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Pharmacology > Exam 5: Anti-Anxiety, Anti-Psychotics > Flashcards

Exam 5: Anti-Anxiety, Anti-Psychotics Flashcards

1
Q

What is the drug of choice for Bi-Polar disorder? What are 2 brand names?

A

Litium: Eska-lith (no, not Eskimo) & Lith-o-bid (I’d bid on Lithium at an auction!)

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2
Q

Lithium-Prevents release of ___________.

A

Neurotransmitters

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3
Q

Lithium-Increases uptake of serotonin precursor

_________.

A

tryptophan

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4
Q

Lithium-Decreases rate of ________ synthesis

A

serotonin

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5
Q

Lithium-Inhibits serotonergic and adrenergic receptor-mediated activation of ______ and second messenger cascades

A

cAMP

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6
Q

Lithium-Administered _______ in form of a salt

A

ORALLY

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7
Q

Lithium-Peaks in blood within ____ hours after

administration

A

2 hours

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8
Q

Lithium-Half-life = ___-36 hours

A

24-36 hours

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9
Q

Lithium-Improvement in condition occurs over several ______ of treatment

A

WEEKS

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10
Q

Lithium-Very ____ therapeutic index = level in blood is monitored WEEKLY

A

LOW

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11
Q

Lithium-Drug is often taken in _____ doses several times per day to minimize toxicity

A

small

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12
Q

Lithium-Produces serious side effects = affects patient _______

A

compliance!

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13
Q

What happens with a drug interaction involving lithium?

A

The drug will INCREASE lithium levels in the blood and cause toxicity

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14
Q

What are the 4 types of drugs that have drug interactions with Lithium?

A

1.Diuretics 2.NSAIDs 3.Anticonvulsants 4.Antihypertensives

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15
Q

NSAIDs are contraindicated with Lithium because NSAIDs inhibit the ______ of lithium. SO we will use ________ instead.

A

renal EXCRETION….acetaminophen

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16
Q

What are the two synonyms for anti-anxiety medications?

A

sedative hyponotics (sedatives) and minor tranquilizers

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17
Q

What is the class of anti-anxiety drugs that is among the most widely used in medicine?

A

Benzodiazepines

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18
Q

_______ (______)* and ________ (_______) account for 75% of 100 million prescriptions written for sedatives/tranquilizers!!!!

A

diazepam (Valium)….chlordiazepoxide (Librium)

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19
Q

All benzodiazepines (BDZ) have same basic structure: _______ AND ________.

A

2 nitrogens “diazo”….Benzene ring = binds to GABA receptors

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20
Q

LETS GET IT!!! What are the 5 Benzodiazepines that Dr. S wants us to know?

A
  1. di-az-ep-am (Valium) 2.lor-az-ep-am (Ativan) 3.al-pr-az-ol-am (Xanax) 4.tri-az-ol-am (Hal-see-on) 5. mid-az-ol-am (Ver-sed)
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21
Q

What is the primary pre-op sedative and inducer of general anesthesia in dentistry?

A

mid-az-ol-am (Versed)

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22
Q

It is NOW known that Benzodiazepines are HIGHLY _______! Does tolerance come into play?

A

addictive…yes tolerance is involved

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23
Q

What are the two schedules for Benzodiazepines?

A

IV and V

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24
Q

What are the 3 distinct effects of Benzodiazepines???

A

1.Effects on behavior 2. Anticonvulsant effects 3.Muscle Relaxation

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25
Q

Benzodiazepines- Effects on Behavior….Reduces _______ and hostility.

A

aggresion

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26
Q

Benzodiazepines- Effects on Behavior….Reduces anxiety at _____ doses.

A

low

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27
Q

Benzodiazepines- Effects on Behavior…causes ______ at high doses.

A

drowsiness

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28
Q

Benzodiazepines- Anticonvulsant Effects…Benzo’s can prevent or arrest generalized seizure produced by _______ or ________.

