4 Flashcards
- group of disorders that involve a chronic stereotyped recurrent attack of involuntary behavior or experience or changes in neurologic function caused by electrical activity in the brain that can be recorded via an EEG
epilepsey
Each eppileptic episode is termed as a
seizure
causes of epilepsey
- infection
- trauma
- genetic or birth influences
- fever
- metabolic/nutritional alterations
- neoplasms
- hereditary
- degenerative diseases
2 major groups of seizures
partial and generalized
simple and complex
partial
tonic clonic and absense
generalized
consciousness is lost in
both types of seizures
petit mal
absense
what is a brief loss of consciousness with characteristic EEG waves and little movement
peitit mal
petit mal usually begin
in childhood
when you have a case of petit mal you are usually
unaware that the seizure is happening
no aura or postical state in
petit mal
drug of choice for tx for petit mal is
ethosuximide or valporic acid
grand mal
tonic clonic
in tonic clonic there are
long period of unconsciosnes
- seizure begins by patient becoming rigid and falling to the ground, then jerking begins, finally the patient becomes limp and comatose
- consciousness returns gradually => confusion, headache, drowsy
tonic clonic
drugs used to treat grand mal are
- Valproic acid, phenytoin (Dilantin), Phenobarbital, and carbamazepine
- Continuous tonic-clonic seizures lasting longer than 30 min. or reoccur before the end of the previous seizure
- an emergency situation
- rapid therapy is required
status epilepticus
drug of choice for status is
- Parenteral benzodiazepines (Valium [diazepam])
the goal of - Parenteral benzodiazepines (Valium [diazepam]) for status epileptiucsu is
- goal is to control seizures and minimize potential adverse reactions
- anticonvulsants are CNS depressants that attempt to prevent
epileptic seizures without causing excessive drowsiness
- usually taken for life
Carbamzepine
tegretol
valproates
depakote
phenytoin
dilantin
- Used to treat convulsions
- Used in dentistry to treat trigeminal neuralgia (tic douloureux)
- CNS depression and GI tract problems are common side effects
- Carbamazepine (Tegretol)
- Sedation and drowsiness
- Deaths have been reported due to hepatic failure
- Hepatic function tests should be performed
- bleeding time may be prolonged
- additive CNS depressant effect
- Valproates (Depakote)
- Most common barbiturate used in the treatment of epilepsy
- Used alone or in combination with phenytoin (Dilantin)
- Used to treat tonic-clonic and partial seizures
- Most common side effect is sedation
phenobarital
most common barbiurate used in epilepsey
phenobarbitol
most commonly used hydantoin
phenytoin dilantin
phenytoin dilantin is associated with
gingival enlargement greater than 50 percent of chronic users
phenytoin dilantin is used to treat both
tonic clonic and partial seizures
what can be used to treat trigeminal neuralgia
phentyoin
You must monitor blood levels of drug with
phentoyoin
some patients when taking phenytoin experiene
hirustism
excess hairness of the trunk or face
hiristism
term given to the congenital abnormality associated with maternal ingestion of phenytoin
fetal hydantoin syndrome
- Craniofacial anomalies, mirocephaly, limb defects, growth deficiency, and mental retardation
fetal hydantoin syndrome
- management of gingival enlargement includes:
- discontinue phenytoin
- improve oral hygiene
- gingivectomy => surgical elimination
management of patient expeirncing tonic clonic seizures
- moving patient to the floor
- tilting the patients head to one side to prevent aspiration
- remove objects from the patients mouth
- Vitals
- 911 if needed
- occurs naturally in the body, are produced by many tissues, and are formed by the tissues on which they act
autacoids
autoscoid antagonists include
