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Pharmacology > Long Quiz-take home > Flashcards

Long Quiz-take home Flashcards

1
Q

schizophrenic disorders

A

distortions of thinking and perception, and affects that are inappropriate or blunted

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2
Q

positive symptoms

A
  • Hallucinations
  • Delusions
  • Bizarre behavior
  • Positive formal thought disorder
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3
Q

negative symptoms

A
  • alogia
  • affective flattening
  • avolition-apathy
  • anhedonia-asociality
  • attentional impairment
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4
Q

what do we use in first line therapy?

Why?

A
  • newer atypical antipsychotics

- not complicated by appearance of extrapyramidal side-effects, or these are much lower than w/ classical antipsychotics

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5
Q

Conventional antipsychotics block=

A

dopamine receptors, cholinergic, NE, and Histamine receptors

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6
Q

Conventional antipsychotics have what effects=

A

-antipsychotic effects, -antiemetic effects, and -sedating effects

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7
Q

Atypical antipsychotic specific for

A
  • dopamine2receptors
  • serotonin
  • NE receptors

*posses antipsychotic effects

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8
Q

atypical antipsychotics have lower=

-conventional antipsychotics are sedating

A

-incidence of adverse effects

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9
Q

what are extrapyramidal effects

A

=result of dopamine blockade in the nigrostriatal pathways of the brain

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10
Q

what are some cardiac effects of of antipsychotics?

A
  • orthostatic hypotension=peripheral a-receptor blockade

- tachycardia

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11
Q

when the block cholinergic receptors are blocked what does it cause?

A

-drymouth, blurred vision, constipation, urinary retention

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12
Q

since they are sedating, what can be used?

A

-a local anesthetic w/ epinephrine used in patients taking antipsychotic drugs

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13
Q

to treat drug-induced extrapyramidal effects what combination used?

A

anticholinergic drugs used w/ antipsychotics

-causing sedation and intense dry mouth

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14
Q

What are the uses of antipsychotic agents

A
  • tx: schizophrenia
  • tx: bipolar
  • conventional antipsychotic used as antiemetic drugs
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15
Q

When antianxiety drugs and opiod analgesic are combined what are the possible dental concerns?

*Sedation is additive

A
  • px may require someone to drive them to and from dental appts
  • px should avoid anything that requires thought or concentration while taking this combination
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16
Q

what to do w/ orthostatic hypotension?

A

-raise dental chair slowly and have the px sit for a few min prior to getting out of chair

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17
Q

what are dental concerns w/ anticholinergic effects?

A
  • px drink plenty or suck an tart, sugarless gum or candy
  • px avoid caffeine-containing fruit juices or alcoholic beverages
  • epinephrine should not be used to treat acute hypotensive crisis
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18
Q

what can extrapyramidal effects do to px?

A

-can impair px’s ability to perform home oral hygiene

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19
Q

what does akathisia do?

A

may make it difficult for px to sit in dental chair

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20
Q

Some symptoms to treat?

*with antipyschotics

A
  • depressed mood
  • anhedonia
  • If present for at least 2 weeks: change in appetite/weight (increase or decrease)
  • altered sleep pattern (increase or decrease)
  • lack of energy
  • difficulty concentrating
  • agitation
  • reduced self-esteem
  • suicidal thoughts or plans
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21
Q

what is the etiology of depression?

A

according to biogenic amine hypothesis:

-with mania, it is due to an alteration in neuronal and synaptic catecholamine concentration at adrenergic receptor sites in the brain

**THEREFORE: depression is deficiency of catecholamine, especially NE

Mania: excess amines

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22
Q

What are the 3 types of antidepressants?

A
  • newer-generation antidepressants
  • tricyclic antidepressants
  • monoamine oxidase inhibitors
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23
Q

What about second-generation antidepressants?

A
  • fewer side effects than tricyclics and MAOIs

- very few drug-drug or drug-food interactions

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24
Q

Name second-generation Antidepressants

A
  • Trazodone (Desyrel)
  • Bupropion(Wellbutrin)
  • SSRIs:
  • fluoxetine(Prozac)
  • paroxetine(Zoloft)
  • fluvoxamine(Luvox)
  • citalopram (Celexa)
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25
Q

What are third-generation Antidepressants?

