CNS Disorders Drug Treatment Chapter

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Questions and Answers

Match the following Selective Serotonin Reuptake Inhibitors (SSRIs) with their brand names:

Citalopram = Celexa Duloxetine = Cymbalta Escitalopram = Lexapro Fluoxetine = Prozac

Match the following adverse effects with Selective Serotonin Reuptake Inhibitors (SSRIs):

Xerostomia = Dry mouth Taste changes = Alteration in taste sensation Aphthous stomatitis = Canker sores Excessive sweating = Increased perspiration

Match the following Serotonin Norepinephrine Reuptake Inhibitors (SNRIs) with their primary effects:

Venlafaxine = Effexor Desvenlafaxine = Pristiq Duloxetine = Cymbalta Tachycardia = Increased heart rate

Match the following symptoms commonly associated with SNRIs:

<p>Urinary retention = Difficulty urinating Sweating = Excessive perspiration Tachycardia = Rapid heartbeat Headaches = Pain in the head</p> Signup and view all the answers

Match the following Tricyclic Antidepressants (TCAs) with their critical effects:

<p>Cardiac toxicity = Risk of heart issues Anticholinergic effects = Drying effects on the body Additive effects = Increased action of medications Interactions with MAOIs = Potential severe reactions</p> Signup and view all the answers

Match the following adverse effects of SSRIs with their descriptions:

<p>Glossitis = Inflammation of the tongue Sexual dysfunction = Impaired sexual performance Palpitations = Irregular heartbeats Increased salivation = Excessive drooling</p> Signup and view all the answers

Match the following types of antidepressants with their mechanism:

<p>SSRIs = Inhibit reuptake of serotonin SNRIs = Inhibit reuptake of serotonin and norepinephrine TCAs = Block reuptake of various neurotransmitters Atypical antidepressants = Have various mechanisms of action</p> Signup and view all the answers

Match the following symptom with its respective category:

<p>Palpitations = CNS effect Taste changes = Gastrointestinal effect Tongue discoloration = Other effect Salivary gland enlargement = Oral effect</p> Signup and view all the answers

Match the following antidepressants with their primary characteristics:

<p>Bupropion (Wellbutrin) = Causes seizures and excessive sweating Trazodone (Desyrel) = Highly sedative and associated with priapism Mirtazapine (Remeron) = Known for somnolence and weight gain Nefazodone (Serzone) = Modulates 5-HT and may cause hepatic failure</p> Signup and view all the answers

Match the class of antidepressants with their main effects or risks:

<p>Monoamine Oxidase Inhibitors (MAOIs) = Risk of severe toxic reactions and food prohibitions Selective Serotonin Reuptake Inhibitors (SSRIs) = Associated with suicidal ideation warnings Serotonin Norepinephrine Reuptake Inhibitors (SNRIs) = Modulate serotonin and norepinephrine levels Tricyclic Antidepressants (TCAs) = Potential for cardiotoxic effects</p> Signup and view all the answers

Match the antidepressant with their specific side effects:

<p>Bupropion (Wellbutrin) = Nausea and vomiting Trazodone (Desyrel) = Fewer anticholinergic effects Vilazodone (Viibryd) = Serotonin reuptake inhibitor Mirtazapine (Remeron) = Dry mouth and constipation</p> Signup and view all the answers

Match the antidepressant agent with the notable warning or caution:

<p>Nefazodone = Increases serum levels of other medications Vortioxetine (Trintellix) = Important for treating mood disorders MAOIs = Require careful management of drug interactions Bupropion = May lead to seizures in susceptible individuals</p> Signup and view all the answers

Match each side effect with the corresponding antidepressant:

<p>Xerostomia = Nefazodone Weight gain = Mirtazapine Priapism = Trazodone Agitation = Bupropion</p> Signup and view all the answers

Match the antidepressant to its classification:

<p>Trazodone = Other Antidepressants Mirtazapine = Other Antidepressants Fluoxetine = Selective Serotonin Reuptake Inhibitors (SSRIs) Duloxetine = Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)</p> Signup and view all the answers

Match the antidepressant with its unique feature:

<p>Vortioxetine = Indicated for major depressive disorder Nefazodone = May cause sexual dysfunction Bupropion = Utilized for smoking cessation Mirtazapine = Often used for insomnia.</p> Signup and view all the answers

