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37 Cards in this Set

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What drug was historically used to treat hypertension and schizophrenia?
Reserpine
What is the method of action of reserpine?
It inhibits the storage of amine neurotransmitters in the brain
Levels of what neurotransmitters in the brain are thought to be the cause of depression?
5-HT (Seratonin) and Norepinephrine
What is depression ultimately caused by?
Decreased amine-dependent synaptic transmission
What is the prototypical agent for tricyclic antidepressents?
Amitriptyline
- What are the elimination half-lives?
- How many half lives does it take to reach a steady state?
- How long does it take to see any clinical significance?
- Why is this?
- 12-76 hrs
- 5 half-lives
- Weeks to months
- Due to remodeling of neuronal networks
What is the method of action for Amitriptyline?
Non-specifically inhibit storage of serotonin and norepinephrine in the CNS
Accounts for therapeutic effects
What other receptors does Amitriptyline bind too?
Adrenergic
Histominergic
Cholinergic
What are the adverse effects of using Amitriptyline?
α-adrenergic - hypotension
Histaminergic - drowsiness
Cholinergic - SLUD (Salivation, Lacrimation, Urination, Defacation)
What is Amitriptyline a secondary agent too?
SSRI's (Selective Seratonin Reuptake Inhibitors)
SNRI's (Selective Norepinephrine Reuptake Inhibitors)
What is the method of action for Trazodone?
- serotonin antagonist and reuptake inhibitor (SARI)
- more specific for serotonin than Tricyclic antidepressents
What is Trazodone used for?
Depression and Insomnia
What are the adverse reactions associated with using Trazodone?
Less than Tricyclic antidepressents
Usually just drowsiness
What are the specific drugs that are SSRI's (Selective Seratonin Reuptake Inhibitors)?
Fluoxetine (Prozac)
Paroxetine (Paxil)
Citalopram (Celexa)
Escitalopram (Lexapro)
Sertraline (Zoloft)
What is the prototypical SSRI drug on which all others are based chemically?
fluoxetine (Prozac)
What is the method of action of SSRI's (Selective Seratonin Reuptake inhibitors)?
Decreases Seratonin reuptake which increases Seratonin levels in the CNS
What are the drugs of choice for initial treatment of depression?
SSRI's
What are the adverse effects of the SSRI's?
Similar to Tricyclic Antidepressents but to a much lesser severity and frequency
What are the SNRI (Selective Norepinephrine Reuptake Inhibitor) drugs?
Which one is the prototypical agent on which the other drugs are based?
bupropion (Wellbutrin) – prototypical agent
venlafaxine (Effexor)
duloxetine (Cymbalta)
What is the Mode of action for the SNRI's?
Decreases the reuptake of both Seratonin and Norepinephrine at the synapse
What is the greatest use of SNRI's?
Most effective in treating antidepression along with anxiety
What is the drug of choice for treating bipolar disorder?
Lithium
What are the ions that Lithium competes with?
Mg++, K+, Na+, Ca++
What is the Mode of action of Lithium in the CNS?
Competes with overactivity of neurotransmitters thought to contribute to mania
What are the adverse effects of Lithium in the CNS?
In the GI?
In the Muscular system?
Dizziness, Lethargy, and Memory loss
Metalic Taste
Hand Tremors, Muscle Weakness
What are the implications for use of Antidepressents in regards to dentistry?
Decreased compliance with oral hygiene
Be careful placing the patient back in the chair for treatment or x-rays
What are the positive symptoms of Schizophrenia?
hallucinations
delusions
thought disorders
insomnia
bizarre behavior
What are the negative symptoms of Schizophrenia?
apathy
a motivation
anhedonia (lack of pleasure from normal pleasurable experiences), asocial behavior
What is the prototypical antipsychotic agent?
What is its mode of action?
chlorpromazine (Thorazine)
Non-specifically inhibit dopamine at the level of its D2 receptor
Of the adverse reactions that stem from Antipsychotics where do the extrapyramidal symptoms come from?
Due to dopamine effects on tracts other than mesocorticolimbic
What are the early onset Extrapyramidal symptoms that are caused by antipsychotics?
- Dystonia : muscle spasms - limbs and facial muscles
- Pseudoparkinsonism
More due to BLOCK of DA
What are the intermediate onset Extrapyramidal symptoms associated with antipsychotic drugs?
Akathisia or Restlessness
What are the newer generation antipsychotics?
risperidone (Risperdal)
quetiapine (Geodon)
olanzapine (Zyprexa)
aripiprazole (Abilify)
What is the mode of action of the newer generation of antipsychotic drugs?
- Inhibit serotonin at the level of its receptors (specifically)
- Also inhibit D2 receptors
What is the use of the newer generation of antipsychotic drugs?
First line agents for treatment of psychosis
What are the adverse effects of the newer generation antipsychotics?
Same as the typical antipsychotics but less severe and frequent
What are the implications for using antipsychotic drugs in dentistry?
- Neuroleptic facial movements
- ↑ sedation when given with opioids
- ↑ oral candidiasis (agranulocytosis, leukocytosis)
- ↓ salivation
- NSAIDs - interaction with lithium