- H1 – H2 receptor blockers
- eicosanoids (prostaglandins, thromboxanes, and leukotrienes)
- serotonin agonists
- angiotensin inhibitors
- cytokinins
where is histamine stored
in the mast cells in the intestinal mucosa and in the CNS
histamine is released from tissues in body by
normal reactions
abnormal reactions
administration of certian drugs
h1 agonist effets of histamine
- vasodilation
- increased capillary permeability
- bronchoconstriction
- pain or itching in cutaneous nerve endings
h2 agonist effects of histamine
- Increased gastric acid secretion
serious
adverse reactions of h2 agonist histamine
anaphalayxis
drug of choice for anaphylasix is
epinephrine parenterally
h2 agonist
- (epi => dilates bronchioles via B2 receptors)
Antihistamines (H1 – Receptor Antagonists)
- antihistamines are agents that are H1 – blockers (prevent or blocks action of histamine)
4 common antihistamines
- diphenhydramine (Benadryl)
- chlorpheniramine (Chlor – Trimeton)
- promethazine (Phenergan)
- loratidine (Claritin)
- diphenhydramine
benadryl
- chlorpheniramine
chlor- trimeton
- promethazine (
phenergran
loratine
claritin
- the H1 – antagonists competitively block or anttagonize histamines effect at:
- Capillary permeability => less tissues edema
- vascular smooth muscle => blocks the dilation of the vascular smooth muscle
- bronchial smooth muscle => bronchodilator
- nerve endings => suppresses pain and itching
less tissue edema
capillary permeability
blocks the dilation of the vascular smooth muscle
vascular smooth muscle
bronchodilator
broncial smooth muscle
suppress pain and itchinb
nerve ending
can produce sedation
principle agent used in OTC sleep aids (Sominex, Nytol)
diphendyramine
- used to treat motion sickness
- also used to treat allergic rhinitis/seasonal hay fever; urticarial attacks (itching)
- meclizine (Dramamine)
meclinzine
dramamine
- they do not cross the blood-brain barrier therefore, no sedation
- usually more expensive
Peripheral (Nonsedating) H1 – Receptor Antagonists
peripheral
nonsedating
developed to replace seldane
fexofendaine *allegra
fexofendaine
allegra
duation of action is 1 2 hours for
fexofendaine
doage is 60 mg 2 times a day for
fexofenaindeine
astemizole
hismanal
- Non-sedating
- MUST be taken on an empty stomach
has been taken off markey
astemizole
hismanal
astemizole is inhibited by
erythromycin/ketoconazole
- Non-sedating
- Duration of action is 24 hours
loratidine claritin
- Recently released
- Seasonal rhinitis
- Duration 24 hours
cetizirine zyrtec
cetirizine
zyrtec
h2 blocking agents
- Cimetidine (Tagamet)
- Used for GI problems (acid reflux)
- Zantac, Pepcid,Axid
a group of agents secreted by the adrenal cortex
- uses in dentistry:
adrenocorticosteroids
- used topically or systemically for the treatment of oral lesions associated with inflammatory diseases
adrenocorticossteroids
2 major groups of adreno
glucocorticoids
mineralcorticoids
affect intermediate carbohydrate metabolism
glucocroticoids
affects the water and electrolyte composition of the body
- the major glucocorticoid present in the body is CORTISOL (hydrocortisone)
mineral coritcrotioids
disease produced by a deficiency of adrenocorticosteroids
addisons disease
components released from adrenal cortex, which includes glucocorticoids/mineralocorticoids
adrenocorticosteroidss
corticosteroids
steroids
agent secreted by the pituitary that causes the release of hormones from the adrenal cortex
Adrenocorticotropic hormone (ACTH)
disease caused by an excess of adrenocorticosteroids
- characterized by “moon facies”, buffalo hump (fat deposited on back of the neck) and weight gain
cushings syndrome
affects carbohydrate metabolism
glucocorticoids
affects the body’s sodium and water balance (fluid levels)
mineralcorticoids
are pallative rather than curative
corticosteroids