Match the warning with the correct antidepressant class:

<p>SSRIs = Suicidal ideation risk MAOIs = Severe food restrictions TCAs = Risk of orthostatic hypotension Other Antidepressants = Variable side effects and drug interactions</p> Signup and view all the answers

Match the following antidepressant classes with their characteristics:

<p>Selective serotonin reuptake inhibitors (SSRIs) = Primarily increase serotonin levels Serotonin norepinephrine reuptake inhibitors (SNRIs) = Increase serotonin and norepinephrine levels Tricyclic antidepressants (TCAs) = Have a risk of cardiovascular side effects Other antidepressant agents = Includes various agents not classified as SSRIs, SNRIs, or TCAs</p> Signup and view all the answers

Match the antidepressant classes with their common uses:

<p>Selective serotonin reuptake inhibitors (SSRIs) = Used mainly for depression and anxiety disorders Serotonin norepinephrine reuptake inhibitors (SNRIs) = Used for chronic pain and depression Tricyclic antidepressants (TCAs) = Used for depression, pain relief, and insomnia Other antidepressant agents = Used for atypical depression and other mood disorders</p> Signup and view all the answers

Match the following side effects with the appropriate antidepressant classes:

<p>Selective serotonin reuptake inhibitors (SSRIs) = Weight gain, sexual dysfunction Serotonin norepinephrine reuptake inhibitors (SNRIs) = Nausea, headache, vertigo Tricyclic antidepressants (TCAs) = Sedation, dry mouth, constipation Other antidepressant agents = Variable side effects depending on the agent</p> Signup and view all the answers

Match the antidepressant classes with their mechanism of action:

<p>Selective serotonin reuptake inhibitors (SSRIs) = Block the reuptake of serotonin Serotonin norepinephrine reuptake inhibitors (SNRIs) = Block the reuptake of serotonin and norepinephrine Tricyclic antidepressants (TCAs) = Inhibit the reuptake of norepinephrine and serotonin Other antidepressant agents = Act through various and unique mechanisms</p> Signup and view all the answers

Match the antidepressant class with an example medication:

<p>Selective serotonin reuptake inhibitors (SSRIs) = Fluoxetine (Prozac) Serotonin norepinephrine reuptake inhibitors (SNRIs) = Venlafaxine (Effexor) Tricyclic antidepressants (TCAs) = Amitriptyline Other antidepressant agents = Bupropion (Wellbutrin)</p> Signup and view all the answers

Match the following antidepressant types with their potential interactions:

<p>Selective serotonin reuptake inhibitors (SSRIs) = May interact with other serotonergic drugs Serotonin norepinephrine reuptake inhibitors (SNRIs) = Can increase blood pressure Tricyclic antidepressants (TCAs) = Can interact with MAO inhibitors Other antidepressant agents = Interactions vary by specific medication</p> Signup and view all the answers

Match the antidepressant classes with important cautions in treatment:

<p>Selective serotonin reuptake inhibitors (SSRIs) = Monitor for serotonin syndrome Serotonin norepinephrine reuptake inhibitors (SNRIs) = Assess for hypertension Tricyclic antidepressants (TCAs) = Caution in patients with heart conditions Other antidepressant agents = Consider unique safety profiles of each drug</p> Signup and view all the answers

Match the antidepressant classes with their common withdrawal symptoms:

<p>Selective serotonin reuptake inhibitors (SSRIs) = Flu-like symptoms, dizziness Serotonin norepinephrine reuptake inhibitors (SNRIs) = Nausea, irritability Tricyclic antidepressants (TCAs) = Insomnia, nausea Other antidepressant agents = Withdrawal symptoms vary significantly</p> Signup and view all the answers

Which of the following is NOT one of the three categories of functional disorders discussed?

<p>Personality disorder (B)</p> Signup and view all the answers

Affective disorders are classified under functional disorders with no evidence of structural or biochemical abnormality.

<p>True (A)</p> Signup and view all the answers

Name one type of drug commonly used to treat bipolar disorder.

<p>Lithium</p> Signup and view all the answers

Selective serotonin reuptake inhibitors primarily target the __________ system.