A

electric shock or analeptic agents (dental anesthetic!!!!)

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29
Q

Benzodiazepines- Anticonvulsant Effects… SO, were in the clinic and suddenly a patient starts to seize shortly after receiving local anesthetic. WHAT TWO drugs can we use to arrest the seizure? How would they be administered?

A
  1. diaz-ep-am (Valium) and 2.mid-azo-lam (Versed)…. slowly through IV
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30
Q

Benzodiazepines- Muscle Realxation Effects…_______ (_____) and ________ (______) = most potent

A

diazepam (Valium) and chlordiazepoxide (Librium) ((75% of all sedatives!!))

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31
Q

Benzodiazepines- Muscle Realxation Effects…Centrally-mediated and requires intact _______

A

spinal cord

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32
Q

Benzodiazepines- Muscle Realxation Effects…Depresses ________ and muscle function in BOTH healthy persons and in patients suffering from skeletal muscle disorders.

A

motor nerve

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33
Q

Mechanism of Action of BDZs-Receptor sites for BDZ are found in the _____.

A

CNS

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34
Q

Mechanism of Action of BDZs-BDZ affect the concentration of most neurotransmitters, including _____.

A

GABA

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35
Q

Mechanism of Action of BDZs-Enhances the inhibitory effect on _____ on neuronal excitability….Causes _________ (a less excitable state) and neuronal stabilization.

A

GABA…hyperpolarization

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36
Q

Mechanism of Action of BDZs-BDZs enhance presynaptic GABA-mediated _______ in spinal cord and other brain regions at low doses…Remember that GABA is _______ = decreases excitation in brain

A

INHIBITION…INHIBITORY

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37
Q

Mechanism of Action of BDZs- the GABA receptor is embedded in neuronal _________ located at the _______ = binds BOTH _____ & _____.

A

plasma membranes…synapse…GABA & BDZ

38
Q

Mechanism of Action of BDZs- Presence of GABA _______ binding of BDZ!! Is this action reversible? Is it fast or slow?

A

ENHANCES….reversible and quick

39
Q

Pharmokinetics of Benzo’s—most have ______ half lives and are metabolized to _________….therefore repeated dosing results in ________ of the drug in the body.

A

VERY LONG…active compounds…accumulation

40
Q

Pharmokinetics of Benzo’s— ________ (______) BREAKS the common Benzo mold and is metabolized RAPIDLY to INACTIVE compounds so there is no significant accumulation! IT is a GOOD CHOICE FOR DENTISTRY!!!

A

lor-az-e-pam (Ativan)

41
Q

Uses of Benzo’s in Medicine, Relief of ______….Skeletal muscle ______ = muscle strains….________ to treat insomnia

A

anxiety…relaxation…hypnotic

42
Q

Uses of Benzo’s in Medicine…can help withdrawal symptoms of _______!

A

alcoholism!

43
Q

Uses of Benzo’s in Medicine, it’s a great _______ medication to decrease apprehension. But be careful it may decrease the effects of anesthesia!

A

pre-operative

44
Q

Uses of Benzo’s in DENTISTRY! To reduce pre-operative anxiety, you can prescribe one of these 4 Benzo’s…WHICH one is preferred c/o half life and onset time???

A

1.diazepam (Valium), 2. lorazepam (Ativan) 3.al-praz-olam (Xanax) 4.tri-az-olam (Halcion)…triazolam (Halcion) has a rapid onset of 15-30 min and has the shortests half life, and its orally adinistered

45
Q

Uses of Benzo’s in DENTISTRY! IV ______ and Anterograde _______.

A

Sedation…amnesia

46
Q

Uses of Benzo’s in DENTISTRY! EMERGENCY intervention for ______.

