Psychotherapeutic+Agents

= Psychotherapeutic Agents =

==== Asia and Velinda will work together on this page (This is week #6 readings. Deadline is April 4th) Psychopharmacology drugs consist of: · Phenothiazines · Tricyclic Antidepressants · Benzodiazepines · Barbiturates · Non- Barbiturates


 * Phenothiazines **

Definition: These drugs slow down the psychomotor activity and calm emotions with suppression of hallucinations and delusions caused by schizophrenia, usually by blocking the dopamine receptors in the brain. This limits the overactivity of dopamine thought to be a contributing cause in schizophrenia.

Primary Use: Used to treat schizophrenia.

Dental implications: Anticholinergic effects can cause xerostomia, which leads to an increase in caries. Patients taking this drug for prolonged periods of time have a reduction in leukocycte count. This can cause these patients to be more prone to getting infection and frequent oral candidiasis.

Therapeutic Uses: Treatment of psychotic states, antiemetics, preoperative medications to relax and calm the patient, antihistamines, control of the manic phase of bipolar disorder, control hallucinations associated with alcohol withdrawal.

Effects on CNS: depression Effects on respiratory system: depression Effects on cardiovascular system: depression

Adverse effects: sedation, extrapyradidal effects (ie: dystonia, tremors, slurred speech, restlessness, slowed thought process, etc), orthostatic hypotension, seizures, and anticholinergic effects.

**Tricyclic Antidepressants (aka First Generation Antidepressants) ** Definition: These drugs treat depression by blocking noreprinephrine and serotonin uptake. There are also second generation antidepressants.

Primary Use: Used to treat depression. TCAs give the depressed patient an elevation of mood, increased ability to sleep, and improvement in concentration.

Dental implications: TCAs can cause xerostomia, which leads to an increase in caries. Local anesthesia should be should be used with caution with patients on this medication. The dental provider should also be aware that this medication can cause tremors. The patient may also experience altered taste sensation, stomatitis, and glossitis.

Therapeutic Uses: Not only depression, but also treatement of chronic pain, delusions, alcoholism, ADHD, incontinence, sleep aids

Effects on CNS: depress initally (wears off after continuous use) Effects on respiratory system: do not significantly effect Effects on cardiovascular system:depress

Adverse effects: sedation, orthostatic hypotension, and anticholinergic effects. The patient may experience headaches, dizziness, tremor, agitation, sweating, insomnia, weight loss, nausea, diarrhea, taste change and xerostomia.

**Benzodiazepines **

Definition: These drugs are used to treat anxiety by acting to depress the CNS. (Diazepam, also known as Valium, is a very common benzodiazepine)

Primary Use: Used to treat anxiety, fear, and apprehension caused by stressful environments (like a visit to the dentist).

Dental implications: Patients may be prescribed benzodiazepines for dental appointments due to their dental anxiety. As dental professional we need to ensure these patients have a driver for these appointments, and take the medication one hour prior to their appointment.

Therapeutic Uses: The therapeutic use of benzodiazepines are anxiety, sedation, hypnosis, normal sleep patterns, alcohol withdrawal symptoms, anticonvulsants, muscle relaxants, and depression.

<span style="color: black; font-family: 'Comic Sans MS'; font-size: 10pt; line-height: 115%; margin: 0in 0in 10pt 0.5in;">Effects on CNS: depression <span style="color: black; font-family: 'Comic Sans MS'; font-size: 10pt; line-height: 115%; margin: 0in 0in 10pt 0.5in;">Effects on respiratory system:insignificant depression in healthy individuals; can cause respiratory failure in those who have pulmonary disease <span style="color: black; font-family: 'Comic Sans MS'; font-size: 10pt; line-height: 115%; margin: 0in 0in 10pt 0.5in;">Effects on cardiovascular system: no significant change

<span style="color: black; font-family: 'Comic Sans MS'; font-size: 10pt; line-height: 115%; margin: 0in 0in 10pt 0.5in;">Adverse effects: Drowsiness, ataxia, incoordination, dysarthria, confusion, apathy, muscle weakness, and some people may experience allergic reactions, paradoxic reactions (such as excitement/hyperactivity in children and older adults).