<p>serotonin</p> Signup and view all the answers

Match the following types of antidepressants with their descriptions:

<p>Selective Serotonin Reuptake Inhibitors = Inhibit the reuptake of serotonin Serotonin Norepinephrine Reuptake Inhibitors = Inhibit the reuptake of serotonin and norepinephrine Tricyclic Antidepressants = Older class with a broader mechanism of action Other Antidepressants = Have varying mechanisms and effects</p> Signup and view all the answers

Which of the following is a common adverse reaction associated with tricyclic antidepressants?

<p>Dry mouth (C)</p> Signup and view all the answers

Second-generation antipsychotics have no dental implications.

<p>False (B)</p> Signup and view all the answers

What is the mechanism of action for serotonin norepinephrine reuptake inhibitors?

<p>Inhibiting the reuptake of both serotonin and norepinephrine.</p> Signup and view all the answers

Which of the following is not a positive symptom of schizophrenia?

<p>Apathy (C)</p> Signup and view all the answers

Bipolar depression is classified under affective disorders.

<p>True (A)</p> Signup and view all the answers

Name two examples of first generation antipsychotic agents.

<p>Haloperidol, Chlorpromazine</p> Signup and view all the answers

Patients often experience ______ when they do not comply with their medication regimen, potentially leading to worsening symptoms.

<p>relapse</p> Signup and view all the answers

Match the following symptoms with their corresponding types:

<p>Agitation = Positive symptom of schizophrenia Flat affect = Negative symptom of schizophrenia Panic disorder = Neurosis Phobia = Neurosis</p> Signup and view all the answers

What is a characteristic of second generation antipsychotic agents?

<p>They have a broader action at multiple receptors. (D)</p> Signup and view all the answers

Alcoholism is classified as a type of neurosis.

<p>True (A)</p> Signup and view all the answers

What are extrapyramidal symptoms often associated with?

<p>First generation antipsychotic agents</p> Signup and view all the answers

Which of the following medications is a Selective Serotonin Reuptake Inhibitor (SSRI)?

<p>Fluoxetine (C)</p> Signup and view all the answers

All SSRIs have the same side effects.

<p>False (B)</p> Signup and view all the answers

Name one adverse effect associated with Serotonin Norepinephrine Reuptake Inhibitors (SNRIs).

<p>Sweating</p> Signup and view all the answers

___ is an example of a Tricyclic Antidepressant (TCA).

<p>Amitriptyline</p> Signup and view all the answers

Match the following medications with their drug classes:

<p>Fluoxetine = SSRI Venlafaxine = SNRI Amitriptyline = TCA Duloxetine = SNRI</p> Signup and view all the answers

Which side effect is commonly associated with SSRIs?

<p>Xerostomia (B)</p> Signup and view all the answers

What effect do Tricyclic Antidepressants (TCAs) have on cardiac health?

<p>Cardiac toxicity</p> Signup and view all the answers

Duloxetine is classified as a Selective Serotonin Reuptake Inhibitor (SSRI).

<p>False (B)</p> Signup and view all the answers

Which of the following is a common side effect of Bupropion (Wellbutrin)?

<p>Excessive sweating (A)</p> Signup and view all the answers

Monoamine Oxidase Inhibitors (MAOIs) can lead to weight loss.

<p>False (B)</p> Signup and view all the answers

What is one serious risk associated with overdose of Monoamine Oxidase Inhibitors (MAOIs)?

<p>Severe toxic reaction</p> Signup and view all the answers

Patients taking MAOIs must avoid certain ___ to prevent adverse effects.

<p>foods</p> Signup and view all the answers

Which antidepressant is associated with priapism requiring surgical intervention?

<p>Trazodone (C)</p> Signup and view all the answers

Which of the following is NOT a known adverse reaction of First-Generation Antipsychotic agents?

<p>Agranulocytosis (D)</p> Signup and view all the answers

Second-Generation Antipsychotic agents are associated with weight gain.

<p>True (A)</p> Signup and view all the answers

List two common side effects of Nefazodone.

<p>Xerostomia, Sexual dysfunction</p> Signup and view all the answers

Match the following antidepressants with their notable side effects:

<p>Bupropion = Seizures Trazodone = Sedation Mirtazapine = Weight gain Nefazodone = Hepatic failure</p> Signup and view all the answers

Name one cognitive effect associated with the use of First-Generation Antipsychotic agents.