A

seizures

47
Q

Adverse Effects of BenZOdiAZapines- _____ depression leading to fatigue, drowsiness, muscle weakness, ataxia
(failure of muscle coordination)

A

CNS

48
Q

Adverse Effects of BenZOdiAZapines- ________ administration = acute hypotension, muscle weakness, apnea and cardiac arrest

A

Parenteral

49
Q

Adverse Effects of BenZOdiAZapines- Heres a DENTAL related adverse effect:_______!!

A

Xerostomia!!

50
Q

Adverse Effects of BenZOdiAZapines- It has ________ effects with other CNS depressants, ESPECIALLY ______, so reduce dose of opiates by ____ of normal dose when a BDZ is added (diazepam)

A

ADDITIVE….alcohol….1/3

51
Q

Adverse Effects of BenZOdiAZapines-What can be the end result of mixing EtOH and Benzo’s?

A

Significant Respiratory Depression

52
Q

Our first Miscellaneous Anti-anxiety agent-buspirone: What is the mechanism of action?… Hey this is cool- it binds to ______ receptors without affecting BZD-GABA receptors!

A

The mechanism of action is UNKNOWN….serotonoin

53
Q

YAY full circle!!! What 5 antimicrobials have drug interactions with our new friend bus-pir-one?

A

1.cipro-flox-acin 2.clar-ithro-mycin 3.erythro-mycin 4.de-oxy-cycline 5.systemic antifungals

54
Q

Oral health considerations with anti-anxiety drugs: ______ is a major cause of cavities and gingivitis.

A

xerostomia

55
Q

Oral health considerations with anti-anxiety drugs: Pt’s get a LACK of interest in ______.

A

Oral Hygiene

56
Q

Oral health considerations with anti-anxiety/anti-depression drugs: CAUTION with EPINEPHRINE, especially in the anti-depressants _______ and ______.

A

tricyclics and MAOIs

57
Q

Oral health considerations with anti-anxiety/anti-depression drugs: did you know? _____ CAUSE BRUXISM and increased EXTRAPYRAMIDAL effects!

A

SSRIs

58
Q

Major Tranquilizers are aka _________ meds.

A

anti-psychotic

59
Q

What is the primary indication for major tranquilizers?

A

Schizophrenia

60
Q

Major Tranquilizers can be used for ________ disorders like Huntington’s disease, Tourette’s syndrome, ballismus.

A

movement

61
Q

What is a secondary indication for the use of major tranquilizers that pt’s on Chemo therapy can use them for?

A

to help curve severe nausea and vomiting

62
Q

Major Tranquilizers-Individual drugs bind to a variety of receptors and act as __________.

A

ANTAGONISTS

63
Q

Major Tranquilizers- Blockade of __________ transmission in various areas of brain is thought to be responsible for their major effects.

A

dopaminergic

64
Q

Major Tranquilizers-________ action = blockage in prefrontal cortex and limbic areas

A

Antipsychotic

65
Q

Major Tranquilizers- __________ side effects = blockade in basal ganglia

A

Extrapyramidal

66
Q

Major Tranquilizers- ________ effects = blockade in chemoreceptor trigger zone of the medulla

A

Antiemetic

67
Q

Major Tranquilizers- One hypothesis: Schizophrenia = overactivity of __________ system, SO antipsychotic medications reduce this activity by blocking ____ receptors!

A

dopaminergic…D2

68
Q

What is the ONLY major tranquilizer that has LOW D2 antagonism and there for the effective dose is lower then expected…FOR EXAMPLE-Most drugs work in striatum (primary site for dopaminergic neurons)…Antipsychotics occupy >___% of striatal D2 sites…THIS DRUG occupies only ____%

A

CLOZE the DOOR…cloz-a-pine (Cloz-ariL)…70%….30%

69
Q

Whats wrong with the dopaminergic hypothesis?-Receptors are blocked within 2-4 hours after drug administration, but therapeutic activity requires several ______ of treatment to achieve full effect…Therapeutic effects is related to slow- developing depolarization ______ of dopaminergic neurons

A

WEEKS..blocks

70
Q

Hypothesis-Schizophrenia is a sccociated with a change in ________ of neurons and drugs help to recover this!

