Drugs For The Treatment Of Central Nervous System Disorders PDF

Drugs for the Treatment of Central Nervous System Disorders Chapter 15 Copyright © 2020 Elsevier Inc. All Rights Reserved. 1  Learning Objectives Lesson 15.1: Drugs for the Treatment of Central Nervous System Disorders...

Drugs for the Treatment of Central Nervous System Disorders Chapter 15 Copyright © 2020 Elsevier Inc. All Rights Reserved. 1  Learning Objectives Lesson 15.1: Drugs for the Treatment of Central Nervous System Disorders (Slide 1 of 2) 1. Name and describe the three categories of functional disorders discussed in this chapter. 2. Outline some basic precautions that the dental health care professional should keep in mind when treating patients with psychiatric disorders. 3. Discuss antipsychotic agents and their mechanism of action as well as the following: Identify first-generation antipsychotics, their adverse reactions, drug interactions, uses, and dental implications. Identify second-generation antipsychotics, their adverse effects, drug interactions, uses, and dental implications. Copyright © 2020 Elsevier Inc. All Rights Reserved. 2  Learning Objectives Lesson 15.1: Drugs for the Treatment of Central Nervous System Disorders (Slide 2 of 2) 4. Discuss antidepressant agents, including: Describe the mechanism of action and adverse reactions of selective serotonin reuptake inhibitors. Describe the mechanism of action and adverse effects of serotonin norepinephrine reuptake inhibitors. Describe the mechanism of action, adverse reactions, and drug interactions of the tricyclic antidepressants. 5. Name several other types of antidepressants and their possible adverse reactions and dental implications. 6. List several drugs used to treat bipolar disorder. Copyright © 2020 Elsevier Inc. All Rights Reserved. 3  Drugs for the Treatment of Central Nervous System (CNS) Disorders  Psychiatric disorders  Antipsychotic agents  Antidepressant agents  Drugs for treatment of bipolar depression Copyright © 2020 Elsevier Inc. All Rights Reserved. 4  Psychiatric Disorders  Functional: Partially of psychogenic origin without evidence (to date) of structural or biochemical abnormality  Psychoses  Affective disorder  Neuroses (anxiety) Copyright © 2020 Elsevier Inc. All Rights Reserved. 5  Psychiatric Disorders: Schizophrenia  Extensive disturbance of personality function  Positive symptoms  Agitation  Extrapyramidal symptoms  Auditory hallucinations  Negative effects  Flat affect  Apathy Copyright © 2020 Elsevier Inc. All Rights Reserved. 6 Psychiatric Disorders: Affective Disorder  Endogenous depression  Exogenous depression  Bipolar depression Copyright © 2020 Elsevier Inc. All Rights Reserved. 7  Psychiatric Disorders: Neuroses  Anxiety  Panic disorder  Phobias  Obsessive-compulsive disorder  Sexual deviation  Alcoholism  Drug dependence Copyright © 2020 Elsevier Inc. All Rights Reserved. 8  Psychiatric Disorders  Communication: Comments or movement may be perceived as threatening  Compliance: Patients often do not take their medicine as prescribed  Suicide: Depressed patients may attempt suicide Copyright © 2020 Elsevier Inc. All Rights Reserved. 9  Antipsychotic Agents  First generation  Second generation  Fluphenazine (Prolixin)  Aripiprazole (Abilify)  Haloperidol (Haldol)  Asenapine (Saphris)  Loxapine (Loxitane)  Clozapine (Clozaril)  Perphenazine (Trilafon)  Iloperidone (Fanapt)  Thiothixene (Navane)  Lurasidone (Latuda)  Chlorpromazine  Olanzapine (Zyprexa) (Thorazine)  Paliperidone (Invega)  Quetiapine (Seroquel)  Risperidone (Risperdal)  Ziprasidone (Geodon) Copyright © 2020 Elsevier Inc. All Rights Reserved. 10  Antipsychotic Agents: Mechanism of Action  First generation: Dopamine antagonists  Second generation: Action at more than one receptor  Slowing of psychomotor activity  Calming of emotion  Suppression of hallucinations and delusions  Antiemetic Copyright © 2020 Elsevier Inc. All Rights Reserved. 11  First-Generation Antipsychotic Agents: Adverse Reactions  Sedation  Extrapyramidal effects  Acute dystonia  Parkinsonism  Akathisia  Tardive dyskinesia  Orthostatic hypotension  Tachycardia  Seizures  Anticholinergic effects Copyright © 2020 Elsevier Inc. All Rights Reserved. 12  Second-Generation Antipsychotic Agents: Adverse Reactions  Clozapine, olanzapine, quetiapine > weight gain  Clozapine > agranulocytosis, granulocytopenia  Hyperglycemia  Diabetes  Metabolic syndrome  Ziprasidone > tachycardia Copyright © 2020 Elsevier Inc. All Rights Reserved. 