<p>Extrapyramidal effects</p> Signup and view all the answers

Clozapine has a risk of ____________, a potentially serious decrease in white blood cells.

<p>agranulocytosis</p> Signup and view all the answers

All antidepressants carry a warning about suicidal ideation and behavior.

<p>True (A)</p> Signup and view all the answers

Match the antipsychotic agents with their notable effects:

<p>Clozapine = Agranulocytosis Quetiapine = Weight gain Ziprasidone = Tachycardia Olanzapine = Metabolic syndrome</p> Signup and view all the answers

Which of the following conditions is treated using antipsychotic agents?

<p>Bipolar disorder (B)</p> Signup and view all the answers

Antipsychotic agents can cause xerostomia, which is a dry mouth condition.

<p>True (A)</p> Signup and view all the answers

Identify one type of drug interaction that antipsychotic agents can have.

<p>CNS depressants or Anticholinergic agents</p> Signup and view all the answers

Flashcards

SSRIs

Selective Serotonin Reuptake Inhibitors; drugs that block the reabsorption of serotonin in the brain.

SNRIs

Serotonin Norepinephrine Reuptake Inhibitors; drugs that block the reabsorption of both serotonin and norepinephrine.

Anticholinergic effects

Side effects from medications that reduce activity of the neurotransmitter acetylcholine.

Cardiac toxicity

Harmful effects of a drug or substance on the heart.

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5-HT Reuptake

The process of serotonin being reabsorbed by the nerve cells.

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Tricyclic Antidepressants (TCAs)

A class of antidepressants that affect multiple neurotransmitters, including serotonin and norepinephrine.

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Adverse effects of SSRIs/SNRIs

Unwanted side effects from SSRIs and SNRIs; including sexual dysfunction, sweating, and gastrointestinal issues.

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MAOIs

Monoamine oxidase inhibitors; a class of antidepressants that affect multiple neurotransmitters.

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MAOIs

Monoamine Oxidase Inhibitors: drugs that block monoamine oxidase, potentially causing sleep issues, low blood pressure, sexual problems and weight gain.

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Bupropion (Wellbutrin)

An antidepressant that can cause seizures, digestive problems, dry mouth, etc.

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Trazodone

An antidepressant with fewer common side effects on heart and nerves than some other classes but can be very sedating.

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Nefazodone

A 5-HT modulator antidepressant, which might cause dry mouth, sexual issues, or liver problems and affects other drugs in the body.

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Mirtazapine

Antidepressant that can cause sleepiness, increased appetite and weight gain, dry mouth, and constipations

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Vortioxetine

A newer type of antidepressant that works based on serotonin interaction.

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Suicide & Antidepressants

All antidepressants carry a warning about increased thoughts of suicide, esp. in adolescents & young adults.

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Dental Implications of Antidepressants

Some antidepressants, like those that alter mood-related chemicals can cause dry mouth which can be problematic for dental health.

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First-Gen Antipsychotics Adverse Reactions

Adverse effects of first-generation antipsychotic drugs include sedation, extrapyramidal effects (like dystonia, parkinsonism, akathisia, and tardive dyskinesia), orthostatic hypotension, tachycardia, seizures, and anticholinergic effects.

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Second-Gen Antipsychotics Adverse Reactions

Adverse effects of second-generation antipsychotics frequently involve weight gain, agranulocytosis (with clozapine), hyperglycemia, diabetes, and metabolic syndrome.

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Antipsychotic Drug Interactions (CNS depressants)

Antipsychotics, combined with CNS depressants, can cause increased sedation and respiratory depression.

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Antipsychotic Drug Interactions (Epinephrine)

Combining antipsychotics and epinephrine can lead to a sudden drop in blood pressure.

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Antipsychotic Uses

Antipsychotics are primarily used to treat schizophrenia, sometimes for antiemetic effects, bipolar disorder, depression, and intractable hiccups.

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Antipsychotic Dental Implications

Dental professionals should be aware of antipsychotic effects, such as xerostomia, extrapyramidal dyskinesia, and orthostatic hypotension, when interacting with patients.

