipsychs?

A 
aripiprazole (Abilify) - used as cross over for bipolar disorder.
clozapine (Clozaril).
risperdone (Risperdal) - used in older people.
olanzapine (Zyprexa).
olanzapine and fluoxetine (Symbyax).
paliperidone (Invega). 
quetiapine (Seroquel). 
ziprasidone (Geodon).
49
Q

What are the indications for use of tranquilizers (antipsychs)?

A

Psychotic disorders: schizophrenia, paranoia.
Acute delirium and dementia.
Manic episodes during induction of lithium.
Movement disorders: Huntington’s, Tourette’s, ballismus.
Intractable hiccups.
Severe nausea and vomiting.

Pharmacology 1 (3 decks)

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