A
  • venlafaxine (Effexor)
  • nefazodone (Serzone)
  • mirtazapine (Remeron)
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26
Q

What is the MO of Second-Generation Antidepressants and SSRIs?

A
  • select inhibit serotonin reuptake
  • little/none effect on NE or Dopamine reuptake
  • Increased serotonin concentrations at nerve endings
  • little or no effect on cardiovascular system
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27
Q

What are indications of second-generation antidepressants?

A
  • depression
  • bipolar affective disorder
  • obesity
  • eating disorders
  • obsessive-compulsive disorder
  • panic attacks
  • myoclonus
  • tx: various substance abuse problems
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28
Q

name drug that uses bupropion{Zyban]

A

bupropion [Zyban]

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29
Q 
Second-generation Antidepressants
Side effects:
-CNS
-GI
-Other
A
  • headache, dizziness, tremor, nervousness, insomnia, fatigue
  • nausea, diarrhea, constipation, dry mouth
  • sexual dysfunction, weight gain, sweating
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30
Q

Second-Generation Antidepressants

A
  • highly bound to plasma proteins

- compete w/ other protein-binding drugs resulting in more free, unbound drug to cause a more pronounced drug effect

31
Q

First-gen antidepressant: Tricyclic Antidepressants are what line?

A

second-line

32
Q

what are common tricyclics?

A
  • amitriptyline(Elavil, Endep)
  • doxepin (Sinequan)
  • imipramine(Tofranil)
  • desipramine(Norpramine)
  • nortriptyline(Aventyl, Pamelor)
33
Q
  • block reuptake of neurotrans, causing accumulation at the nerve endings
  • thought that increasing concentrations of neurotrans will correct the abnormally low levels that lead to depression
A

mech of action of tricyclics

34
Q

drug effects of NE blocked

A

-antidepressant, tremors, tachycardia, additive pressor effects w/ sympathomimetic drugs

35
Q

drugs of serotonin

A

-antidepressant, nausea, headache, anxiety, sexual dysfuncition

36
Q

indications of tricyclics

A
  • depression
  • childhood enuresis (imipramine)
  • obsessive-compulsive disorders(clomipramine)
  • adjunctive analgesics
  • trigeminal neuralgia
37
Q
  • sedation
  • impotence
  • orthostatic hypotension
  • in older px: dizziness, postural hypotension, constipation, delayed micturition, edema, muscle tremors
A

side effects of tricyclics

38
Q

when theres an overdose of tricyclics?

A
  • lethal 70-80%

- CNS and cardiovascular systems affected resulting from seizures or dysrhythmias

39
Q

what can u do w/ overdose of tricyclics?

A
  • no antidote
  • decrease drug absorption w/ activated charcoal
  • speed elimination by alkalinizing urine
  • manage seizures and dysrhythmias
  • basic life support
40
Q
  • highly effective

- considered second-line tx for depression not responsive to cyclics

A

MAOIS

41
Q

What is the disadvantage of MAOIS?

A

Potential to cause hypertensive criss when taken w/ tyramin

42
Q

-inhibit the MAO enzyme sys in the CNS
Amines (dopamine, serotonin, NE) aren’t broken down, so high levels in brain
*alleviate symptoms of depression

A

MOA of MAIOS

43
Q

Indications of MAIOS

A
  • Depressioin, especially types of reverse vegetatve symptoms such as increased sleep and appetite
  • depression that doesn’t respond to other agents such as tricyclics
44
Q

most common side effect of MAIO

A

Orothostatic hypotension

45
Q

-tachycardia, dizziness, insomnia, anorexia, blurred vision, palpitations, drowsiness, headache, nausea, impotence

A

other side effects of orthostatic hypotension

46
Q

symptoms appear 12 hrs aftern ingestion

-tachycardia, circulatory collapse, seizures, coma.

