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Amy Hyatt
Chapter 6 & 7 Pharmacology Objectives
1. Define key terms.
 Antipsychotics: Drugs used to manage patients with psychosis
 Depression: Feelings of hopelessness, sadness, and a general disinterest in life; in
most cases, there is no known cause; may be due to neurotransmitter abnormality
 Epilepsy: Disorder of the nervous system in which abnormal electrical activity in
the bran causes involuntary effects (seizures)
 Focal Seizure:
 General Seizure:
 Mania: Mental disorder characterized by extreme excitement, happiness,
overactivity, and agitation; usually refers to the high of the highs and lows
experiences in manic-depressive disorder
 Schizophrenia: Category of phychosis- an extensive disturbance of the patient’s
personality function with a loss of perception of reality
2. Identify the pharmacologic and adverse reactions associated with antipsychotic
agents.
 Pharmacologic Effects: Antipsychotic, drowsiness, antiemetic (prevents vomiting)
 Adverse Reactions: Orthostatic hypotension, xerostomia, extrapyramidal (areas in
the brain affecting bodily movements: twitching, muscle spasms, etc)
3. List two ways to handle a patient differently taking antipsychotic agents from a
non-medicated patient.
 Explain that one of the extrapyramidal effects is severe intermittent pain in the
region of the TMJ. It may be important to speak with the patients physician to
decrease the dose or add an anticholinergic (which would counteract the spasms).
 It is also important to use caution in patient interactions. The patient may
misinterpret your verbal or non-verbal actions.
 Also, check for xerostomia (many drugs cause this)
 The disease may cause difficulty in following an oral care program (depends on
the disease severity)
4. Identify the pharmacologic and adverse reactions associated with TCA’s.
 Pharmacologic Effects:
o In a normal patient, an undesirable sedation and fatigue and strong
atropine-like side effects are noted. In the depressed patient, a feeling of
well-being, elevation of mood, and a dulling of depressive ideation are
noted.
o Affects the norepinephrine and serotonin levels in the brain
 Adverse Reactions:
o CNS: Induce some degree of sedation, nausea, and can produce tremors.
Also, orthostatic hypotension
o Autonomic system: Xerostomia, blurred vision, tachycardia, constipation,
and urinary retention.
o Cardiac: Cardiac toxicity has occurred (MI, CHF, arrhythmias, and
episodes of tachycardia)
5. Identify the pharmacologic and adverse reactions associated with SSRI’s.
 Pharmacologic Effects: Blocks the reuptake of serotonin, increasing its duration
of action. Tends to produce CNS stimulation (activation) rather than CNS
depression.
 Adverse Reactions: Xerostomia, taste changes, apthous stomatitis, glossitis,
headache, dizziness, tremor, agitation, sweating, and insomnia, weight loss.
6. State the advantages and disadvantages of SSRI’s over the TCA’s.
 Advantages: Unlike many of the TCA’s, the SSRI’s tend to produce CNS
stimulation (activation) rather than CNS depression. There is an increase in the
duration of action with SSRI’s. Their advantage lies in their adverse reaction
profile (less side effects).
 Disadvantages: Need several weeks to see effect
7. Describe advantages of the atypical antidepressants over the TCA’s.
 They have fewer anticholinergic effects and less cardiotoxicity, and some have
less sedation effects
8. Identify the pharmacologic and adverse reactions associated with MAOI’s.
 Pharmacologic Effects: Ability to inhibit monoamine oxidase. (The action as
antidepressants is assumed to be related to the increased availability of
monoamines in the CNS or SANS).
 Adverse Reactions: Possess many adverse effects and an overdose can lead to a
severe toxic reaction. They interact with many drugs, such as amphetamines, and
with foods, such as cheeses, wines, and fish, precipitating a hypertensive crisis
and even death.
9. Name the agent used to treat bipolar disorder.
 Lithium
10. Describe the effect of the NSAIDS on lithium.
 Some NSAIDS can decrease lithium clearance, leading to an increase in lithium
levels (can produce lithium toxicity).
11. State other medical use for the drug bupropion.
 Used as an adjunct in smoking cessation. Also can be used for controlling of
overeating.
12. Describe the diagnosis and overall management of epilepsy.
 Doctors use brain scans and other tests to diagnose epilepsy.
 Once epilepsy is diagnosed, it is important to begin treatment as soon as possible.
For about 80% of those diagnosed with epilepsy, seizures can be controlled with
modern medicines and surgical techniques.
13. List the dental concerns associated with phenytoin.
 Gingival enlargement/overgrowth
o Monitor for gingival enlargement
o Provide extensive oral hygiene instructions
o Schedule more frequent oral prophylaxis
 If the patient has nausea, avoid drugs that are gastric irritants
 Vitamin deficiency (vitamins D and folate)
 Do not have patient stop taking or decrease dose because abrupt withdrawal of
phenytoin may precipitate status epilepticus
14. Discuss the use of benzodiazepines in the treatment of seizure disorders.
 Used as an adjunct to treat absence seizures not responsive to ethosuximide
 Drowsiness and ataxia occur frequently
 Behavior disturbances and adverse neurologic effects can occur
 Oral manifestation include increased salivation, coated tongue, dry mouth, and
sore gums