A

morphology

71
Q

Pharmacokinetics of tha MAJOR tranq’s—Administered ______ or by _____.

A

orally or IM

72
Q

Pharmacokinetics of tha MAJOR tranq’s— Maximal concentration in blood is achieved __-4 hours after oral administration and within ___-40 minutes after IM….Half-life = ___-40 hours…_____ time daily dosing

A

2…30min..18…one time

73
Q

Pharmacokinetics of tha MAJOR tranq’s— All drugs have similar ______.

A

efficacy (except for cloz-a-pine)

74
Q

Major Tranq’s-Side Effects> Are they addictive??

A

Not addictive

75
Q

Major Tranq’s-Side Effects> Extrapyramidal side effects:
movement disorders…________– akinesia (difficulties in initiating movement), tremor, rigidity..This is caused by the block of ____ receptors in the ______ ganglia.

A

Parkinsonism!!…D2…basal ganglia

76
Q

Major Tranq’s-Side Effects> ______ = jimmy legs/restless leg syndrome can occur

A

A-kath-isia (so your pt will be moving during tx)

77
Q

Major Tranq’s-Side Effects> _______ – sustained muscular contraction

A

Dys-tonia

78
Q

Major Tranq’s-Side Effects> ________ – abnormal movements, particularly of FACE and TONGUE, but may also be of trunk and limbs…Noticeable after at least ___ months of chronic treatment

A

Tardive Dyskinesia…6 (think it will be easy to work on these patients???)

79
Q

Major Tranq’s-Side Effects> YAY! Even more meds!!! Most extrapyramidal side effects are treatable with __________ drugs

A

anti-cholenergic (makes sense, stop movement=stop Ach)

80
Q

Major Tranq’s-Side Effects>Sedation and autonomic side effects are caused by blockade of _______, ________ and ________ receptors

A

histamine, cholinergic, and adrenergic

81
Q

Major Tranq’s-Side Effects>Take home message-it aint ______ to be on these meds.

A

easy

82
Q

Anti-Psych DRUG INTERACTIONS!! Antipsychotics ________ CNS effects of: sedatives, analgesics, antihistamines

A

POTENTIATE

83
Q

Anti-Psych DRUG INTERACTIONS!! Antipsychotics potentiate the respiratory depression caused by _______

A

OPIOIDS

84
Q

Anti-Psych DRUG INTERACTIONS!! Antacids = decrease ______ of antipsychotics

A

absorption

85
Q

Anti-Psych DRUG INTERACTIONS!! Anticonvulsants = decrease ______ levels of antipsychotics

A

plasma

86
Q

Anti-Psych DRUG INTERACTIONS!! Antipsychotics may alter ______ of antihypertensive medications

A

efficacy

87
Q

What are the 6 anti-psychotic’s Dr. S wanted us to know?

A
  1. HALO-per-id-ol (Haldol) 2.Pro-Chlor-per-az-ine (Compro) 3.ProMETHazine (Phenadoz) (WEEEZY BABY) 4.Ari-pip-ra-zole (Abilify) 5.Ris-per-DONE (Risperdal) 6.CLOZ-a-pine (Clozaril)
88
Q

Critical Points for DENTISTS Re: AntiPsychotics—May cause ________ disturbances = check white blood cell counts

A

hematologic

89
Q

Critical Points for DENTISTS Re: AntiPsychotics—May alter ________ of heart, so caution with ________, and there is a risk for ________.

A

QT interval… epinephrine… arrhythmias

90
Q

Critical Points for DENTISTS Re: AntiPsychotics— Cause extrapyramidal effects (movement disorders)….LIKE ________ and _________.

A

Bruxism AND Tardive dyskinesia

Pharmacology (23 decks)

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