13 terms

Dental Therapeutics Exam 1

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Cocaine (type of drug, schedule MOA)
TYPE: psychomotor stimulant (administered topically in 1 or 4% concentration to the mucous membranes of the oral cavity)

SCHEDULE: II

MOA: blocks reuptake of DA, NE, and 5HT (DAT, NET, and SERT inhibition)
Methamphetamine (type of drug, MOA, adverse rxns)
- TYPE: psychomotor stimulant

- MOA: inhibitions of DA reuptake (1. blocks DAT, 2. phosphorylation of DAT --> internalization, 3. blocksVMAT-2, 4. reversal of DAT)

ADVERSE RXNS: meth mouth

*pseudophendrine (Sudafed) and ephedrine can be used as precursors to methamphetamine (no longer available OTC)
Methylphenidate (brand, type of drug, MOA, metabolism, adverse rxns, drug interactions)
- BRAND: Ritalin, Concerta

- TYPE: ADHD drug (psychomotor stimulant)

- MOA: inhibits the reuptake of DA and NE (inhibition of DAT and NET)

-METABOLISM: metabolized by carboxylesterase NOT CYP!! (**alcohol makes the structure of methylphenidate more stable, therefore preventing it from being cleared out of the system. thus, prolonged effects)

- ADVERSE RXNS: weight loss, reduced appetite, insomnia, irritability/jitteriness, stomach aches, headaches, growth delay, abuse potential (rare: zombie-like state, HTN, tics/abnormal movements, hallucinations)

- DRUG INTERACTIONS: contraindicated with MAOI; possible interaction with anticonvulsants, warfarin, TCAs; decrease effectiveness of anti-HTN drugs
Atomoxetine (brand, type of drug, MOA, metabolism, adverse rxns)
BRAND: Strattera

TYPE: ADHD drug (psychomotor stimulant)

MOA: selective inhibitor of NE reuptake

METABOLISM: CYP2D6

ADVERSE RXNS: a/n/v, HTN, insomnia, liver injury

*slower onset compared to methylphenidate and amphetamines

*no apparent abuse potential; no growth delays
ADHD Drugs
- methylphenidate (Ritalin, Concerta)
- dexmethylphenidate (Focalin)
- Atomoxetine (Strattera)

Others:
- Bupropion
- TCAs
- Clonidine
- Guanfacine
- Risperidone
- Olanzapine
- Ziprasidone
- Haloperidol
Considerations for ADHD in the dental office
- avoid the use of anti anxiety drugs (makes behavior worse)
- treatment should be scheduled at peak level of action for ADHD meds
- common dental manifestations: dry mouth, bruxism
Three factors of ADHD
- hyperactivity
- inattention
- impulsivity
uses of psychomotor stimulants
- obesity
- ADHD
- narcolepsy
-shift work sleep disorder
- obstructive sleep apnea/ hypopnea syndrome
general classification of CNS stimulants
- psychomotor stimulants
-psychomimetics
sleep conditions
- narcolepsy
- shift work sleep disorder
- obstructive sleep apnea/hypopnea syndrome
Modafinil and Armodafinil (brand, type of drug, schedule, MOA, metabolism, adverse rxns)
- BRAND: Provigil and Nuvigil

- TYPE: nootropic/ "smart drugs"/ sleep stimulants

- SCHEDULE: IV

- MOA: increases synaptic concentration of NE,. DA. 5-HT, glutamate, histamine; decreases GABAergic inhibitory effects

- METABOLISM: CYP2C19

- ADVERSE RXNS: headache, n/v, anxiety, dry mouth, increased HR, nervousness, insomnia

*Co-administration of modafinil with CYP2C19 metabolized drugs, such as diazepam, phenytoin and propranolol, leads to increases in circulating levels of these compounds
Caffeine (type of drug, MOA, metabolism, adverse rxns)
*chemically similar to theophylline

- TYPE: psychomotor stimulant (mild bronchodilator for asthma tx)

- MOA: antagonist to the adenosine receptor

- METABOLISM: CYP1A2

- ADVERSE RXNS: increased HR, nervousness, jitteriness, euphoria, mental alertness, abuse
Nicotine (type of drug, MOA, adverse rxns)
- TYPE: psychomotor stimulant

- MOA: binds to nicotinic acetylcholine receptor on the presynaptic (inotropic) neuron.. this causes an influx of sodium and calcium ions--> action potential firing --> increase in DA release

- ADVERSE RXNS: Acute side effects: irritation and burning sensation in the mouth, increase HR and BP, nausea, vomiting, abdominal pain;
Long-term side effects (smoking): bladder and lung cancer, CV disorders, COPD and GI disorders
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