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HD 4 - dental relevance > Psychiatric disorders > Flashcards

Psychiatric disorders Flashcards

1
Q

4 classifications of hypnotics

A
  1. benzodiazepines
  2. anti-histamines
  3. miscellaneous
  4. barbiturates - old fashioned
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2
Q

how does drug induced sleep effect NREM + REM levels

A

increases NREM, decreases REM

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3
Q

5 actions of benzodiazepines

A
  1. hypnotic
  2. anxiolytic
  3. anticonvulsant
  4. muscle relaxant
  5. amnesic
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4
Q

which of these BDZ has the longest half life:
tempazepma
loprazolam
nitrazepam

A

nitrazepam - used for early morning wakening

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5
Q

3 sites of action of BDZs

A
  1. reticular limbic system RAS - control alertness (hypnotic)
  2. limbic system in cortex - controls emotion (anxiolyitc)
  3. other sites of cortex - anticonvulsant
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6
Q

MOA of BDZ

A

increase GABA - so reduce function in certain brain pathways

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7
Q

if medazolam and methadone are taken together what may happen?

A

respiratory arrest

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8
Q

drug used for BDZ reversal?

A

flumazenil

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9
Q

MOA of antihistamines

A

H2 blockers produce CNS depression

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10
Q

what antihistamine is used in children

A

promethazine

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11
Q

what are Z drugs and at what receptors do they work?

A

hypnotics - non-BDZ but work at BDZ receptors

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12
Q

4 main types of anxiolytics

A
  1. alcohol
  2. BDZs
  3. buspirone
  4. beta blockers
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13
Q

which BDZ reduces alcohol/drug withdrawal

A

chlordiazepoxide

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14
Q

when are buspirone used

A

short term anxiety control for specific reason - does not cause sedation, acts as serotonin agonist

no withdrawal

causes dry mouth

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15
Q

which BDZ in dental formulary?

A

temazepam + diazepam (plus flumazenil)

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16
Q

what is the difference between hypochondriasis + somatisation?

A 
hypochondriasis = focuses on underlying disease
somatisation = focuses on symptoms
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17
Q

psychogenic pain characterisitcs:

A 
inconsistent with anatomical landmarks
investigations negative
continuous
prevents sleep but doesn't wake up 
analgesia ineffective
associated with emotional factors
18
Q

what causes korsakoffs psychosis?

A

B1/thiamine deficiency most commonly associated with chronic alcoholism

19
Q

3 positive neurotransmitters

A

adrenaline, noradrenaline, dopamine

20
Q

3 negative neurotransmitters

A

serotonin, GABA, dopamine

21
Q

where does serotonin act?

A

cerebral cortex

22
Q

how does fluoxetine improve mood?

A

blocks re uptake of serotonin

23
Q

dopamine acts on 4 pathways in which part of brain?

A

frontal cortex

24
Q

which neurotransmitter is responsible for reward/motivation?

A

dopamine

25
Q

which neurotransmitter mediates arousal?

A

noradrenaline

26
Q

where are antipsychotics metabolised?

A

liver

27
Q

which neurotransmitter do APs effect and how?

A

dopamine - increase

decrease chloinergics

28
Q

how do APs effect alcohol + anxiolytics?

A

increase sedation

29
Q

APs - 4 dentally relevant things to be aware of

A

EPS
xerostomia
sedation
postural hypotension

30
Q

first choice drug therapy for depression?

A

SSRIs

31
Q

what guidance should be followed to deal with depression?

A

NICE CG 90 2009 - depression in adults

NICE CG 91 depression in adults with chronic health problems

32
Q

simple MOA for antidepressants?

A

increasing monoamines

33
Q

4 categories of ADs

A

SSRIs - selective serotonin inhibitors
SNRIs - selective noradrenaline reuptake inhibitors (3rd line)
TCA - tricyclic antidepressants
MAOIs - monoamine oxidase inhibitors

34
Q

what happens if you take SSRIs + SNRIs together?

A

serotonin syndrome - pyrexia

35
Q

MOA of SSRIs

A

block re-uptake of serotonin in pre-synaptic cleft

36
Q

as well as depression, SSRIs may be used for what conditions?

A

chronic pain e.g. burning mouth syndrome

37
Q

what SSRI is used for burning mouth syndrome?

A

paroxetine

38
Q

how do SSRIs effect sedation?

A

decrease sedation

39
Q

why is the MOA of TCAs considered dirty?

A

non-selective:
targets re uptake of both serotonin + Noradrenaline
causes antihistaminergic activity (sedation)
blocks Na K + Ca channels (decrease pain)
enhances GABA peripherally

40
Q

3 disadvantages to TCAs

A

side effects - (xerostomia)
dangerous in overdose
2-3 weeks before effective

41
Q

MAOIs MOA

A

block monoamine oxide enzyme which degraded monoamines - so increases MA levels

42
Q

symptoms + cause of MAOI crisis?

A

hypertension + headache

dietary intake of monoamine (tyramine rich foods) high + MAOI

xs monoamines

HD 4 - dental relevance (12 decks)

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