A

MAIO OVERDOSE

47
Q

MAIO TX:

A

PROTECT BRAIN AND HEART ELIMINATE TOXIN

  • gastic lavage
  • urine acidification
  • hemodialysis
48
Q

hypertensive crisis and tyramine in MAIO

A

ingestion of foods and/or drinks w/ a.a tyramine leads to hypertensive crisis, wich may lead to cerebral hemorrhage, stroke , coma, death

49
Q

AVOID FOODS THAT CONTAIN TYRAMINE

A
  • Aged, mature cheeses, smoked/pickled or aged meats, fish, poultry (herring, sausage, corned beef, salami, pepperoni, pate)
  • yeast extracts
  • red wines (Chianti, burgundy, sherry, vermouth)
  • Italian broad beans (fava beans)
50
Q
  • occasionally a TCA may be given w/ an MAOI
  • If decision is made to switch to a TCA, there must be a 2 week ‘wash out’ period between drugs
  • if decision to made to switch to an SSRI, there must be a 2-5 week ‘wash out’ period between MAIO therapy and SSRI THERAPY
A

ANTIDEPRESSANTS: MAOIS

51
Q

to treat bipolar

A

lithium

52
Q

bipolar disorder is:

A

cyclic recurrence of mania alternating w/ depression

53
Q

a narrow therapeutic index drug that requires 2-4 weeks before a positive therapeutic effect is achieved

A

lithium

*has many adverse effects

54
Q

polyuria, fine hand tremor, slurred speech, coarse hand tremor, ataxia, nausea, vomiting, and diarrhea

A

adverse effects of lithium

55
Q

what can alter lithium levels?

A

Sodium levels

56
Q

what can decrease lithium clearance leading to increased lithium levels

A

nonsteroidal antiinflammation drugs

57
Q

dental concerns of lithium

A

-polydipsia:
increased sugar and caffeine consumption
-interacts w/ ipubrofen bcoz of lower lithium levels beczo of fluid retention
-elevated HR indicate lithium toxicity
-be concerned about epinephrine
-use of aspirin and other NSAIDS with GI, UPSET

58
Q

stress or anxiety due to dental tx treated w/ pharmacologic and nonpharma methods.

-tx choice depends on px and their stress level

A

antianxiety agents

59
Q

what is the the most common drug used to tx anxiety

A

Benzodiazepines

60
Q

what is the MOA of benzodiazepines?

A
  • bind to benzodiazepine receptors and acts as agonist
  • enhance action of inhibitory neurotransmitter y-aminobutyric acid (GABA)
  • decreases excitation in limbic system
61
Q

Effects of benzodiazepines

A
  • behavior=sedation, reduce anxiety and panic
  • anticonvolusant
  • ms relaxation
62
Q

fatigue, drowsiness, ms weakness, ataxia

  • anterograde amnesia
  • respiratory effects
  • dental effects: xerostomia, increased salivation, swollen tongue, bitter or metallic taste
A

adverse rxns of benzodiazepines

63
Q

uses of benzodiazepines

A

short-term tx of anxiety, panic attacks, insomnia, alcohol withdrawel
-some seizures

64
Q
  • drugs are the original sedative-hypnotics
  • very narrow therapeutic index
  • associated w/ hight rate of abuse and complete respiratory and cardiovascular depression
  • lethal in an overdose
A

barbituates

65
Q
  • produce pharma effect by enhancing GABA receptor binding

- CNS system depression, analgesia, anticonvulsant effects

A

barbiturates

66
Q

in what time of px is CNS depression exaggerated?

A

elderly and liver or renal failure

67
Q

at what dose are lethal?

A

higher doses

68
Q

chronic long-term use of barbituates leads to:

A

physical and psychologic dependence

69
Q

what does barbituates stimulate?

A

liver microsomal enzymes

70
Q

name nonbenzodiazepine-nonbarbiturate sedative-hypnotics

A

chloral hydrate

71
Q

what to do w/ gastric irration and disagreeable odor and taste?

A
  • mix w/ food or milk

- mix w/ fruit juice

72
Q

what is the latest group of drugs used to tx insomnia

A

nonbenzodiazepine benzodiazepine receptor agonists

73
Q

what melatonin receptor agonist (recently approved by FDA) to tx insomnia that is characterized by difficulty falling asleep

A

ramelteon

74
Q

what are adverse effects of melatonin receptor agonist?

A

somnolence and dizziness

Pharmacology (5 decks)

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