most extenisive use of coritcosteroids in medinine and dentistry is in the tx
of a wide variety of inflammatory allergic conditions
- rheumatoid arthritis, rheumatic fever, lupus, acute bronchial asthma, and severe and acute allergic reactions
is the most common corticosteroid used orally
prednisone
- Topical corticosteroids:
- Hydrocortisone (weakest)
- Triamcinolone (in between)
- Augmented betamethasone (most potent)
- adrenocorticosteroids stimulate acid secretion
cautions with ulcer patients
- can exacerbate hypertension
are essential in small quantities for the maintenance of cell structure and
metabolism
vitamins
vitamins are
- they are a group of low-molecular-weight compounds
- classified into 2 groups:
- water soluble => vitamins B and C
2. fat soluble => vitamins A, D, E, and K
water soluable
b and c
fat soluable
a d e k
vitamins act in three ways
- as coenzymes => water soluble vitamins
- as antioxidants => vitamins C & E
- as hormones => vitamin A & D
co enzymes
water soluable vitamins
antioxidants
c and e
hormones
a and a
ascorbic acid
vitamin c
vitamin c natural sources
- Citrus fruits, green peppers, tomatoes, strawberries, broccoli, raw cabbage, baked potatoes, and papaya
vitamin c is readily destroyed
by cooking
RDA for vitamin c is
60 mg
required for collagen and wound healing
vitamin c
definiecny of vitamin c
scurvy
- Functions of Vitamin C are:
- Collagen formation
- Sythesis of epinephrine/norepinephrine
excess intake of c can
intake (1 gm/day) can lead to precipitation of oxalate stones in the urinary tract (kidney stones)
- enhances the absorption of Iron (Fe
- Thiamine (Vit. B1)
- Pork, whole-grain breads, cereals, pasta, peas, dried brewer’s yeast
thiamine b1 is destroyed by heat greater than
100
- RDA => adult – 1.5 mg (males), 1.1 mg (females)
b1
definecny of b1 leads to
beriberi - Peripheral neuritis, muscle weakness, paralysis of limbs, enlargement of heart, tachycardia
- oral manifestations
burning tongue with
b1 thimanine
most common use of thamine deficiecy is
alcholism
- Wernicke’s encephalopathy/Korsakoff’s associate with
b1 thiamine
- Wernicke’s encephalopathy/Korsakoff’s
severe deficiency
- thiamine has also been used as an insect repellant
riboflavin
vitamin b2
riboflavin b2 is
h20 soluable
best sources for ribovlain b2 is
dairy products organ meat liver
what is destroyed by uv radiation
b2
RDA range 1.3-1.8
b2
b2 maintains integrity of
erythrocytes
symptoms of b2 are
sore throat and angular cheilitis
- Most likely seen in alcoholics or patients with severe GI disease causing loss of appetite
b2
niacin
nicotinic acid
b3
niacin is connected in the body to
niacinamide or nicotinamide
- Deficiency of niacin is called
pellegra
- Sources of niacin are:
- Lean meats, fish, liver, poultry, peas, and whole grains
- RDA => 15-20 mg
b3
pellegra is associated with
b3
pellegra can be diagnosed by the three ds
- Dermatitis, diarrhea, and dementia
- burning sensation throughout the mouth and the tongue is beefy red
____ can occur => 1 ASA ½ hour before the niacin is ingested
fushing
b3 niacin is useful in the treatment
hyperlipidemia
b6
pyridoxine
sources of b6
whole-grain cereals, meat, peas, eggs
- RDA => 1.5 – 2 mg/day
b6 pyridoxine
- Vit. — deficiency is rare
- Vit. —is inhibited by isoniazid (INH)
b6
- Is destroyed by heating in neutral or alkaline solution
folic acid
folic acid sources are
- Sources => liver, fruits and vegetables, wheat germ, and yeasts
- RDA => 180-200 g (micrograms)
folic acid
deficiency is the most common deficiency in the US and can produce megaloblastic anemia
folic acid
causes of def in folic acid
- Causes => inadequate diet, pregnancy, chronic alcoholism
allergic reactions are rare in
folic acid
- Cyanocobalamin
b12
- has a cyanide molecule attached to the cobalt atom
Cyanocobalamin
vitamin b 12
