Log Dose Effect Curve:
The ____ _____ of the drug is plotted where the dose is increasing sharply.
Therapeutic Range
Log Dose Effect Curve:
The ____ ___ of a drug is where the curve plateaus.
Maximum Response
Name this : A function of the amount of a drug to produce an effect. This is greater when the dose is _____(larger or smaller)
Potency
Smaller
Maximum intensity of effect or response that can be produced by drug regardless of dose!
Efficacy, administering more drug will NOT increase the efficacy of the drug but will often increase the probability of adverse drug reactions. EFFICACY and POTENCY of a drug are UNRELATED!
Equals half the amount of time for a drug to fall to half the original blood level; relates to duration of effect
Half-Life
Routes of drug administration affects both ____(the time it takes for the drug to have an effect) and ____(the length of drug's effect)
Onset and Duration
Routes of Drug Administration:
May be ____(Placed directly into the GI tract by oral or rectal administration) or _____ (drug bypasses GI tract; includes injection, inhalation and topical administration)
enteral
parenteral
Enteral Drug Administration: Oral Route: Large absorbing area present in :
small intestine
Oral Route: Drugs may be inactivated by GI acidity or enzymes (example: ____)
insulin
Drug blood levels are more or less predictable in oral administration?
Less
Orally delivered drugs must pass through _________ FIRST (can inactivate some drugs); termed _________
hepatic portal circulation;
first pass effect
Drugs with high first pass effect have SMALLER or LARGER oral to parenteral dose ratio? (Ex. _____) ;they require a (larger or smaller ____ dose
LARGER
Morphine
LARGER
Phase 1 reactions are carried out by microsomal or _______ enzymes (also known as the "______" in the ______.
The concentration of theses enzymes can be affected by drugs and environmental substances such as smoking; alcohol tolerance is a common example
Cytochrome P-450 enzymes;
mixed function oxidases;
Liver;
Induction
Rectal Route: Given as suppositories, creams or enemas. Can be used if patient is ____or _____. Drugs are (greatly or poorly) _____ absorbed.
vomiting or unconscious;
poorly
Name the Parenteral Drug Administration Routes:
Intravascular IV
Intramuscular IM
Subcutaneous
Intradermal
Inhalation
Topical
This parenteral drug administration produces the most rapid drug response. Absorption phase bypassed. For EMS situations.
Disadvantages: ____(caused by local irritation). Allergy can happen with this.
Once put in, can't get drug out-________.
IV;
phlebitis;
Drug irretrievability
Name this Route of administration: Absorption occurs due to high blood flow in skeletal muscles-________.
Useful to provide _____ effect.
Deltoid or gluteal regions most common injection sites.
_____ increases absorption.
IM (intramuscular route);
sustained;
Massage
Route used to administer protein products.
Subcutaneous
Common ex.) of this route is insulin and Local anesthetics. May produce sterile abscess.
Subcutaneous
Injected into epidermis- what route is this?
Intradermal
Common example of this route is tuberculin skin test.
Intradermal
Provides rapid delivery of drug across the large surface area of respiratory mucosa.
Inhalation route
common examples of this route is inhalers for asthma and nitrous oxide/oxygen sedation.
inhalation route
Drug application to body surface. Contraindicated if surface is ulcerated, burned or abraded.
Topical Route
Topically applied drugs have increased or decreased concentration of the drug?
Most effective with less or more keratinized tissue? Used when local effect is desired.
May have systemic uptake- true or false?
increased;
less;
true
Study of how a drug is absorbed, distributed, metabolized and excreted by the Body.
Pharmacokinetics (ADME)
Absorption of drugs may be ____ or Passive. Transfer of drug from site of administration to the blood stream.
______drugs readily move across MOST biological membranes by diffusion (only drugs to pass the ______)
Active;
Lipid soluble drugs;
blood brain barrier
Absorption occurs at _______sites.
Dependent on several factors: Name one
MANY (mouth, stomach, muscle, etc);
massaging the area (The others are:
drug pH, drug solubility, surface area, circulation, temperature at site)
Process by which a drug reversibly leaves the blood stream and enters the system it targets.
Distribution!!!!!!!!!!!!!
Distribution:
After being absorbed, drug is distributed to an organ with the highest or lowest blood flow? (oral doses go to the _____; sublingual goes to the _____)
Depends on blood flow, capillary permeability (BBB).