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Electroconvulsive Therapy (ECT)

A medical treatment for severe depression, involving inducing controlled seizures.

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Types of Antidepressants

Antidepressants include SSRIs, SNRIs, TCAs, and other types.

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Psychiatric Disorders

Mental illnesses, some partially caused by psychological factors, without clear physical or chemical causes.

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Functional Disorders

Psychiatric disorders seemingly caused by psychological factors, with no apparent structural or biochemical abnormalities.

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Antipsychotic Agents

Drugs used to treat psychosis, such as schizophrenia.

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Antidepressant Agents

Medications used to treat depression.

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First-Generation Antipsychotics

Older antipsychotic drugs, known for their potential side effects.

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Second-Generation Antipsychotics

Newer antipsychotic drugs, often having fewer extrapyramidal side effects.

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SSRI (Mechanism)

Selective Serotonin Reuptake Inhibitors block the reabsorption of serotonin.

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Bipolar Disorder Treatments

Various drugs are used to treat the mood swings in bipolar conditions.

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Schizophrenia Positive Symptoms

Unfavorable symptoms of Schizophrenia, including agitation, extrapyramidal symptoms, and auditory hallucinations.

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Schizophrenia Negative Symptoms

Symptoms of Schizophrenia involving a decrease in normal behaviors, such as flat affect and apathy.

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Affective Disorders

Mental disorders involving changes in mood, including endogenous depression, exogenous depression, and bipolar depression.

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Neuroses

A group of mental disorders involving anxiety, panic disorders, phobias, obsessive-compulsive disorder, and sexual deviations.

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Antipsychotic First Generation

Early antipsychotic drugs acting primarily on dopamine receptors.

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Antipsychotic Second Generation

Newer antipsychotic drugs targeting multiple receptors, potentially having a more favorable side-effect profile than first gen.

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Antipsychotic Mechanism of Action

Antipsychotics reduce psychomotor activity, calm emotions, suppress hallucinations and delusions, and sometimes prevent nausea.

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Psychiatric Patient Communication/Compliance

Important considerations for patients with mental disorders, focusing on potential misinterpretations of communication and treatment adherence difficulties.

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SSRIs

Selective Serotonin Reuptake Inhibitors; drugs that block the reabsorption of serotonin in the brain.

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First-Gen Antipsychotics Adverse Reaction

Side effects of first-generation antipsychotic drugs, including sedation, movement problems (extrapyramidal effects), low blood pressure, fast heart rate, seizures, and dry mouth.

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SNRIs

Serotonin Norepinephrine Reuptake Inhibitors; drugs that block the reabsorption of both serotonin and norepinephrine.

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Second-Gen Antipsychotics Adverse Reaction

Side effects of second-generation antipsychotics often include weight gain, blood-cell problems (with clozapine), and an increased risk of diabetes and metabolic disorders.

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Adverse effects (SSRIs/SNRIs)

Unwanted side effects from SSRIs and SNRIs; including sexual dysfunction, sweating, and GI issues.

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Antipsychotic Drug Interactions (CNS depressants)

Combining antipsychotics and CNS depressants can cause increased sleepiness and slowed breathing.

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Tricyclic Antidepressants (TCAs)

A class of antidepressants that affect multiple neurotransmitters, including serotonin and norepinephrine.

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Antipsychotic Drug Interactions (Epinephrine)

Combining antipsychotics with epinephrine (adrenaline) can lead to a sudden drop in blood pressure.

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Antipsychotic Uses

Antipsychotics are primarily used to treat schizophrenia, but also have applications in managing nausea, bipolar disorder, and severe depression.

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Anticholinergic effects

Side effects from medications that reduce activity of the neurotransmitter acetylcholine.

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Cardiac toxicity

Harmful effects of a drug or substance on the heart.

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Antipsychotic Dental Implications

Dental professionals should be mindful of potential side effects such as dry mouth, unusual muscle movements (EPS), and low blood pressure, which can impact patient interactions and treatment.

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Types of Antidepressants

Various classes of antidepressants such as Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs), also referred to as Tricyclic antidepressants or other types.

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Xerostomia

Dry mouth

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5-HT reuptake

The process of serotonin being reabsorbed by nerve cells.