- only sources of Vit. B12 in nature are certain microorganisms that synthesize the vitamin
- good sources => liver, meat, milk, cheese, and eggs
- RDA => 2 g (micro) with an additional .2 g and .6 g during pregnancy and lactation
b12
pernicious anemia is associate with
b12
- With pernicious anemia
a maintenance injection of B12 is recommended once a month for life
is important in the metabolism of fats/carbs
b12
autoimmune disease that prevents the production of intrinsic factor => blood clotting
pernicious anemia
burning tongue syndrome
b12
- B12 supplement is recommended
im route 100/month
- Egg yolk, bran, yeast, and beef liver
- RDA => 5-10 mg
panthotenic acid
required for gluconeogenesis and synthesis of fatty acids and sterols and steroid hormones
panthothenic acid
- It is essential to normal epithelial function
panthotehnic acid
- Deficiency is rare but can develop in people with liver disease or alcoholism
panthotenic acid
- Necessary for normal growth and for maintaining the health and integrity of certain epithelial tissues
vitamin a
- Vit. A represents a group of
retinoids and carotenoids
a and a 2
retinoids
retonoids are found in
orange colored fruits/veg
provide the greatest source of Vit. A in most diets
carotenes
- Found in => apricots, peaches, tomatoes, carrots, pumpkins, broccoli, spinach, and sweet taters
carotenes
rda for vitamin a
- RDA => 800-1000 refined equivalents (RE) [800-1000 g]
is essential for the maintenance of the photoreceptor mechanism of the retina
vitamin a
vitamin a
prevents or reverses the transformation of premalignant cells to malignant cells
a def in vitamin a will lead to
night blindness (nyctalopia) => impaired vision in dim light
nyctalopia
night blindnes
- Excessive intake of Vit. A results in a
toxic condition
toxic condition
hypervitaminosis a only after long term daily digestion of more than 50,000 re
- Use or exposure to ——- during pregnancy can cause serious birth defects => pregnancy category “X”
retinoids
tretinoin
retin a
isotretinoin
accutane
etretinate
tegison
vit a analouges
- Tretinoin (Retin – A)
- Acid form of Vit. A
- Used to treat acne (topically)
- Isotretinoin (Accutane)
- Used orally for severe cystic acne
- Pregnancy category “X”
- Etretinate (Tegison)
- Treat severe recalcitrant psoriasis
- Pregnancy category “X”
- Lifetime ban for being a blood donor
vitamin d is a collective term for
d2 and d3
produced in the skin of mammals by Sunlight (UV rays)
d3
ergocalciferol
d2
the form of vitamin D used in vitamin supplements
d2
- RDA => 10 mg (400 IU) => child; 5-10m (200-400 IU) => adults
vitamin d
- Promotes mineralization of bone by stimulating intestinal absorption of calcium
d
def of vitamin d in children is known as
rickets
- Usually have bones that are unusually soft and easily bent, compressed, or fractured
- Curving of the spine and bowing of the legs
- Collapse of the ribs and protrusion of the sternum (pigeon breast syndrome)
rickets
- adult deficiency => in d is
osteomalacia
decreased bone density in
d
occurs when the equilibrium between resorption and formation of bone becomes negative
osteoporosis
osteoporosis vitamin d occurs in
thin white female smokers
predisposing to fractures
- recommended calcium intake of ——–mg recommended for post-menopausal
1200-1500
- 3 drugs for the management of osteoporosis:
- Fosamax, Etidronate (Didronel), Calcitonin (Miacalcin)
etidronate
didronel
miacalcin
calcitonin
functions as a antioxidant
vitamin e
- Sources => vegetable oils, greens and vegetablesq
e
rda of e is
10-30
def of e is
anemia
- Dose for protective cardiovascular effect is —IU for vitamin e
400
- Occurs in green vegetables => alfalfa, cabbage, spinach, egg yolks, liver
k
- RDA => males – 40-80 g; females – 45-65 g
k
e is assential for four clotting factors
(II, VII, IX, and X)
- Antagonized by anticoagulant drugs (warfarin)