Binding of drugs to proteins (especi
Highest;
Liver;
Heart;
plasma albumin
The liver is the major site for _____?
Drug Metabolism, NOTE: liver disease may impair metabolism!!!!!
Drug elimination terminates drug ______!
Drugs are most often eliminated by ______and/or ____ into the urine or bile.
EFFECTS;
biotransformation;
excretion
The most important excretion site in elimination is_____?
Other routes include: liver, lungs, bile, GI, sweat, milk, exhalation, sweat, ____ and ____ ___ ____.
Renal (Kidney)
saliva;
gingival crevicular fluid
Elimination: May be excreted unchanged or as _______ (when drug is changed)
Fat soluble drugs are or are not excreted in the urine.
metabolites;
NOT (need to be metabolized into water soluble form by liver.)
**The major route of fluoride elimination from the body is _______
excretion in urine
What factors alter drug effects:
a.) patient compliance
b.) sex
c.) age and weight (kg)
d.) time of administration
e.) psych factors
f.) tolerance
g.) all the above
G.
____Rule and ____Rule use AGE in determining child's dose of drug; The ___ ___ Rule is MOST accurate and employs weight (in kg) to determine child's dose of drug to safely administer.
Cowling's Rule & Young's Rule;
Surface Area
The amount of desired effect is excessive;does related is called
Toxic reaction
Dose related reaction that is not part of the desired therapeutic outcome is called____; non therapeutic action of drug such as __________________
Side Effect;
Drowsiness that occurs with antihistamine use
Abnormal drug response that is usually genetically related ________
Idiosyncratic reaction
Hypersensitivity response to a drug to which the patient has been previously exposed; NOT DOSE RELATED
Drug Allergy
Causal relationship between maternal drug use and congenital abnormalities is called ______.
Teratogenic Effect
This drug is used for morning sickness of pregnant women- ______
Another name for Shortened limbs from this drug is called ______
Thalidomide induction;
Phocomelia
Effect of one drug is altered by another. May result in toxicity or lack of efficacy
Drug Interactions
Immune Hypersensitivity reaction. May be mild or life threatening (anaphylaxis)
Allergic Reactions
Treatment of mild reactions:___________________
Treatment of anaphylactic reaction:_______________
antihistamine with or without steriods;
Epi subcutaneously with or without steroids
Which of the following can not generate gingival overgrowth?
A.) Mouthbreathing
B.) Digoxin
C.) Phenytoin
D.)Genetic factors
E.) Cyclosporine
F.) Beta Blockers
G.) Calcium Channel Blockers (nifedipine, dilatiazem)
B and F
Gingival overgrowth associated with phenytoin use generally occurs in the _____region.
Anterior facial
Mouthbreathers would exhibit inflamed gingiva in the _____ region
anterior
What is cyclosporine used for?
Organ rejection preventative medication
This system has automatic involuntary responses. Responsible for blood pressure, heart rate, GI motility, salivation, bronchial/smooth muscle tone.
Requires neurotransmitters. Includes 2 divisions:
Autonomic Nervous System: PANS and SANS
The rest and digest system is called ?
The neurotransmitter is called?
Parasympathetic;
acetylcholine
Constricts or Dilates for PANS:
blood vessels-
bronchioles-
pupil and lens-
Dilates BV leading to GI tract, increasing blood flow.
constricts bronchioles
constricts lens and pupil
This ANS stimulates salivary gland secretion
PANS, it also accelerates peristalsis and absorbs nutrients
Name two other names for parasympathomimetics(used to mimic the effects of the PANS)
Cholinergic agents or muscarinic (Boards will use these words)
What do cholinergic agents or muscarinic drugs treat?
xerostomia, urinary retention, glaucoma
1.)Name examples of cholinergic agents:
2.)Cholinergic agents is derived from what?
1.)Pilocarpine (stimulates saliva)
Nicotine
2.) plant alkaloids
Contraindications for cholinergic agents are all except:
a.) asthma (causes bronchoconstriction)
b.) peptic ulcer (increases GI secretion)
c.) xerostomia
d.) cardia disease (decreases heart rate)
e.) GI/Urinary obstruction(increases GI motility
C
Blocks acetylcholine receptors by inhibiting acetylcholine effects
Anticholinergic Agents
1.)Examples of anticholinergic agents are?
2.)The effects of anticholinergic agents are:
A-
B-
C-
D-
1.)Immodium (treats diarrhea)
Atropine (used pre-op to decrease saliva in dental setting)
scopolamine (used for motion sickness prevention)
2.)
