Anti anxiety agents and drugs to treat CNS disorders

another term for Anti-anxiety Agents

Sedative-hypnotic agents

Sedative –

a small dose which causes mild CNS depression (reduce activity/some anxiolytic effects)

Sedative dose calms patient routinely on days without a dental appointment, but they may need a hypnotic dose to produce calmness on days with dental appointments

Hypnotic –

a large dose which causes greater CNS depression (induces sleep)

Sedative dose calms patient routinely on days without a dental appointment, but they may need a hypnotic dose to produce calmness on days with dental appointments

Benzodiazepines*

*Most commonly prescribed antianxiety drugs

Hypnotic anti-anxiety agents

Nonbenzodiazepine-Nonbarbiturate Sedative

Nonbenzodiazepine Receptor Hypnotics

Melatonin Receptor Agonist

Orexin Receptor Antagonist

Benzodiazepine Agents common endings

-azepam

-azolam

Benzodiazepines - Mechanism of Action

Enhance or facilitate the action of the neurotransmitter γ-aminobutyric acid (GABA)

AKA slows down brain by blocking specific signals, produces calming effect

GABA

a major inhibitory transmitter in CNS

benzodiazepines uses

Behavioral effects

Low dose: anxiety and panic reduction

High dose: drowsiness and sleep

Repeated doses: reduce REM sleep and can

interfere with restorative sleep

Muscle relaxation

Reduces pain in skeletal muscles (maybe -

studies vary)

Reduces muscle spasticity caused by cerebral

palsy and paraplegia

Antiseizure effects

Increase the seizure threshold

diazepam

used parenterally, to prevent seizures

associated with LA toxicity and to treat status

epilepticus (seizure 5+ mins or do not return to

normal between seizures)

clonazepam

oral, helps to prevent partial

seizures

CNS depression

manifested as fatigue, drowsiness, muscle weakness, ataxia, light headedness, dizziness

Ataxia

(lack of muscle coordination & balance)

Benzodiazepines - Adverse Reactions

CNS depression

Opposite effects can occur - talkativeness,

anxiety, nightmares, tremulousness, hyperactivity, and increased muscles spasticity

Anterograde amnesia

Respiratory depression

Thrombophlebitis

GI upset, difficulty urinating, allergic reactions

(mild)

BENZODIAZEPINES - DENTAL USE

Anxiety Control

Conscious Sedation

Insomnia Management

BARBITURATE AGENTS - Common endings

-ital

-barbital

what is the Original sedative-hypnotic agents

Barbiturates

Barbiturates contraindications

Absolute contraindication in patients with

intermittent porphyria or a positive family history of porphyria

Drug interactions

porphyria

Rare condition that affects body's ability to produce heme (gives blood its color)

NONBENZODIAZEPINE-NONBARBITURATE SEDATIVE-

HYPNOTIC

Buspirone

buspirone

Anxioselective - anxiolytic without hypnotic, anticonvulsant, or muscle-relaxant properties

Onset = about 1 week*

*Because of this, not appropriate to treat dental anxiety

May cause nervousness or insomnia

No effect on driving, non-addictive, no withdrawal symptoms

NONBENZODIAZEPINE RECEPTOR HYPNOTICS

Used to treat insomnia only

zolpidem (Ambien)

zaleplon (Sonata)

eszopiclone (Lunest)

baclofen (Lioresal Intrethecal)

has been used to treat trigeminal neuralgia (off-labeled) which is very challenging to manage

zolpidem (Ambien)

May be given to dental patient who has difficulty falling asleep the night before appointments

Patients should not drive while taking and may have residual effects the next day

eszopiclone (Lunest)

Patients should not drive while taking and may have residual effects the next day

Patients may experience an unpleasant taste while taking

ANTIPSYCHOTIC AGENTS

Used to treat: schizophrenia, schizoaffective disorder, delusional disorder, and other disorders with psychosis symptoms

ANTIPSYCHOTIC AGENTS - Common endings

-azine

-apine

ANTIPSYCHOTIC AGENTS - MOA - first generation

dopamine antagonist

Effective against positive symptoms

More side effects

ANTIPSYCHOTIC AGENTS - MOA - second generation

action at multiple receptors (dopamine, serotonin, and norepinephrine)

Effective against both positive and negative symptoms

Less side effects

1ST GEN ANTIPSYCHOTIC AGENTS - PHARMACOLOGIC

EFFECTS

Antipsychotic effect

Antiemetic effect

Treatment of intractable hiccups and certain drug withdrawals

Antipsychotic effect -

slow psychomotor activity in agitated patients and calm emotion with suppression of hallucinations and delusions

Antiemetic effect -

depression in part of brain that causes nausea and vomiting

Acute dystonia -

muscles spasms face/neck

specifically muscles of mastication causing pain near TMJ

tardive dyskinesia -

repetitive body movements involving tongue, lips, face, and jaw

Parkinsonism -

symptoms of resting tremors

akathisia -

increased compulsive motor activity

1ST GEN ANTIPSYCHOTIC AGENTS - ADVERSE REACTIONS

Sedation

Extrapyramidal effects

Acute dystonia

Parkinsonism

akathisia

tardive dyskinesia involving tongue, lips, face, and jaw

Orthostatic hypotension - caution when patients are getting out of dental chair post treatment

Anticholinergic effects - blurred vision, xerostomia, and constipation

Extrapyramidal effects -

drug induced movements*

2ND GEN ANTIPSYCHOTIC AGENTS - PHARMACOLOGIC

EFFECTS

Bipolar disorder

Depression

ANTIPSYCHOTIC AGENTS - DRUG INTERACTIONS

CNS Depressants

Epinephrine

Anticholinergic Agents

ANTIDEPRESSANTS - GENERAL INFORMATION

Used to manage: depression, chronic pain (adjunctive), and migraines

Types

SSRIs, SNRIs, TCAs, MAOIs, bupropion, trazodone, mirtazapine, nefazodone, and vilazodone

ANTIDEPRESSANTS - SSRIs

Selective Serotonin Reuptake Inhibitors (SSRIs)

Oral effects of SSRIs

Xerostomia (10-15%)

Taste changes, aphthous stomatitis, glossitis

Rare - increased salivation, salivary gland

enlargement, and tongue discoloration or edema

ANTIDEPRESSANTS - SNRIs

Serotonin-Norepinephrine Reuptake Inhibitors

(SNRIs)

Inhibit reuptake of serotonin and NE

ANTIDEPRESSANTS - TCAs

Tricyclic Antidepressants (TCAs)

Block reuptake of serotonin and NE

what type of patients use TCAs

Reserved for patients with moderate to severe

treatment-resistant depression

ANTIDEPRESSANTS - MAOIs

Monoamine Oxidase Inhibitors (MAOIs)

many adverse reactions

last resort drug