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What are the four types of Psychotropic Medications
- 1. Antipsychotics (also called neuroleptics)
- 2. Antidepressants
- 3. Anxiolytic agents for the treatment of anxiety disorders
- 4. Sedative/hypnotics
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__________ is the most common type of psychosis but affects only approximately __% of population
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In Schizophrenia the over activity of dopamine causes the _________, and then a deficiency in dopamine causes the ___________
- positive symptoms
- negative symptoms
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What are some positive and negative clinical Symptoms of Schizophrenia
Positive symptoms: Hallucinations, delusions, paranoia, and suspiciousness
Negative symptoms: Emotional and social withdrawal and lack of interest
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What are the Two types of antipsychotic drugs? They Act by attaching to _______ and thereby preventing _______ from attaching. When about ___% of the receptors are blocked, psychotic behavior is reduced
- Typical antipsychotics
- Atypical antipsychotics
- D2 receptors
- dopamine
- 65%
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Describe the typical antipsychotic drugs and what symptoms do they treat
- “Older” drugs
- Treat positive symptoms, not negative symptoms
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Name a low potency typical antipsychotic drug
chlorpromazine (Thorazine)
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Name a high potency typical antipsychotic
haloperidol (Haldol)
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What are the Adverse Effects Associated with Typical Antipsychotic Drugs
- Anticholinergic effects
- –Due to binding to muscarinic receptors
- –Dry mouth, urine retention
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What are the Extrapyramidal symptoms associated with Typical Antipsychotic Drugs
- Dystonia (abnormal muscle contraction)
- Acute akathisia (sense that the patient must keep moving; swaying from foot to foot)
- Parkinsonism (tremors, impaired gait) Benztropine (Cogentin) may help relieve the early onset side effects
- Tardive dyskinesia usually occurs with chronic drug use. Characterized by persistent movements of the tongue (rolling) and lips (lip smacking), lateral jaw movements, blinking, rocking back and forth, and facial muscle movement
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Typical Antipsychotic Drugs also cause the blocking of ________ and _______ receptors causing
- histamine receptors: Sedation, drowsiness
- α1-adrenergic receptors:
- Cardiac safety is of concern.
- Tachycardia
- Orthostatic hypotension
- Precautions when administering epinephrine
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Describe the atypical antipsychotic drugs
Transiently (bind loosely) occupy dopamine receptors and then rapidly detach to allow normal dopamine transmission
- Fewer D2 receptor effects
- Lessens EPS (extrapyramidal symptoms)
- Atypical because also blocks serotonin receptors
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Name four Atypical Antipsychotic Drugs
- risperidone (Risperdal)- considered to be first line therapy
- ziprasidone (Geodon)
- quetiapine (Seroquel)
- clozapine (Clozaril)
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Which Atypical Antipsychotic Drug was the first atypical antipsychotic available in the United States, causes seizures and blood disorders such as agranulocytosis and used as a last resort
clozapine (Clozaril)
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Oral dyskinesias in may result in
bruxism, broken teeth, tongue trauma, and ulcerations
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What are the side effects of Atypical Antipsychotics
- Sedation and weight gain
- –Due to histamine blocking
- Seizures
- Diabetes
- High triglycerides
- Orthostatic hypotension
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Antipsychotics can cause
________ blockade and what should be cautioned
α-adrenergic receptor
- Epinephrine-containing local anesthetics may cause hypotension and tachycardia
- Avoid levonordefrin-containing local anesthetics
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Anticholinergic side effects of Patients Taking Antipsychotics
Monitor for xerostomia, root caries, and oral candidiasis
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There is a greater incidence of ______ in patients with schizophrenia and patients should be monitored for ________
- hyperglycemia (diabetes mellitus)
- periodontal disease
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Mood disorders include
- major depressive episode (depression)
- dysthymia – a milder type of depression
- bipolar disorder
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For someone to be have major depression they have to have ______ symptoms everyday for ______ and the symptoms include
- 5
- 2 weeks
- depressed mood, markedly diminished interest or pleasure in activities, weight gain, sleep changes, feelings of worthlessness or guilt, poor concentration, thoughts of death, and fatigue or loss of energy
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Depression causes decreased levels of _________ and _______ in the brain
norepinephrine and/or serotonin
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Tricyclic Antidepressants inhibit the reuptake of _________ from the synapse and what is an example
- (inactivation) norepinephrine and/or serotonin
- amitriptyline (Elavil)
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TCA’s are used for the dental management of:
- Nocturnal bruxism (after appliance therapy has failed)
- Chronic orofacial pain
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TCAs nonselective blocking of receptors cause many side effects such as
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TCAs block the uptake of both NE and EPI so there can be an accumulation of EPI levels causing
Cardiac arrhythmias, hypertension
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