k
iron
zinc
calcium
minterals
iron
fe
found as hemoglobin
iron
____ of the iron in the body is essesential
80
rgan meats (heart/liver), brewer’s yeast, egg yolks, oysters, red meats, and dried beans
iron
- RDA => males – 10 mg/day; females – 15 mg/day
iron
- Basic function is to allow movement of O2 and CO2 from one tissue to another
iron
def of iron is
anemia
decrease in the quality or quantity of RBC’s
anemia
- sources => seafood and meat
- RDA => 15 mg/day
- Required to transport CO2 in blood and eliminate it in the lungs
- Deficiency can affect reproduction and can stunt growth
zinc
- 5th most prevalent element in the body
calcium
calcium is in
- present in bones, teeth, and extracellular fluids
- RDA => 800-1500 mg
calcium
caclicum can be
- Can be used parenterally to elevate serum calcium in an emergency
- Also used during CPR, treatment of hyperkalemia, and hypermagnesemia
patients taking dilantin may exhibit
vitamin d def
are secreted by endocrine glands
- pituitary, thyroid, parathyroid, pancreas, adrenals, gonads
hormones
s a small endocrine gland located at the base of the brain
pituitary gland
- Called the “master gland” => regulates effect on other endocrine glands and organs of the body
pituitary gland
pituitary gland definicieny is
- deficiency is known as hypopituitarism
- produces decreased metabolism - Addison’s disease
- dwarfism - decreased libido
- diabetes - retarded dental
- hypothyroidism development
- hypersecretion of pituitary hormones can produce
- sexual precocity (premature development)
- goiter
- Cushing’s disease
- Acromegaly
- Gigantism
premature development
sexual precocity
growth hormone
somaotropin
- Secretes growth hormone (somatotropin), luteinizing hormone (LH), follicle-stimulating hormone (FSH), thyroid stimulating hormone (TSH), adrenocorticotropic hormone (ACTH)
- FSH/LH used in the treatment of infertility
anterior piuitary
posteriour pituiatry secretes two hormones
vasopression and oxytocin
used for the treatment of transient diabetes insipidus
vasopression
used to induce labor, control postpartum hemorrhage, and induce postpartum lactation
oxytocin
- Thyroid gland secretes 2 iodine containing thyroid hormones:
- Thiiodothyronine (T3) and tetraiodothyronine (T4 – thyroxine)
- 50-125 mg/day
- iodine deficiency is known as goiter
- marine life is the only common food that is naturally rich in iodine
- use of iodized salt has lead to a decrease in goiter
iodine
- Thyroid hormones are synthesized from
iodine and tyrosine
tsh stimulates release
also secreted by the thyroid, regulates calcium metabolism
calcitonin
- Hypofunction of the thyroid in
cretinism
- Hypofunction of the thyroid in
myxedema
- Main characteristics are mental/physical retardation
hypthyroidism
- Most commonly used hormone for replacement therapy
levothyroxine (synthroid)
cold intolerancle with
hypthyroidism
2 forms of hypthyroidism
graves and plummer
diffuse toxic goiter => enlarged, highly vascular
graves
toxic nodular goiter => nodules within gland
plummer
- heat intolerance
- exophthalmos (protruding eyes)
- excess levels of circulating thyroid hormone produce thyrotoxicosis
- the use of epinephrine should be avoided if poorly treated or untreated thyrotoxic patients => arrhythmias and cardiac arrest
hyperthyroidism
- treatment of hyperthyroidism:
- radioactive iodine 131I \ both will create hypothyroidism
- thyroidectomy / (Tx with synthroid after)
- 2 1 hormones secreted by the islets of Langerhans if the pancrease are:
- insulin (fuel storage) + glucogon (fuel mobilization)
insulin
fuel storage
glucogon
fuel mobilzation
- insulin (fuel storage) + glucogon (fuel mobilization)
diabete mellitus
classes of diabete mellitus
- Classifications:
- Type I (IDDM)
- Type II (NIDDM)
- new criteria for the diagnosis of DM is 2 consecutive fasting blood sugars of greater than — mg/dL