A- Anticholinergic agents
B- Blurred vision and bladder retention
C- Constipation
D- Dry mouth
SANS neurotransmitter is?
Norephinephrine
True or False: Acetylocholine is also the neurotransmitter at the sympathetic preganglionic synapses, some sympathetic post-ganglionic synapses and at some sites in the CNS.
True
SANS or PANS-
Vasoconstriction
Dilates bronchioles of the lungs
increase heart rate
dilates pupils
SANS
*Dilates pupils
Another name for sympathomimetics is?
adrenergic agents
Cholinergic or adrenergic agents?
Epinephrine
Pseudoephrine
Albuterol
Adrenergic
PANS or SANS:
Used to treat: Colds, asthma, anaphylactic shock, glaucoma, cardiac arrest, ADD
SANS
What are some adverse effects of adrenergic agents?
**CNS disturbances (anxiety, fear, headache, tremor)
**Cardiac arrythmias
cerebral hemorrhage
pulmonary edema
Contraindications for those taking adrenergic agents include:
Epi is contraindicated in a cocaine or meth abuser if the abuser has used in last 24 hours.
Angina, uncontrolled hypertension or uncontrolled hyperthyroidism
Oral signs you can see in a methamphetamine abuser?What are the treatment options?
Rampant caries, burned mucosal surfaces-necessitating dental and dental hygiene intervention.
No meds are available, only cognitive behavioral interventions (usually HIV pts on Meth)
Adrenergic drugs to know are:
Albuterol- bronchodilator (ex.) Ventolin)
few cardio effects.
Dopamine-Drug of choice for SHOCK, administered by continuous infusion
Clonidine- Minimizes symptoms that accompany withdrawl from opiates and benzodiazepines (antianxiety)
B-Adrenergic Blocking Agents: There are two types of beta receptors: Beta 1 receptors located ______ and beta 2 located ?
Beta 1- Heart
Beta 2- all of the body but mainly in the lungs, muscles and arterioles
1.)Actions on the beta 1 receptors (increase of decrease) heart rate and BP and the heart itself requires more oxygen.
2.)What happens when beta 1 receptors are blocked?
3.)When is beta 1 prescribed?
1.)increase;
2.)They have an opposite effect: lower BP and HR and are useful when the heart itself is deprived of oxygen.
3.)After a heart attack
Beta blockers prevent the release of ____, which is a hormone produced by the kidneys which leads to constriction of BV.
renin
Drugs that block beta 2 receptors have a relaxing effect and are prescribed for anxiety, migraine and alcohol withdrawl, among others. Many beta blockers affect type 1 and type 2 receptors
_____ should not be used in patients with asthma or any reactive airway disease- doing so can block the effects of beta 2 agonists, such as albuterol.
Non-selective beta blockers
B adrenergic agents are effective in treating all of the following except:
a.) cardiac arrhythmias
b.) angina pectoris
c.) hyperthroidism
d.) myocardial infarction
e.) urinary retention
f.) glaucoma
g.) migraine prevention
E
Name the drug:
prototype of B-adrenergic blockers(works on heart and lungs)
lowers BP by lowering cardiac output
adverse reactions include: bronchoconstriction
arrhythmias
Propranolol
Name the drug:
reduces aqueous humor in the eye, used topically to treat glaucoma
Timolol (Tim has eye issues)
Name this drug:
Cardioselective B-blocker
Eliminates bronchoconstrictor effect
Used in treating hypertensive asthmatic patients
Atenolol (ATTENTION, someone is having an asthma attack!)
Name this drug:
Cardioselective beta-blocker
Used for hypertension, prevention of myocardial infarction and angina
Metroprolol (Lopressor)-can be used on patients with albuterol
*Know difference between beta blockers from diuretics and meds used to treat hypertension
Name a nonopiod analgesic
ASPIRIN- considered an NSAID
Aspirin uses include:
reduces fever-
reduces pain-
reduces inflammation-
antipyretic
analgesia
antiinflammatory
1)Aspirin reduces inflammation by interfering with ?
2)Fever reduced through action on what part of the brain?
1)prostaglandin synthesis (released from pain)
2)hypothalamus
Aspirin increases or decreases clotting time?
DECREASES
Side effects of aspirin are all of the following except:
a) interferes with clotting (contra with coumadin due to drug interaction)
b) Glaucoma
c) GI irritation
d) hypersensitivity
e.) Reye's syndrome
B
In children and adolescents with either chicken pox or influenza, the use of aspirin has been epidemiologically associated with this.