13 Antipsychotic Agents: Drug Interactions  CNS depressants  Sedation  Respiratory depression  Epinephrine  Acute drop in blood pressure  Anticholinergic agents  Antimuscarinic peripheral effects Copyright © 2020 Elsevier Inc. All Rights Reserved. 14  Antipsychotic Agents: Uses  Schizophrenia  Antiemetic effects: Prochlorperazine (Compazine)  Bipolar disorder  Depression  Intractable hiccups  Certain drug withdrawals Copyright © 2020 Elsevier Inc. All Rights Reserved. 15  Antipsychotic Agents: Dental Implications  Use caution with patient interactions  Xerostomia  Oral hygiene instruction  Extrapyramidal dyskinesia  Extrapyramidal effects involving TMJ  Sedation  Epinephrine in local anesthetic is safe  Orthostatic hypotension Copyright © 2020 Elsevier Inc. All Rights Reserved. 16  Antidepressant Agents  Electroconvulsive therapy (ECT)  Selective serotonin reuptake inhibitors (SSRIs)  Serotonin norepinephrine reuptake inhibitors (SNRIs)  Tricyclic antidepressants (TCAs)  Other antidepressant agents Copyright © 2020 Elsevier Inc. All Rights Reserved. 17  Selective Serotonin Reuptake Inhibitors (SSRIs) (Slide 1 of 2)  Inhibit the reuptake  Oral of 5-HT  Xerostomia  CNS  Taste changes  Gastrointestinal (GI)  Aphthous stomatitis  Glossitis  Other  Increased salivation  Sexual dysfunction  Salivary gland  Excessive sweating enlargement  Palpitations  Tongue discoloration or edema Copyright © 2020 Elsevier Inc. All Rights Reserved. 18  Selective Serotonin Reuptake Inhibitors (SSRIs) (Slide 2 of 2)  Citalopram (Celexa)  Duloxetine (Cymbalta)  Escitalopram (Lexapro)  Fluoxetine (Prozac)  Fluvoxamine (Luvox)  Sertraline (Zoloft)  Paroxetine (Paxil) Copyright © 2020 Elsevier Inc. All Rights Reserved. 19  Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)  Inhibit reuptake of serotonin and norepinephrine  Adverse effects: Similar to the SSRIs  Sweating  Tachycardia  Urinary retention  Venlafaxine (Effexor)  Desvenlafaxine (Pristiq)  Duloxetine (Cymbalta) Copyright © 2020 Elsevier Inc. All Rights Reserved. 20  Tricyclic Antidepressants (TCAs)  CNS  Anticholinergic effects  Cardiac  Cardiac toxicity  Potentiate actions of amphetamines  Potentiate pressor effect of epinephrine  Interact with MAOIs > severe toxic reaction  Additive anticholinergic effects Copyright © 2020 Elsevier Inc. All Rights Reserved. 21 Monoamine Oxidase Inhibitors (MAOIs)  Large variety of drugs that have the ability to inhibit monoamine oxidase  Many adverse effects: Sleep disturbances, orthostatic hypotension, sexual dysfunction, and weight gain  Overdose can lead to a severe toxic reaction  Patients taking MAOIs are given detailed food prohibitions  Patient taking an MAOI should not be given any drug unless prescriber has first consulted a reference source on drug interactions Copyright © 2020 Elsevier Inc. All Rights Reserved. 22  Other Antidepressants: Bupropion (Wellbutrin [SR])  Seizures  Constipation  Nausea and vomiting  Xerostomia  Headache  Excessive sweating  Tremors  Agitation  Dizziness Copyright © 2020 Elsevier Inc. All Rights Reserved. 23  Trazodone (Desyrel)  Advantages  Fewer anticholinergic effects  Less cardiotoxic  Disadvantages  Highly sedative  Associated with priapism requiring surgical intervention Copyright © 2020 Elsevier Inc. All Rights Reserved. 24  Nefazodone, Mirtazapine, Vilazodone, and Vortioxetine  Nefazodone (Serzone): 5-HT modulator  Xerostomia  Sexual dysfunction  Increases serum levels of alprazolam, triazolam, digoxin  Hepatic failure  Mirtazapine (Remeron): 5-HT modulator  Somnolence  Weight gain  Constipation  Dry mouth  Vilazodone (Viibryd): Serotonin reuptake inhibitor  Vortioxetine (Trintellix) Copyright © 2020 Elsevier Inc. All Rights Reserved. 25  Suicide and Antidepressants  All antidepressants carry a black box warning about suicidal ideation and behavior  All depressed children, adolescents, and adults should be monitored for suicidal ideation and behavior Copyright © 2020 Elsevier Inc. All Rights Reserved. 26  Dental Implications  Sympathomimetic amines  Xerostomia  Second-generation antipsychotics Copyright © 2020 Elsevier Inc. All Rights Reserved. 27  Drugs for Treatment of Bipolar Depression: Lithium  Side effects  Polyuria  Fine hand tremor  Thirst  Slurred speech  Ataxia  Nausea, vomiting, diarrhea  Overdose toxicity  CNS symptoms  Muscle rigidity  Hyperactive deep reflexes  Excessive tremor  Muscle fasciculation Copyright © 2020 Elsevier Inc. All Rights Reserved. 28  Antiepileptic Drugs  Carbamazepine  Valproate  Gabapentin  Atypical antipsychotics  Olanzapine (Zyprexa)  Aripiprazole (Abilify) Copyright © 2020 Elsevier Inc. All Rights Reserved. 29