126
3 ps in diabetes mellitus
- 3 P’s => polyphagia, polydipsia, and polyuria
type 1
iddm
- Usually in patients younger than 30 years
- Results from an autoimmune destruction of the pancreatic cells
- Complete lack of insulin secretion
- Without insulin => FATAL
- Tx with injections of insulin
type 2 niddm
- Older than 40 years
- Pancrease secretes enough insulin to prevent Ketoacidosis, but not enough to normalize plasma glucose
- Type II has a slower onset, less severe symptoms, lack of Ketoacidosis
- Treated first with diet and exercise, then oral agents, and then insulin
- complications of diabetes:
- susceptible to dental caries
- xerostomia
- periodontal disease
- delayed wound healing
- can cause blindness
- gangrene => feet/legs
measure of the patients glucose control at the time that the blood is sampled
serum gluclose
- Tx of hypoglycemia
- Awake => fruit juice, cake icing, glucose gel
- Unconscious => IV dextrose (50%)
- Insulin
- Administered by
sq injection
- Insulin
- Administered by
nph
neutral protein hagedorn
assoc with inslunin
- Lowers blood glucose but used alone, does not produce hypoglycemia
- Dose 500-2550 mg divided into 2-3 daily doses
glucophage
- Increases the breakdown of glycogen to glucose, elevating blood glucose
glucagen
- disease treated are asthma, COPD, and upper respiratory tract infections
respiratory drugs
patients have a persistent life-threatening bronchospasm despite drug therapy
status asthmaticus
- Reversible airway obstruction with inflammation
- Precipitated by: allergens, exercise, stress, and upper respiratory infections
asthmas
copdd
chronic obstructive pulmonary disease
- Irreversible airway obstruction associated with chronic bronchitis or emphysema
copd
is associated with almost all COPD’s
smoking
is a result of chronic inflammation of the airways and excessive sputum production
chronic bronchitis
is a result of chronic inflammation of the airways and excessive sputum production
emphysema
sympathomietic agents
adrenergic agonists
- produce bronchodilation by stimulation of receptors in the lungs
sympathomeitic agents
drugs used to treat respiratory disease
symp agents
non selective
selective
sustained b
a. epinephrine and isoproterenol => bronchodilation by stimulating 2 – receptors
nonseletive non specific b
a. albuterol => inhalation or orally
b. 1st line of Tx for asthma
c. drugs of choice for emergency Tx of acute asthma attack
selective specific b2
a. salmeterol (serevent) => new
b. onset is delayed and duration lasts approx. 12 hours
c. NOT used for management of acute asthma attack
i. Onset 10-20 min
sustained b
mdi
metered dose inhalers
mdi advantages
- Delivers the medication directly into the bronchioles
- Bronchodilator effect is greater than a comparable oral dose
- Inhaled dose can be accurately measured
- Onset of action is rapid
- MDI’s are compact, portable, and sterile
disadvaages of mdi
- difficult to use properly
- can be abused
- medications available in MDI’s:
- - agonists
- corticosteroids
- cromolyn
- Ipratropium and Leukotriene – blocking drugs
common inhalers include
beclomethasone, triamcinolone, and fluticasone
treat asthmas
corticosteroids
- Candidiasis can result from chronic use
cortic
- Usually added to the treatment regimen when asthmatic patients uses more than 3 inhalations of albuterol weekly
corticoster
reduces inflammation within nasal cavities
- Beclomethasone (Vancenase)
beclomethasone
vancenase
pathway inhibitors
leuokttriene
zafiruklast
cromolyn
produce bronchoconstriction
leukotrienes
is an example of leuko
- Zafirlukast (Accolate) is an example
- Increases the effect of warfarin
cromolyn
nasal crom
least toixic of al asthma meds
cromolyn nasalcrom
- effective only for the prophylaxis of asthma
