Psychopharmacology for Dentists

Question 1

Name the 4 Antidepressants

Answer 1

• Tricyclic Antidepressants (TCAs)
• Selective Serotonin Reuptake Inhibitors (SSRIs)
• Serotonin and Noradrenaline Reuptake Inhibitors (SNRIs)
• Noradrenaline and Specific Serotonin Antagonist (NaSSA)

Question 2

How do Tricyclic Antidepressants (TCAs) work

Answer 2

• E.g.) Amitriptyline, Iofepramine

• Inhibit 5-HT and NA uptake
- Produces therapeutic effect

• Block of M1, H1, alpha-1 receptors and so produces side effects

Question 3

How do Selective Serotonin Reuptake Inhibitors (SSRIs) work

Answer 3

• e.g.) fluoxetine, sertraline, citalopram
• Inhibit 5-HT uptake
• Produces therapeutic effect:
• antidepressant
• OCD, panic, anxiety

Side effects:

• Nausea
• Early increased anxiety

• Overall well tolerated and good first line treatments

Question 4

How do Serotonin and Noradrenaline Reuptake Inhibitors (SNRIs) work

Answer 4

•venlafaxine
• Inhibit 5-HT and NA uptake
- similar to SSRI in terms of therapeutic and side effects

Question 5

How do Noradrenaline and Specific Serotonin Antagonists (NaSSA) works

Answer 5

• Mirtazapine

• Blocks alpha-2 receptors;
- Produces antidepressant effect (increases 5-HT release)

• Blocks 5-HT2 receptors:
- Produces decreased anxiety

• Blocks H1 receptors:
• Produces sedation

• Lacks sexual side effects, but may cause weight gain

Question 6

What are Anxiolytics /Hypnotics

Answer 6

• Benzodiazepines (diazepam, lorazepam)

• Relieve anxiety immediately, good for short term use
• S/Es - very few expect dependency

Z-drugs like Zopiclone are used as hypnotics as they have shorter half lives

• Antidepressants are the drug choice for treating anxiety but take longer to work

Question 7

What are Antipsychotics

Answer 7

TYPICALS - First generation antipsychotics - Haloperidol

ATYPICALS - Second generation antipsychotics - Olanzapine and Risperidone

Question 8

How do TYPICAL antipsychotics work?

Answer 8

• They block D2 (dopamine 2 receptors)
• Also antagonise histamine, NA, acetylcholine receptors causing side effects
• Little dopamine - parkinsons (antipsychotics could cause Parkinson’s symptoms)
• Too much dopamine - psychosis (visa-versa symptoms)

Question 9

Side effects of antipsychotics

Answer 9

• Changes to blood pressure (as blocks alpha-1)
• blocks M1 - Dry mouth, constipation
• Blocks H1 - cause drowsiness

Question 10

How do ATYPICAL antipsychotics work

Answer 10

• Work on the D2 receptor AND 5HT2A receptor:

- Helps with positive and negative symptoms

Question 11

Give the two examples of Mood Stabilisers and contraindications/side-effects

Answer 11

• LITHIUM:

• Renal and thyroid dysfunction
• Teratogenic
• Interacts w/ other drugs (NSAIDs)

• VALPROATE:
- Not for women of child bearing potential due to teratogenicity (foetus interaction)

Question 12

Name Non-Pharmacological approches

Answer 12

• ECT (electroconvulsive therapy)
• Phototherapy

• Psychological Therapies:
- Behaviour, Cognitive,, Family, Sex & Relationship

• Social interventions:
- Finance, accommodation, employment

• Rehab:
- chronic mentally ill