<span style="color: black; font-family: 'Comic Sans MS'; font-size: 10pt; line-height: 115%; margin: 0in 0in 0pt 0.5in;">**<span style="color: black; font-family: 'Arial','sans-serif'; font-size: 14pt; line-height: 115%;">Barbiturates **

<span style="font-family: 'Comic Sans MS',cursive;">Definition: These drugs are derivatives of barbituric acid which are used as sedatives and hypnotics.

<span style="font-family: 'Comic Sans MS',cursive;">Primary Use: Used to manage tonic-clonic seizures and other convulsive disorders.

<span style="font-family: 'Comic Sans MS',cursive;">Dental Implications: Potential drug interactions call for extensive medical history review and accurate records of what drugs the patient has taken, as well as physician consultations when the medical history is unclear. Barbituates have also had use as IV sedativeas and anesthetics, although less common.

<span style="font-family: 'Comic Sans MS',cursive;">Therapeutic Uses: Used as sedatives, hypnotics, and to manage convulsions including tonic-clonic seizures.

<span style="font-family: 'Comic Sans MS',cursive;">Effects on CNS: depresses CNS <span style="font-family: 'Comic Sans MS',cursive;">Effects on respiratory system: sedative doses have little effect on respiration, but increased doses lead to increased respiratory depression <span style="font-family: 'Comic Sans MS',cursive;">Effects on cardiovascular system:sedative doses do not affect the cardiovascular system but hypnotic doses produce mild hypotension and a decrease in heart rate

<span style="font-family: 'Comic Sans MS',cursive;">Adverse Effects: adverse reactions primarily result from the combination of barbiturates with other CNS depressants, abuse potential, and their ability to produce hepatic microsomal enzymes which can interfere with the absorption and effectiveness of other drugs such as warfarin.

<span style="font-family: 'Comic Sans MS',cursive;"> **<span style="font-family: Arial,Helvetica,sans-serif; font-size: 140%;"> Non-Barbiturates ** <span style="font-family: 'Comic Sans MS',cursive;"> <span style="font-family: 'Comic Sans MS',cursive; font-size: 70%;">Definition: These drugs are sedative/hypnotics that do not derive from barbituric acid, such as chloral hydrate

<span style="font-family: 'Comic Sans MS',cursive; font-size: 80%; line-height: 0px; overflow: hidden;"> <span style="font-family: 'Comic Sans MS',cursive; font-size: 110%;">Primary Use: See Barbiturates

<span style="font-family: 'Comic Sans MS',cursive;">Dental Implications: These drugs have few dental indications, however, chloral hydrate has been used as a sedative for uncooperative children in pediatric dentistry.

<span style="font-family: 'Comic Sans MS',cursive;">Therapeutic Uses: used as sedatives and hypnotics, has also been used to treat alcohol withdrawal.

<span style="font-family: 'Comic Sans MS',cursive;">Effects on CNS: depresses CNS <span style="font-family: 'Comic Sans MS',cursive;">Effects on respiratory system: minimal effects, but depression increases with higher dosage. <span style="font-family: 'Comic Sans MS',cursive;">Effects on cardiovascular system: minor cardiovascular effects in conventional doses, but as dose is increased, cardiovascular depression may result. Can precipitate cardiac arrhythmias.

<span style="font-family: 'Comic Sans MS',cursive;">Adverse Effects: Combination of chloral hydrate with alcohol can increase the effects of intoxication resulting in stupor, coma, and death. Significant doses can be passed from mother to infant in breast milk; enough to sedate the baby. Research has shown that caution is needed because chloral hydrate is a mutagen and carcinogen, although no carcinogenic effects have been seen in therapeutic doses.