- prevents the antigen induced release of histamine, leukotrienes, and other substances from sensitized mast cells
- least toxic of all asthma medications
- available OTC for allergic rhinitis
cromolyn nasalcrom
- Consists of theophylline (Theo-Dur), caffeine, and theobromine
methyxanthines
- Theophylline used to treat
chronic asthma, chronic bronchitis, and emphysema
- Erythromycin can increase serum levels of —–e => toxicity
theophylline
is an old remedy for asthma
atropine
ipratropium
atrovent
drugof choice for copd
ipratropium
- Low lipid solubility makes it bronchoselective
- Minimized side effects
- Drug of choice for COPD
ipratriprium
upper respiratorany agents
nasal decongestants expectorants acetylcysteine antitussives detrometorphan
drugs promoting the removal of exudates or mucus from the respiratory passages
expectorants
destroy or dissolve mucus
mucolytics
Robitussin)
- Most popular expectorant
guaifensestin
musmomyst
acetylcysteine
- Loosens secretions in pulmonary diseases
- Used orally as an antidote for acetaminophen toxicity
acetyclinsteine
- May be opioids or related agents used for the symptomatic relief of non productive cough
antitussives
- The DM in cough medicines (Robitussin DM)
- Opioid-like compound suppressing the cough reflex by its direct effect on the cough center
dextromethrophan
gastrointensital drugs
ucler and gerd
GERD gastroesophael reflux disease
- “heart burn”
- most prevalent GI disease in the US
- stomach contents flow backward through the cardiac sphincter, up into the esophagus (esophagitis)
- can be interpreted as a heart attack
gerd treated in 2 ways
- treated in 2 ways:
1. decrease the acid in the stomach
2. constrict the cardiac sphincter - antacids are used for acute relief of symptoms
- Occur in stomach or small intestines
- Most related to the organism Helicobacter Pylori
- Some develop as a result of chronic NSAID use
ulcers
drugs to treat gi disase
histamine, ppi, antacids, simethicone, antiemetics
- Block and inhibit basal and nocturnal gastric acid secretion
- Cimetidine (Tagamet) is prototype
- Axid, Pepcid, and Zantac => all OTC now
- Smoking increase acid production and reduces the effects of H2 – blockers
histmaine 2
- Omeprazole (Prilosec) => 1st PPI
- Potent inhibitor of gastric acid secretion
- Nexium
ppi
protion pump inhibitors
- Acute Gastritis => most common type => heart burn or upset stomach
- Partially neutralize hydrochloric acid in the stomach
- Sodium bicarbonate rapidly neutralizes gastric acid
- Preferred antacid ingredients => calcium carbonate, aluminum and magnesium salts, and magnesium-aluminum hydroxide gels
- Rolaids, Tums, Gaviscon, Mylanta, Maalox, etc.
antacids
simethicone
mylicon gas x
- Used to relieve flatulence (gas
simethicone
- Used to control nausea
- Promethazine (Phenergan) and prochlorperazine (Compazine)
- Dimenhydrinate (Dramamine)/meclizine (Bonine) => motion sickness
antiemetics
- The most critical time for the fetus is developing.
- Administered drugs may cause severe birth defects.
- Dental tx: Intra/extraoral examination after completion of medical/dental history, dental prophylaxis, oral hygiene instructions. No radiographs unless absolutely necessary.
- Avoid elective dental treatment.
- Nursing shortly after the mother has taken a drug orally will produce the least potential problems in the infant.
- Nursing is contraindicated if certain drugs are ingested. Breast milk must be expressed and discarded.
first trimesters
- The most optimal time for dental treatment to be completed.
- Comprehensive dental care may be performed – dental radiographs should be avoided if possible
second tri
- It may be uncomfortable for the patient to lie flat on their back.
FDA Pregnancy Categories – A, B, C, D, and X
third tri
- Nursing shortly after the mother has taken a drug orally will produce the least potential problems in the infant.