Reye's Syndrome
In place of aspirin, _____ is used in peiatrics for both is analgesics and antipyretic action.
acetaminophen
Aspirin: Toxicity (termed ______)
GI upset
Confusion and dissiness
Dim Vision
____(Ringing in the ears )
Respiratory and metabolic acidosis and death
Salicylism
Tinnitus
Nonsteroidal Antiinflammatory Drugs (NSAIDS)
Prototype: Ibuprofen
1)Mechanism of action: _________
2)Actions of ibp are: Name 3
3)This does not interefere with clotting. True or false
GI Irritation (contra with peptic ulcer disease, irritation is less tha
1)inhibition of prostaglandin synthesis;
2)Antiinflammatory
Antioyretic
Analgesic
3)False
____ is available in suspension form for pediatric use as an antipyretic.
ibuprofen
Ibuprofen can decrease the pharmacological effects of MANY drugs including all except:
a.) ACE inhibitors
b.) Aspirin
c.) beta blockers
d.) Antituberculosis agents
e.) corticosteroids
f.) cyclosporine
g.) Lithium
h.) Loop diuretics
D
What are the actions of acetaminophen?
analgesic
antipyretic
Acetaminophen has NO antiinflammatory action (therefore it is NOT considered an NSAID ) or effect on clotting.
TRUE OR FALSE
TRUE
What is the drug of choice for a patient on coumadin or with peptic ulcer disease and he has a headache?
Acetaminophen
Overdose of acetaminophen can result in?
hepatotoxicity
liver necrosis
death
For post operative pain medication recommendation following root planing is ibuprofen or acetaminophen?
acetaminophen
Used to manage pain when nonopioids fail. Blocks pain receptors in the brain without loss of consciousness. This is called ____.
Prototype: ______.
Narcotic/Opioid Analgesics
Prototype: Morphine
Other types are Demerol, Dilaudid, and Codeine
What is the most commonly used opioid used in dentistry?
Codeine (usually ued in conjunction with acetaminophen)
Codeine alone is a schedule ___ drug
A.) I
B.) II
C.) III
D.) IV
B. Schedule II narcotic, codeine in combination is a schedule III.
Codeine is also used as a _______.
Sign of overdose/addiction to ANY Opioid is dilated or pinpoint pupils?
antitussive (cough suppressant)
PINPOINT PUPILS
* An overdose with Opioids can lead to what?
Codeine may cause ___(vomiting), which is NOT a sign of allergy, its a SIDE EFFECT.
Respiratory depression and death
emesis
Codeine may lead to constipation- "C"odeine, "C"onstipation
This drug is an opioid antagonist, used to treat opioid overdose, should be in dental emergency kit.
NARCAN
Efficacious for treating narcotic withdrawl and dependence. Taken orally once a day, suppresses narcotic withdrawl for 24-36 hours. Only effective in cases of addiction to heroin, morphine, and other opioid drugs
METHADONE
Heroin users will exhibit ____pupils and cocaine users will exhibit ____pupils
heroin-pinpoint (The "hero" will pinpoint the bad guy)
cocaine-dilated
NSAIDS are the best pain medication for heroin addicts? True Or False
TRUE- they will also display a bluish tinge around the lips
The ability to kill bacteria, irreversible action is called:
bactericidal or bacteriostatic
bactericidal
The ability to inhibit or slow the multiplication or growth or bacteria is called: bactericidal or bacteriostatic
bacteriostatic
(look over page 385 on the board review book, I did not put all of them in here)
Lowest concentration needed to inhibit visble growth of an organism
Minimum Inhibitory Concentration (MIC)
Range of activity of a drug
Spectrum
Occurs when the combination of two antibiotics produces more effect than would be expected of their individual effects were added.
A.) Antagonism
B.) Synergism
B
Occurs when a combination of two agents produces less effect than either agent alone.
A.) Antagonism
B.) Synergism
A.) Antagonism
Most commonly prescribed antibacterial in the dental profession is called
PENICILLIN VK *****
effective against 90% of bacteria involved in dental infections
(amoxicillin, augmentin, ampicillin)
Most effective against rapidly growing organisms.
Penn VK preferred over ____ (which is inactivated by gastric acids) due to less erratic absorption.