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ECT

A medical treatment for severe depression involving inducing controlled seizures.

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Monoamine Oxidase Inhibitors (MAOIs)

A type of antidepressant that prevents the breakdown of mood-boosting chemicals in the brain, leading to potential side effects like sleep issues, low blood pressure, sexual problems, and weight gain.

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Bupropion (Wellbutrin [SR]) adverse effects

Side effects of Bupropion can include seizures, digestive problems, dry mouth, and more.

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Trazodone (Desyrel) benefits

It is less likely to impact the heart or cause nerve-related side effects compared to some other antidepressants.

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Trazodone (Desyrel) disadvantages

This antidepressant can cause significant drowsiness and an uncommon issue called priapism (a prolonged erection) which may require medical intervention.

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Suicide risk and antidepressants

All antidepressants have warnings about thoughts of suicide, especially in children, teens and young adults.

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Dental Implications of some antidepressants

Certain antidepressants can cause dry mouth, which can negatively effect oral health.

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Nefazodone (Serzone) Potential Issues

Nefazodone (Serzone) can affect other medications and even potentially cause liver problems.

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Mirtazapine (Remeron) Common Effects

Mirtazapine (Remeron) side effects often include sleepiness, weight gain, constipation, and dry mouth.

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Study Notes

Drugs for the Treatment of Central Nervous System Disorders

  • The chapter discusses drugs used to treat central nervous system (CNS) disorders, specifically psychiatric disorders.
  • Three categories of functional disorders are discussed.
  • Basic precautions for dental professionals when treating patients with psychiatric disorders are outlined.
  • Antipsychotic agents, their mechanisms of action, adverse reactions, drug interactions, uses, and dental implications are discussed.
  • First-generation antipsychotics and their associated side effects, along with their dental implications, are included.
  • Second-generation antipsychotics and their side effects, drug interactions, uses, and dental implications are also discussed.
  • Antidepressant agents, including mechanism of action, side effects, and drug interactions are detailed.
  • Several other antidepressant types and their potential implications are listed.
  • Several drugs used for bipolar disorder are listed.
  • Psychiatric disorders, including schizophrenia, affective disorders, and neuroses are discussed.
  • Characteristics of each of these disorders are outlined (e.g. schizophrenia; positive symptoms, negative effects).
  • Communication and compliance issues with psychiatric patients are addressed.
  • Specific drugs are listed and described for functional psychiatric disorders (e.g.: first generation antipsychotics and second-generation antipsychotics).
  • Adverse drug reactions and dental implications are noted for many classes of drugs.
  • Lists of specific drugs within the categories are included.
  • Included is information about the mechanisms of action of various types of psychiatric drugs.

Antipsychotic Agents

  • First-generation antipsychotics include: Fluphenazine, Haloperidol, Loxapine, Perphenazine, Thiothixene, and Chlorpromazine.
  • Second-generation antipsychotics include: Aripiprazole, Asenapine, Clozapine, Iloperidone, Lurasidone, Olanzapine, Paliperidone, Risperidone, Ziprasidone.
  • First-generation agents are primarily dopamine antagonists.
  • Second-generation agents act on more than one receptor.

Antipsychotic Agents: Mechanism of Action

  • First-generation agents primarily target dopamine receptors.
  • Second-generation agents target multiple receptors.
  • Agents produce slowing of psychomotor activity, calming of emotional responses, and suppression of hallucinations and delusions.
  • Some agents have antiemetic properties.

First-Generation Antipsychotic Agents: Adverse Reactions

  • Sedation is a common side effect.
  • Extrapyramidal effects (including acute dystonia, parkinsonism, akathisia, and tardive dyskinesia) are possible side effects.
  • Orthostatic hypotension, tachycardia, and seizures are also potential side effects.
  • Anticholinergic effects may occur as well.

Second-Generation Antipsychotic Agents: Adverse Reactions

  • Weight gain is associated with some agents (e.g. clozapine, olanzapine, quetiapine).
  • Agranulocytosis and granulocytopenia are possible side effects of clozapine.
  • Hyperglycemia and diabetes are also potential adverse reactions
  • Some agents may increase the risk of tachycardia (e.g., ziprasidone).
  • Metabolic syndrome is a potential side effect associated with some agents.