- Nursing is contraindicated if certain drugs are ingested. Breast milk must be expressed and discarded.
true
local anesthitics may
- May cause fetal bradycardia if administered in large doses.
- May cause fetal bradycardia if administered in large doses.
lidocaine is a cat
b
has been shown to be teratogenic in rats and rabbits (category C).
bupivacaine
- Mepivacaine and procaine have not been tested thus designated as category
c
is the local anesthetic of choice for the pregnant woman.
lidocaine
- Does not produce adverse affects in the fetus if small doses are administered.
- vasoconstrictor should not be utilized for short appointments.
epinephrine
Used in the lowest possible dose, for the shortest amount of time.
anagelisics
Aspirin – Studies in animals suggest that aspirin:
- May cause birth defects involving the eyes, CNS, GIT, and skeleton.
- Well controlled studies in humans have not demonstrated the aspirin increases the incidence of birth defects.
- Use of aspirin during the third trimester may prolong gestation, complicate delivery and increase the risk of maternal or fetal hemorrhage.
- Produce effects similar to aspirin, may complicate delivery.
nonsteroidal anti inflm agents
- Ibuprofen is designated as
category B and is the NSAIA of choice for the nursing mother.
- No controlled human studies have been performed; may be associated with fetal renal changes in large doses.
acetaminphen
- Other than codeine, the opioids have not been associated with teratogenicity.
true
- Use of codeine in the first trimester may lead to abnormalities in the respiratory, gastrointestinal, cardiac, and circulatory system as well as cleft lip and palate.
true
near term use of opoids may produce
resp depression in the infant
- Should be used only when there is definite indication.
antiinfective agent
penicillin a
- Should be used only when there is definite indication.
- Other than the estolate form, appears to be safe for use during pregnancy.qerythromycin
erythromyic
- Not associated with teratogenicity, however, should not be used unless specific indications exist.
cephalosprins
- Contraindicated during pregnancy because of adverse affects to the fetus.
- Cross the placenta and are deposited in fetal teeth and bone.
- Deciduous teeth become stained and fetal bone growth inhibited.
- Not known if amount excreted in nursing mother is enough to harm the infant.
tetra
- Should be used only for bacteria resistant to penicillin.
clindimyicn
- Contraindicated in the first trimester.
- If the drug must be administered to a nursing mother, the breast milk should be expressed and discarded. During treatment and forty-eight hours after the last dose.
metroniadizole
- Safely administered during pregnancy to treat oral candida infections.
- Not well absorbed into the systemic circulation when taken orally or topically.
nystatin
- No adverse reactions noted but nystatin is more likely safer.
clotrimazole
- Teratogenic in animals; producing abnormal number of digits.
- If it must be used in nursing mothers, breast milk should be expressed and discarded during therapy and for 72 hours after ingesting the last dose.
ketoconazole
antianxiety agents
nitrous oxide
benzodipines
barbituas
- Chronic exposure to trace amounts are associated with higher rates of spontaneous abortion and birth defects regardless of whether a man or woman was exposed.
nitrous oxide
- Use in the first trimester may lead to an increased risk of congenital malformations such as cleft palate, cleft lip, and neural tube defects.
- Benzodiazepines are indicated for use during pregnancy only for the treatment of status epilepticus.
- Chronic ingestion may produce fetal addiction, floppy infant syndrome or neonatal flaccidity.
- Not recommended for nursing mothers.
benzodiapines
- Phenobarbital is thought to be teratogenic.
- May be safe for nursing mothers, look for signs of sedation in the infant.
barbiturates
alchol
- Strong evidence it is teratogenic.
- Fetal Alcohol Syndrome is associated with changes that occur in an infant exposed to excessive intake of alcohol by the mother. Involves abnormalities in growth retardation, CNS abnormalities, and facial dysmorphology (microcephaly, microphthalmia, short palpebral fissures, and thin lips). Also show more tremors, hypertonia( muscle spasms), restlessness, crying, and abnormal reflexes.