Penicillin G
(Amoxicillin is preferred due to TID versus QID dosing)
Pencillins work by destroying _______which leads to lysis.****
bacterial cell wall integrity
1.)Penicillin is the most likely antibiotic to produce what?
2.)Most common allergic reaction is?
1.)Anaphylactic reaction (greatest danger of penicillin use) patients who are allergic to penn are also allergic to its derivatives.
2.) A rash
Penn CAN be given to pregnant women, TRUE or FALSE
TRUE
Amoxicillin is NOT effective against penicillinase, also known as ______.
Clavulanic acid + amoxicillin=______
beta lactamase
Augmentin (prevents penicillinase from breaking it down)
1.)Avoid use of this drug in pregnancy and early childhood due to tooth discoloration.
2.) What should you NOT take with this drug?
1.)Tetracyclines
2.) dairy products, antacids, or iron tablets (causes chelation of this drug which reduces GI absorption)
Mixing tetracyclines with other antibiotics usually results in _____
ANTAGONISM
Tetracycline has an ability to concentrate where? ****
GINGIVAL CREVICULAR FLUID****
Tetracycline is often used topically to treat ________ disease,
May be used systemically to treat ______
AGGRESSIVE Perio
NUG/NUP
***Tetracycline antibiotics including doxycycline- are bacteriostatic and work by ___________
inhibiting protein systhesis
An example of Nitromidazole is :_____
This drug is effective against what type of bacteria?
a.) anaerobes
b.) aerobes
c.)obligate anaerobes
s.) facultative anaerobes
Due to anabuse like reaction, alcohol should be avoided which means the patient should us
Metronidazole
obligate anaerobes
Zero Alcohol mouth rinse for this patient on this drug. Vomiting can occur! (Adam is metro and will vomit if he consumes alcohol)
Most common side effects of antibacterials is:_______
Secondary fungal infections like: ________ and ______.
GI upset (cramping, nausea, comiting, diarrhea)
candidiasis and yeast infections
Allergic reactions can also occur.
Name 4 antituberculosis agents:
"Think RIPE
Rifampin-red urine, tears and saliva
Isoniazid-may lead to hepatotoxicity
Pyrazinamide-may lead to hepatoxicity
Ethambutol-decreased red/green color discrimination and visual acruity
Myambutol is also known as ______.
Rifater refers to ____
Ethambutol;
isoniazid, rifampin and pyrazinamide
_____may be given in place of ethambutol.
Streptomycin
* If the patient indicates taking isoniazid ONLY, it is most likely being prescribed for what?
a PREVENTATIVE agent against tuberculosis
___ many sputum smears are necessary to determine the person no longer has TB
3 consecutive smears
The _____is an antigen used to aid in the diagnosis of TB exposure; known as Mantoux skin test
(PPD) Purified protein derivative
A reaction us measured in millimeters of induration (meaning you have it) (hard swelling) at the site approx 48-72 hours after PPD has been administered.
A positive sign does mean the person has TB. True or False
FALSE
***A positive sign does NOT mean the person tested has ACTIVE disease! Only that they have been EXPOSED to the disease!
*Differentiate between TB drugs and HIV drugs
Fungal infections common after ______ or ____use and in _____individuals
antibiotics or steriod
immunocompromised
___topical antifungal agent is most frequently used in dentistry. Used to treat candidiasis.
This common antifungal medication can be taken orally. _______
Nystatin;
Fluconazole (diflucan), others are Mycelex(clotrimazole) and Nizoral (ketoconazole)
Cardiac conditions in which an antibiotic needs to be taken prior to a dental appointment are all except: (can be more than 1)
a.) Artifical heart valves
b.) history of infective endocarditis
c.)Mitral valve prolapse
d.) Rheumatic heart disease
e.) Bicusp
C,D, E, F
A patient does not need a premed if they have a ventricular septal defect, atrial septal defect, or hypertropic cardiomyopathy. True or False
True
These patients DO need a premed before their appointment: True/False
a.) unrepaired or incompletely repaired cyanotic congenital heart disease (including those with shunts and conduits)
b.)Completely repaired congenital heart defect with prosthetic materi
True
Most prosthetic joint prostheses do NOT need a prophylactic antibiotic coverage.
True or False
TRUE (For the sake of the board, know it this way)
It may be needed if it has been less than 2 years following replacement surgery, previous infections, or multiple joint replacements
ANSWER YES or NO
Premed for Stents?
Premed for Shunts?
Splenectomy?