Antipsychotic Agents: Drug Interactions

  • Antipsychotics can interact with central nervous system (CNS) depressants, potentially increasing sedation and causing respiratory depression.
  • Epinephrine can interact with antipsychotics, potentially causing hypotension.
  • Antipsychotics can interact with anticholinergic agents by exhibiting additive anticholinergic effects.

Antipsychotic Agents: Uses

  • Antipsychotics are commonly used to treat schizophrenia.
  • They can also be used for their antiemetic effects (e.g., Prochlorperazine).
  • Some are used for bipolar disorder.
  • Others may be used to treat depression, intractable hiccups, or certain drug withdrawals.

Antipsychotic Agents: Dental Implications

  • Use caution with patient interactions; some antipsychotics may cause xerostomia, and extrapyramidal effects which can affect TMJ.
  • Oral hygiene instructions are necessary due to xerostomia and other potential effects.
  • Epinephrine can safely be used; orthostatic hypotension is a possible side effect.

Antidepressant Agents

  • Electroconvulsive therapy (ECT), Selective serotonin reuptake inhibitors (SSRIs), Serotonin norepinephrine reuptake inhibitors (SNRIs), Tricyclic antidepressants (TCAs), and other antidepressant agents.

Selective Serotonin Reuptake Inhibitors (SSRIs)

  • Inhibit the reuptake of 5-hydroxytryptamine (5-HT).
  • May cause xerostomia, altered taste, aphthous stomatitis, glossitis, increased salivation, enlarged salivary glands, and tongue discoloration or edema.

Selective Serotonin Reuptake Inhibitors (SSRIs) (specific drugs)

  • Citalopram (Celexa)
  • Duloxetine (Cymbalta)
  • Escitalopram (Lexapro)
  • Fluoxetine (Prozac)
  • Fluvoxamine (Luvox)
  • Sertraline (Zoloft)
  • Paroxetine (Paxil)

Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)

  • Inhibit the reuptake of both serotonin and norepinephrine.
  • Common side effects may include: sweating, tachycardia, urinary retention.

Tricyclic Antidepressants (TCAs)

  • Potential side effects include: cardiac toxicity, effects similar to amphetamines and epinephrine, interactions with monoamine oxidase inhibitors (MAOIs) leading to severe toxic reactions.
  • Additive anticholinergic effects are a concern.

Monoamine Oxidase Inhibitors (MAOIs)

  • Inhibit monoamine oxidase.
  • Potential side effects include sleep disturbances, orthostatic hypotension, sexual dysfunction, and weight gain.
  • Drug interactions result in overdose toxicities; specific prohibitions from diet and other medications are a concern.

Other Antidepressants: Bupropion (Wellbutrin [SR])

  • Potential side effects may include: seizures, constipation, nausea, vomiting, xerostomia, headache, excessive sweating, tremors, agitation, and dizziness.

Trazodone (Desyrel)

  • Advantages: Fewer anticholinergic effects, less cardiotoxic.
  • Disadvantages: Sedative, associated with priapism.

Nefazodone, Mirtazapine, Vilazodone, and Vortioxetine

  • Nefazodone (Serzone): 5-HT modulator; possibly causes xerostomia, increased serum levels of other medications, and hepatic failure.
  • Mirtazapine (Remeron): 5-HT modulator; potential effects are somnolence, weight gain, and constipation.
  • Vilazodone (Viibryd): Serotonin reuptake inhibitor.
  • Vortioxetine (Trintellix)

Suicide and Antidepressants

  • All antidepressants carry a black box warning regarding suicidal thoughts and behaviors.

Dental Implications

  • Sympathomimetic amines and second-generation antipsychotics may cause xerostomia.

Drugs for Treatment of Bipolar Depression: Lithium

  • Potential side effects, including polyuria, fine hand tremor, thirst, slurred speech, ataxia, nausea, vomiting and diarrhea.
  • Overdose toxicity may cause CNS symptoms, muscle rigidity, hyperactive deep reflexes, excessive tremors, and muscle fasciculation.

Antiepileptic Drugs

  • Carbamazepine, Valproate, Gabapentin.
  • Atypical antipsychotics (Olanzapine, Aripiprazole) may also be used as antiepileptic agents.

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