Generic Names Trade Names (Examples) Generic Names Trade Names (Examples) Antihistamine Derivatives Benzodiazepine Derivatives Non-benzodiazepine
ANTIPSYCHOTIC DRUGS (*atypical antipsychotics)
Nonphenothiazine Derivatives Benzodiazepine Derivatives Other Agents Phenothiazine Derivatives Tricyclic Derivatives Aliphatic Piperazine Piperidine SSRIs (Selective Serotonin Reuptake Inhibitors) Anticholinergics Other Agents (Nontricyclics) Other Agents MAO Inhibitors
Gelenberg AJ, Bassuk EL: The Practitioner’s Guide to Psychoactive Drugs, 4th ed., New York, Klewer, 1997Harborview Medical Center, Harborview Mental Health Services, Pharmacy, Seattle, WA; Karen P. Hansen, PharmD, MS. Little JW, Falace DA, Miller CS, Rhodus NL: Dental Management of the Medically Compromised Patient, 6th ed. St. Louis: C.V. Mosby, 2002. Malamed SF: Handbook of Local Anesthesia, 4th ed. St. Louis: C.V. Mosby, 1997. Figure 4. Table of drugs used in psychiatry Classifications/Medications Dental Considerations
All are anticholinergic.1 All can cause orthostatic hypotension.
Limit the use of epinephrine2 and other vasoconstrictors, which can cause a serious rise in blood pressure and/or cardiac arrhythmias.
Do not use levonordefrin (Neo-Cobefrin).
Can produce xerostomia1 (generally less frequently than the tricyclics).
Limit the use of epinephrine2 and other vasoconstrictors, in the absence of data regarding inter- action with epinephrine.
Can decrease/eliminate analgesia from codeine due to inhibition of codeine metabolism to activeanalgesic metabolite (morphine).
Can produce xerostomia1 (generally less frequently than the tricyclics) via an anticholinergic (maprotiline) or unidentified mechanism (others).
Can cause orthostatic hypotension (most with trazodone, nefazodone, and mirtazapine).
Limit the use of epinephrine2 and other vasoconstrictors in the absence of data regarding inter- action with epinephrine.
All are anticholinergic,1 but less so than tricyclics. All can cause hypotension (especially orthostatic).
Special consideration needed when using dental anesthesia or prescribing post-procedure pain medication. Use no medication containing phenylephrine. Limit the use of epinephrine2 and other vasoconstrictors. Never use meperidine (Demerol, others). MAOIs interact with a number of med- ications to cause hypertensive crisis. Always check with a pharmacist or patient’s prescriber before administering/prescribing medication.
Dry mouth1 frequently reported, generally secondary to lithium-induced polyuria; may be effect of lithium on thirst and saliva flow. Rarely stomatitis can occur.
Altered taste due to taste of lithium tablet (metallic) or secretion of lithium into saliva.
Can get increased lithium levels (with toxicity) with concurrent nonsteroidal anti-inflammatoryagents, e.g., ibuprofen (Motrin, Advil, Nuprin, etc.)
Anticholinergic1 side effects. Can cause orthostatic hypotension.
Limit the use of epinephrine2 and other vasoconstrictors. Avoid erythromycin or clarithromycin due to risk of Tegretol toxicity.
Mouth sores and unexplained sore throat may be early signs of potentially serious hematologictoxicity (agranulocytosis, aplastic anemia).
All have anticholinergic1 side effects. All can cause orthostatic hypotension.
Limit the use of epinephrine2 and other vasoconstrictors.
All produce extrapyramidal side effects3 (jaw and neck rigidity, motor restlessness).
All can produce tardive dyskinesia3 (repetitive, involuntary movements of extremities and trunk, “chewing” motion of jaw). Early signs include abnormal movements of tongue (rolling, lateral, protruding movements) and mouth (lip-smacking, chewing motions, grimacing).
Patient can control these movements temporarily with attention.
All have anticholinergic1 side effects. 1Xerostomia (dry mouth) secondary to decreased flow of saliva (via NOTE: All psychiatric medications (except stimulants) are to some degree
anticholingergic or other mechanisms) predisposes patient to
sedating. All can potentiate both anesthesia and the effects and side effects of
increased caries and gingival changes that may affect denture fit.
sedating post-procedure pain medications.
Another anticholinergic side effect of dental concern is
NOTE: Limit acetaminophen (Tylenol, others) dose to = 2 grams per day in
chronic alcohol users to minimize risk of liver damage. 2Use epinephrine with caution with careful monitoring for toxicity NOTE: Nitrous Oxide (N20) should be used with extreme caution in people who
(e.g., increased blood pressure, cardiac arrhythmias including
are on psychotropic medications due to potential for initiating a hypotensive
tachycardia; or hypotension with antipsychotics). Not more than
reaction and an increased risk of hallucinations in psychotic patients. Do not
2–3 cartridges of local anesthetic with epinephrine 1:100,000
administer N20 to recovered alcoholics and drug abusers as it may increase the
are recommended at any one appointment; aspirate and inject
slowly. Avoid use of all other forms of epinephrine (retraction
SOURCE: Harborview Medical Center, Harborview Mental Health Services,
cord, topical for control of bleeding).
Outpatient Programs, Karen P. Hansen, PharmD, MS. For specific questions, call
Contact pharmacist or practitioner familiar with its use. Due
to the lack of information regarding interactions of psychotropic
For further information, see series of articles, Drug Interactions in Dental
medications with other vasoconstrictors, their use is best limited.
Practice, Parts I–IV, JADA,, January–May 1999, comments in September 1999.
(For more information see: Little JW, Falace DA, Miller CS,
Rhodus NL: Dental Management of the Medically CompromisedPatient, 6th ed. St. Louis: C.V. Mosby Co., 2002, pp. 439–477) .
For additional information contact: Patricia E. Doyle, RDH, 1305 4th Avenue,
3Atypical antipsychotics cause less of these side effects.
Suite 820, Seattle, WA 98101 (206-624-1773).
ETHICAL PERSPECTIVES IN NEUROLOGY Joseph S. Kass The practice of neurology presents a series of ethical challenges for the clinician. Theserarely have simple or straightforward solutions, but require careful consideration by theneurologist. This section of , written by colleagues with particular interest inthe area of bioethics, provides a case vignette that raises one or more ethical questi
LA PASSION CLASSIFICATRICE EN PSYCHIATRIE : UNE MALADIE CONTEMPORAINE ? Claire GEKIERE, psychiatre de secteur dans le Nord-Isère Colloque du CEFA : « PASSIONS », 8-9 décembre 2006, Paris Trier, compter, classer passionne les psychiatres de longue date. De « L’aliéniste » décrit par Machado de Assis en 1881, qui interne dans sa maison de fous les quatre cinquièmes des habitants de la