Lens and Breast Implants?
IV drug abusers?
No
Yes (Will you marry me? Shunt up! Yes I will!)(This is a Non cardiac condition)
No-More than 2 years after surgical removal. (This is a Non-cardiac condition.)
No
Yes-IV abusers have potential for constant bacteremias.
Drug regimens for the heart:
If patient is not allergic to penicillin, administer amoxicillin: _____mg, ___mins to ___hr before procedure for adult patients; ___mg/kg for children.
If patient is allergic to pens, administer what drugs?
2000mg(2g) 30 mins to 1 hr; 50mg for children
cephalexin or other first generation oral cephalosporin, clindamycin, azithromycin, clarithromycin
Drug Regimens for Joint Replacements:
If patient is not allergic to penicillin, administer: amoxicillin ____mg, _____hr before procedure.
If patient is allergic to penicillin, administer one of the following drugs ____minutes prior to procedure
Cephalexin
2000mg(2grams) one hour before;
30-60mins
2000mg
2000mg
name the abbreviations:
1)ac-
2)gt-
3)hs-
4)by mouth-
5)after meals-
6)prn-
7)qd-
8)sig-
9)ud-
1-before meals
2-drop
3-at bedtime
4-po
5-pc
6-as needed
7- every day
8- label;instructions for use
9- as directed
Heroin is a schedule___ drug because it is the highest and has no accepted medical use.
Written prescription with providers signature only;no refills is a schedule ___ drug
Schedule___-Can be purchased OTC in some states.
Schedule___is same as schedule II
I-highest abuse potential
II- High
V-Least abuse potential
IV-Less
III** Moderate abuse potential
1-Any prescription for a controlled substance requires a ______.
2-Any prescription for a schedule II must be ____ or ____
3-Some states require the use of triplicate prescription blanks for schedule ___ drugs.
1-DEA number;
2-written or typed. A designate of the dentist( such as a dental hygienist) may write the prescription but the prescriber must personally sign the prescription in ink.
3- III
Potent CNS depressants. Produces a reversible loss of consciousness and insensitivity to painful stimuli. Nutrous oxide is considered an incomplete anesthetic.
General Anesthetics.
Put in order the stages of anesthetics:
a.)Delirium or excitement: Begins with unconsciousness and is associated with involuntary movement and excitement.
b.) Respiratory or medullary paralysis: Complete cessation of all respiration, if this stage is not
C,A,D,B
*______such as Valium may be given PRIOR to general sedation.
Benzodiazepines
Usually short acting barbiturates. Intravenous _____ used for sedation in dental setting.
Intravenous anesthetics;
benzodiazepines
Inhaled anesthetics: _____is most commonly used inhaled anesthetic. Rapid onset, rapid recovery. Works by raising pain threshold
Nitrous Oxide; exhalation route of excretion. No biotransformation (breathe out same way taken in) Sweating caused by vasodilation of extremities.
Nitrous oxide tanks are what color?
Blue
_____ System must be in place for removal of nitrous oxide (prolonged exposure assoc. with increased abortions and miscarriages.
Scavenger
*****What are some contraindications for Nitrous Oxide?
COPD, URI (includes stuffy nose), emotional behavioral instability, pregnancy (first trimester MOST crucial), Cystic fibrosis, lack of communication (language barrier
**** Long term recreational abuse of nitrous oxide can lead to:
Neurological symptoms similar to Parkinson's Disease. Vitamin B12 deficiency leading to numbness and tingling in extremities.
Inflammation is related to ____ Drugs. Specific ___ drugs are used to treat: congestive heart failure, angina, hypertension.
Cardiovascular Drugs: hypertension, angina, heart attack, congestive heart failure, arrhythmias, CVA.
Contraindications: Acute myocardial infarction-within 3-6 months, unstable angina, uncontrolled congestive heart failure and arrhythmias, significant, un
Most common type of drug used in treatment of CHF (increases contractile strength)-_______
_____is most commonly used product.
-Digitalis Glycosides;
-Digoxin (Lanoxin)- increases gag reflex and salivation. (Tetracycline and erythromycin increase digoxin levels.
Digitalis Glycosides: in combination with sympathomimetics, digoxin can lead to cardia arrhythmias; therefore, ___- added to LA should be used with caution****
vasoconstrictors
Drug of choice for acute angina.
Nitroglycerin- works as a vasodilator (specifically, smooth muscle relaxant)**** Generally given sublingually to treat angina attacks.
