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!)
2
Q
Lithium-Prevents release of ___________.
A
Neurotransmitters
3
Q
Lithium-Increases uptake of serotonin precursor
_________.
A
tryptophan
4
Q
Lithium-Decreases rate of ________ synthesis
A
serotonin
5
Q
Lithium-Inhibits serotonergic and adrenergic receptor-mediated activation of ______ and second messenger cascades
A
cAMP
6
Q
Lithium-Administered _______ in form of a salt
A
ORALLY
7
Q
Lithium-Peaks in blood within ____ hours after
administration
A
2 hours
8
Q
Lithium-Half-life = ___-36 hours
A
24-36 hours
9
Q
Lithium-Improvement in condition occurs over several ______ of treatment
A
WEEKS
10
Q
Lithium-Very ____ therapeutic index = level in blood is monitored WEEKLY
A
LOW
11
Q
Lithium-Drug is often taken in _____ doses several times per day to minimize toxicity
A
small
12
Q
Lithium-Produces serious side effects = affects patient _______
A
compliance!
13
Q
What happens with a drug interaction involving lithium?
A
The drug will INCREASE lithium levels in the blood and cause toxicity
14
Q
What are the 4 types of drugs that have drug interactions with Lithium?
A
1.Diuretics 2.NSAIDs 3.Anticonvulsants 4.Antihypertensives
15
Q
NSAIDs are contraindicated with Lithium because NSAIDs inhibit the ______ of lithium. SO we will use ________ instead.
A
renal EXCRETION….acetaminophen
16
Q
What are the two synonyms for anti-anxiety medications?
A
sedative hyponotics (sedatives) and minor tranquilizers
17
Q
What is the class of anti-anxiety drugs that is among the most widely used in medicine?
A
Benzodiazepines
18
Q
_______ (______)* and ________ (_______) account for 75% of 100 million prescriptions written for sedatives/tranquilizers!!!!
A
diazepam (Valium)….chlordiazepoxide (Librium)
19
Q
All benzodiazepines (BDZ) have same basic structure: _______ AND ________.
A
2 nitrogens “diazo”….Benzene ring = binds to GABA receptors
20
Q
LETS GET IT!!! What are the 5 Benzodiazepines that Dr. S wants us to know?
A
- 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)
21
Q
What is the primary pre-op sedative and inducer of general anesthesia in dentistry?
A
mid-az-ol-am (Versed)
22
Q
It is NOW known that Benzodiazepines are HIGHLY _______! Does tolerance come into play?
A
addictive…yes tolerance is involved
23
Q
What are the two schedules for Benzodiazepines?
A
IV and V
24
Q
What are the 3 distinct effects of Benzodiazepines???
A
1.Effects on behavior 2. Anticonvulsant effects 3.Muscle Relaxation
25
Benzodiazepines- Effects on Behavior....Reduces _______ and hostility.
aggresion
26
Benzodiazepines- Effects on Behavior....Reduces anxiety at _____ doses.
low
27
Benzodiazepines- Effects on Behavior...causes ______ at high doses.
drowsiness
28
Benzodiazepines- Anticonvulsant Effects...Benzo's can prevent or arrest generalized seizure produced by _______ or ________.
electric shock or analeptic agents (dental anesthetic!!!!)
29
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?
1. diaz-ep-am (Valium) and 2.mid-azo-lam (Versed).... slowly through IV
30
Benzodiazepines- Muscle Realxation Effects..._______ (_____) and ________ (______) = most potent
diazepam (Valium) and chlordiazepoxide (Librium) ((75% of all sedatives!!))
31
Benzodiazepines- Muscle Realxation Effects...Centrally-mediated and requires intact _______
spinal cord
32
Benzodiazepines- Muscle Realxation Effects...Depresses ________ and muscle function in BOTH healthy persons and in patients suffering from skeletal muscle disorders.
motor nerve
33
Mechanism of Action of BDZs-Receptor sites for BDZ are found in the _____.
CNS
34
Mechanism of Action of BDZs-BDZ affect the concentration of most neurotransmitters, including _____.
GABA
35
Mechanism of Action of BDZs-Enhances the inhibitory effect on _____ on neuronal excitability....Causes _________ (a less excitable state) and neuronal stabilization.
GABA...hyperpolarization
36
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
INHIBITION...INHIBITORY
37
Mechanism of Action of BDZs- the GABA receptor is embedded in neuronal _________ located at the _______ = binds BOTH _____ & _____.
plasma membranes...synapse...GABA & BDZ
38
Mechanism of Action of BDZs- Presence of GABA _______ binding of BDZ!! Is this action reversible? Is it fast or slow?
ENHANCES....reversible and quick
39
Pharmokinetics of Benzo's---most have ______ half lives and are metabolized to _________....therefore repeated dosing results in ________ of the drug in the body.
VERY LONG...active compounds...accumulation
40
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!!!
lor-az-e-pam (Ativan)
41
Uses of Benzo's in Medicine, Relief of ______....Skeletal muscle ______ = muscle strains....________ to treat insomnia
anxiety...relaxation...hypnotic
42
Uses of Benzo's in Medicine...can help withdrawal symptoms of _______!
alcoholism!
43
Uses of Benzo's in Medicine, it's a great _______ medication to decrease apprehension. But be careful it may decrease the effects of anesthesia!
pre-operative
44
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???
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
Uses of Benzo's in DENTISTRY! IV ______ and Anterograde _______.