Most often patients are asymptomatic (occasional headache, visual changes and dizziness are experienced). Most common of all cardiovascular diseases affecting 60 million Americans.
Hypertension (Meds)
Considered first line therapy for hypertension. Promotes excretion of sodium and water which decreases blood volume and pressure.
Diuretics
Most commonly used thiazide diuretic, associated with xerostomia. Must avoid orthostatic hypotension (slowly rise chair)
hydroclorothiazide
Most common loop diuretic. Used in management of hypertensive patients with CHF (high bp)
Furosemide (Lasix)
Propranolol (Inderol) and Metaprolol (Lopressor) are what type of drugs?
A.) Calcium channel blockers
B.) ACE inhibitors
C.) B-Adrenergic Blocking Agents
D.) Anticoagulants
C.) B-Adrenergic Blocking Agents-decreases cardiac output-second line of therapy.
Epi is okay to use on a patient taking nonspecific B-blockers. True or False
FALSE! The patient may have a 2-4 fold increase in vasopressor response; use caution with EPI USE!!! Neither gingival retraction cord containing epi nor 1:50,000 should be used!!
Work by producing systemic vasodilation by BLOCKING vasoconstriction in smooth muscle of blood vessels. One of the few antihypertensive agents whose effect is NOT reduced by NSAIDS. Causes-Xerostomia and gingival englargement
Calcium Channel Blockers
Cardizem (Dilitiazem)
Nifedipine (Procardia, Adalat)
are drugs used for what?
Calcium Channel Blockers used for hypertension
Blood pressure is lowered when these drugs block the conversion of _?__ to __?___ (causes vasodilation). Hypertension medication. Dysgeusia(which means _?_____)is common oral side effect.
Adverse reactions: Hypotension, allergic rxns, Dry cough**
1)angiotension 1 to angiotension 2
2) altered taste
3)Angiotension Converting Enzyme Inhibitors (ACE)
What is Lisinopril (Prinivil, Zestril), Captopril (capoten), and
Enalapril (Vasotec)
used for?
To lower BP, they are ACE inhibitors!!!
____ decrease the effectiveness of ACE inhibitors!!
_____ is a common ACE inhibitor used primarily for CHF.
Avoid ____ hypotension with ACE inhibitors
NSAIDS
Enapril
postural (orthostatic)
The most common therapy to reduce intravascular clotting is ____.
The most serious drug interaction of this is _____.
Prevents the conversion of the inactive vit. ___ to its active form.
Anticoagulants (Warfarin (Coumadin);
Aspirin;
Vit. K;
Antibiotics can also potentiate the effects of warfarin (due to effect on vit. K)
*
Dose reduction only advised by physician, allow several days for a change in effect if dose of warfarin is changed du
One of the most commonly employed anticoagulant agents in hospitalized patients-_____. Given by ____ only!
Heparin;
injection only
What is Phenytoin (Dilantin) used for?
What does this cause?
Often used in conjunction with ____?
Anticonvulsant;
gingival overgrowth;
phenobarbital
Most common barbiturate used in the treatment of epilepsy. Most common side effect is sedation.
Phenobarbital
Structurally related to tricyclic antidepressants-_______;
Used primarily for______; Special interest in dentistry because it frequently is used to treat ______*****
Does this cause gingival hyperplasia?
Carbamazepine (Tegretol);
parital seizures;
Trigeminal neuralgia;
does NOT cause gingival hyperplasia
A sharp pain is confined to one side of the face and can be initiated by touching a trigger zone. Which of the following best characterizes this condition?
A) Bell's palsy
B) Herpes zoster
C) Cerebral palsy
D) Trigeminal neuralgia
E) Myofascial pain dysfu
D.) Trigeminal neuralgia
Name the most common antihistamine-____.
Used to treat mild allergic rxns. Side effects are:____ and _____.
Antihistamines block ___receptors.
___ receptors: (bronchospasm and vasodilation); where antihistamines work.
___ receptors (gastric acid secretion
Benedryl;
xerostomia and sedation;
histamine;
H1
H2
Used to manage Diabetes Mellitus:____; usually administered by _____.
The most common adverse reaction assoc. with insulin is ______
Insulin;
subcutaneous injection;
hypoglycemia
Non-insulin dependent is Type ___ (therapy-oral hypoglycemics such as _______.
Insulin dependent (therapy-_______)
____ is an oral medicine used to treat NIDDM.
Shortness of breath is or is not associated with hypoglycemia.