Sedation...amnesia
46
Uses of Benzo's in DENTISTRY! EMERGENCY intervention for ______.
seizures
47
Adverse Effects of BenZOdiAZapines- _____ depression leading to fatigue, drowsiness, muscle weakness, ataxia
(failure of muscle coordination)
CNS
48
Adverse Effects of BenZOdiAZapines- ________ administration = acute hypotension, muscle weakness, apnea and cardiac arrest
Parenteral
49
Adverse Effects of BenZOdiAZapines- Heres a DENTAL related adverse effect:_______!!
Xerostomia!!
50
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)
ADDITIVE....alcohol....1/3
51
Adverse Effects of BenZOdiAZapines-What can be the end result of mixing EtOH and Benzo's?
Significant Respiratory Depression
52
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!
The mechanism of action is UNKNOWN....serotonoin
53
YAY full circle!!! What 5 antimicrobials have drug interactions with our new friend bus-pir-one?
1.cipro-flox-acin 2.clar-ithro-mycin 3.erythro-mycin 4.de-oxy-cycline 5.systemic antifungals
54
Oral health considerations with anti-anxiety drugs: ______ is a major cause of cavities and gingivitis.
xerostomia
55
Oral health considerations with anti-anxiety drugs: Pt's get a LACK of interest in ______.
Oral Hygiene
56
Oral health considerations with anti-anxiety/anti-depression drugs: CAUTION with EPINEPHRINE, especially in the anti-depressants _______ and ______.
tricyclics and MAOIs
57
Oral health considerations with anti-anxiety/anti-depression drugs: did you know? _____ CAUSE BRUXISM and increased EXTRAPYRAMIDAL effects!
SSRIs
58
Major Tranquilizers are aka _________ meds.
anti-psychotic
59
What is the primary indication for major tranquilizers?
Schizophrenia
60
Major Tranquilizers can be used for ________ disorders like Huntington’s disease, Tourette’s syndrome, ballismus.
movement
61
What is a secondary indication for the use of major tranquilizers that pt's on Chemo therapy can use them for?
to help curve severe nausea and vomiting
62
Major Tranquilizers-Individual drugs bind to a variety of receptors and act as __________.
ANTAGONISTS
63
Major Tranquilizers- Blockade of __________ transmission in various areas of brain is thought to be responsible for their major effects.
dopaminergic
64
Major Tranquilizers-________ action = blockage in prefrontal cortex and limbic areas
Antipsychotic
65
Major Tranquilizers- __________ side effects = blockade in basal ganglia
Extrapyramidal
66
Major Tranquilizers- ________ effects = blockade in chemoreceptor trigger zone of the medulla
Antiemetic
67
Major Tranquilizers- One hypothesis: Schizophrenia = overactivity of __________ system, SO antipsychotic medications reduce this activity by blocking ____ receptors!
dopaminergic...D2
68
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 ____%
CLOZE the DOOR...cloz-a-pine (Cloz-ariL)...70%....30%
69
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
WEEKS..blocks
70
Hypothesis-Schizophrenia is a sccociated with a change in ________ of neurons and drugs help to recover this!
morphology
71
Pharmacokinetics of tha MAJOR tranq's---Administered ______ or by _____.
orally or IM
72
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
2...30min..18...one time
73
Pharmacokinetics of tha MAJOR tranq's--- All drugs have similar ______.
efficacy (except for cloz-a-pine)
74
Major Tranq's-Side Effects> Are they addictive??
Not addictive
75
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.
Parkinsonism!!...D2...basal ganglia
76
Major Tranq's-Side Effects> ______ = jimmy legs/restless leg syndrome can occur
A-kath-isia (so your pt will be moving during tx)
77
Major Tranq's-Side Effects> _______ – sustained muscular contraction
Dys-tonia
78
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
Tardive Dyskinesia...6 (think it will be easy to work on these patients???)
79
Major Tranq's-Side Effects> YAY! Even more meds!!! Most extrapyramidal side effects are treatable with __________ drugs
anti-cholenergic (makes sense, stop movement=stop Ach)
80
Major Tranq's-Side Effects>Sedation and autonomic side effects are caused by blockade of _______, ________ and ________ receptors
histamine, cholinergic, and adrenergic
81
Major Tranq's-Side Effects>Take home message-it aint ______ to be on these meds.
easy
82
Anti-Psych DRUG INTERACTIONS!! Antipsychotics ________ CNS effects of: sedatives, analgesics, antihistamines
POTENTIATE
83
Anti-Psych DRUG INTERACTIONS!! Antipsychotics potentiate the respiratory depression caused by _______
OPIOIDS
84
Anti-Psych DRUG INTERACTIONS!! Antacids = decrease ______ of antipsychotics
absorption
85
Anti-Psych DRUG INTERACTIONS!! Anticonvulsants = decrease ______ levels of antipsychotics
plasma
86
Anti-Psych DRUG INTERACTIONS!! Antipsychotics may alter ______ of antihypertensive medications
efficacy
87
What are the 6 anti-psychotic's Dr. S wanted us to know?
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
Critical Points for DENTISTS Re: AntiPsychotics---May cause ________ disturbances = check white blood cell counts
hematologic
89
Critical Points for DENTISTS Re: AntiPsychotics---May alter ________ of heart, so caution with ________, and there is a risk for ________.
QT interval... epinephrine... arrhythmias
90
Critical Points for DENTISTS Re: AntiPsychotics--- Cause extrapyramidal effects (movement disorders)....LIKE ________ and _________.
Bruxism AND Tardive dyskinesia