Type 2; metaformin {glucophage}
Type 1; insulin subcutaneously;
Glyburide (DiaBeta, Micronase);
Is nOT
For mild asthma, recommended tx is inhaled:
a.) B-antagonist
b.) B-agonist
as needed, example of this is:
Answer=B-Agonist=Albuterol
____ is used to alleviate acute attack of asthma, rarelyt used
____ produces dilation, useful as bronchodilator in tx of asthma and reverse bronchospasm
Isoproterenol;
Metaproterenol;
Short acting bronchodilator: _____, used for immediate relief.
_____- Used for long term to prevent asthma attacks. ex.)______.
Corticosteroid plus long acting bronchodilator ex.)_______.
Long acting bronchodilators: relieves asthma for longer periods of
Albuterol (Proventil, Ventolin) and (Pirbuterol) Maxair ;
Corticosteroids-Flovent (budesonide);
Advair;
Salmeterol (Serevent)
_____ is used to treat chronic asthma and bronchospasm assoc. with emphysema and chronic bronchitis; _________ can increase serum levels of this drug and toxicity may result.*****
Theophylline;
erythromycin
*** _____ Should be avoided in asthematics (4-19% have aspirin hypersensitivity)
Aspirin
COPD Meds: _____ are the first line of treatment;
____ is the drug of choice for long term management of COPD
Anticholinergics;
Ipratropium (Atrovent)
Upper Respiratory Infections: Nasal decongestants are B-adrenergic agonists that act to ___ the blood vessels of the nasal mucosa. Should not be used more than few days at a time because of rebound swelling and ___.
Drugs that promote removal of exudate o
constrict;
congestion;
Expectorants'
antitussives
_____ is a systemic antacid that is contraindicated in some CV patients due to high sodium load.
Sodium bicarbonate
Antacids:Partially neutralize hydrochloric acid in stomach. Can inhibit absorption of: ___,___, and ___
Tetracyclines, Digitalis, and Iron
___ is the most prevalent GI disease in the U.S.
GERD (Gastroesophageal reflux disease
GERD is treated in 2 ways. Name them
Histamine 2 Blocking Agents;
Proton Pump Inhibitors (PPI)
Histamine 2 Blocking Agents (ex. Cimetidine (______), famotidine (____) should not be used in combination with ____ (disrupts absorption).
Protein pump inhibitors ex.)_____
TagametHB; Pepcid AC
Omeprazole (Prilosec; potent inhibitor of gastric acid secretion.
The patient who lists Tagamet on the health history is likely to be treated for ____ ____.
Gastric Ulcers-DO NOT cause gingival bleeding!
Zidovudine (AZT), Didanosine (ddl), Zalcitabine (ddC), Stavudine (d4T), are commonly used for what infections?
HIV infections (Also HIV Protease inhibitors)
Synthroid is given for:
a.) hyperthyroidism
b.) hypothyroidism
If the patient is suddenly taken off this, what can occur?
hypothyroidism-Caution when using EPI anesthetics!
Myxedema Coma
ALl are acceptable drugs to use during pregnancy except:
a.)local anesthetics; lidocaine, prilocaine, mepivacaine
b.) acetaminophen
c.) aspirin
d.) penn V
e.) amoxicillin, and nystatin
f.)cephalosporins, clindamycin
C.) Aspirin
Also, LA will not affect a nursing baby!
If penicillinase is cultured from an infection, what should not be given?
Amoxicillin
NSAIDS increase or decrease the effectiveness of muscle relaxants?
decrease
The Nicotine Replacement Therapy that begins working faster than other nicotine replacement products is:
nicotine nasal spray (fastest nicotine blood level)
Zyban(wellbutrin)-antidepressant used for smoking cessation
Chantix- non nicotinic medication
SSRIs (Selective serotonin inhibitors) are used for what?
Name a few examples please!
antidepressants
Fluxetome (prozac), Sertraline (zoloft), Citalopram (celexa), Escitalopram oxalate (Lexapro), Paroxetine (Paxil, Paxil CR)
____ are antidepressants rarely used today due to fatal interactions with certain analgesics (ex.) demerol, SSRI's, tyramine containing foods (aged cheese, smoked meats/fish, beer/wine, etc.)
MAO's (Monoamine oxidase inhibitors
Lipitor (Atorvastatin) and Mevacor (Lovastatin) is used for what?
lower cholesterol