Drug use in Dentistry

Question 1

how can drug use result in death

Answer 1

allergy to the drug
toxicity of the drug
drug interactions

Question 2

what is drug interactions

Answer 2

drugs can have an effect on the absorption/metabolism of other essential medicines

Question 3

what is warfarin

Answer 3

warfarin is an anti-coagulant which inhibits numerous coagulation factors
the effect of warfarin is changed by many prescription including antimicrobials, antifungals and antivirals

Question 4

what is carbamazepine

Answer 4

used for the treatment of epilepsy

prone to drug interactions

Question 5

what are the drug classes

Answer 5

 Local anesthetic 
 Antimicrobials 
 Drugs in pain and inflammation 
 Drugs used in sedation
 Emergency medical drugs (e.g used for anaphylaxis)

Question 6

what is local anesthetic

Answer 6

used to reduce the awareness of pain

they are all pH sensitive in the tissues

Question 7

how does local anesthetic work

Answer 7

acts on nerve ion channels to block the propagation of the action potential and hence block the reception of pain

Question 8

what is the effect of local anesthetic on blood flow

Answer 8

vasodilator

Question 9

what are examples of local anesthetics

Answer 9

lignocaine
prilocaine
bupivacaine
mepivacaine

Question 10

what are antimicrobials

Answer 10

they include antibiotics, antiviral and antifungals

Question 11

what are the most commonly prescribed antibiotics

Answer 11

amoxycillin
metronidazole
doxycycline
clindamycin

Question 12

what is the most commonly prescribed antiviral

Answer 12

aciclovir - herpes (systemic or topical)

Question 13

what is the most commonly prescribed anti fungal

Answer 13

nystatin - topical

fluconazole - systemic

Question 14

what are non steroidal antiinflammatory drugs used for

Answer 14

reduce the inflammatory mediators

Question 15

what are corticosteroids

Answer 15

drugs that are used to reduce the inflammatory process

Question 16

describe the features paracetamol

Answer 16

antipyretic and analgesic
little anti inflammatory action
few side effects
unrestricted sale
1g four times daily 
often combined with other analgesics

Question 17

what are the different classes of NSAID

Answer 17

salicylates
propionic acid derivatives
phenyl acetic acid derivatives

Question 18

what is an example of a salicylate NSAID

Answer 18

aspirin

Question 19

what is an example of a propionic acid derivative NSAID

Answer 19

ibuprofen

Question 20

what is an example of a phenyl acetic acid derivative NSAID

Answer 20

diclofenac

Question 21

when is diclofenac used

Answer 21

it is prescription only

very effective as an analgesic when there is inflammatory based pain

Question 22

how do NSAIDs work

Answer 22

inhibit prostaglandin synthesis by changing balance of PGE1 and PGE2
they inhibit cycle-oxygenase enzyme which regulates the production of prostaglandins from arachidonic acid

Question 23

what are side effects of NSAID

Answer 23

platelet inhibition - harder to clot

problems for severely asthmatic patients

Question 24

what is the dose for aspirin

Answer 24

300-600mg up to 4 times daily

Question 25

what is the pharmacokinetics for aspirin

Answer 25

rapid absorption from the GIT eliminated by 1st order kinetics - easily metabolized inhibits cox 1

Question 26

what happens to the body during overdose of aspirin

Answer 26

enzyme saturation | acidosis

Question 27

what does inhibition of COX-1 by aspirin result in

Answer 27

o Reduced synthesis of prostaglandins o Reduced production of inflammatory mediators o Anti-pyrexic – reduces fever o Can be taken BEFORE inflammatory process starts (pre-emptive analgesia)

Question 28

what are the side effects of aspirin

Answer 28

``` gastric irritation inhibition of platelet function bronchospasm allergic reaction drug interaction ```

Question 29

what is the dose for ibuprofen

Answer 29

200-600mg 3 times daily

Question 30

describe the features of diclofenac

Answer 30

prescription only more effective than ibuprofen dose is 50mg 3 times daily

Question 31

how to corticosteroids reduce inflammation

Answer 31

by inhibiting: - capillary permeability - formation of bradykinin - migration of white blood cells - reduce eicosanoid synthesis

Question 32

what are examples of topical corticosteroids

Answer 32

``` steroid inhalers (asthma) hydrocortisone cream (eczema) steroid treatment for mouth ulcers ```

Question 33

what are the different types steroid treatments for mouth ulcers

Answer 33

beclomethasone inhalers hydrocortisone adhesive tablets betamethasone solutions

Question 34

what are examples of systemic corticosteroids

Answer 34

prednisolone (tablets) | dexamethasone (injection)

Question 35

what is prednisolone for

Answer 35

prevent transplant rejection | treat immunological diseases

Question 36

what is dexamethasone for

Answer 36

to reduce swelling after surgery

Question 37

what are the side effects of systemic steroids

Answer 37

* High blood pressure * Weight gain (fluid) * Fat distribution change * Gastric ulceration * Adrenal suppression * Osteoporosis * Diabetes

Question 38

what are drugs used in sedation that reduce anxiety called

Answer 38

anxiolytics

Question 39

what are the types of anxiolytics

Answer 39

benziodiazepines - diazepam, madapolam | gas - nitrous oxide

Question 40

describe the action of benzodiazepine

Answer 40

act on GABA receptors (gaba A) have an allosteric effect on receptor and increase action of GABA receptor greater influx of negative ions makes it less likely that a neuron will fire an action potential

Question 41

what is a big disadvantage to benzodiazepine

Answer 41

rebound effect, less effective when taken for longer

Question 42

what happens in phase 1 of metabolizing benzodiazepine

Answer 42

converted into metabolites of lesser, equal or greater activity

Question 43

what happens in phase 2 of metabolizing benzodiazepine

Answer 43

conversion to inactive metabolites

Question 44

describe the features of nitrous oxide

Answer 44

inhaled as gas no needle technique no organ metabolism issues - excreted unchanged interferes with folic acid metabolism

Question 45

what are the medical emergency drugs used for

Answer 45

Asthma Heart attacks Diabetic emergencies Seizures

Question 46

what is the dose for ibuprofen

Answer 46

200-600mg 3 times daily

Question 47

what is the dose for diclofenac

Answer 47

50g 3 times daily

Question 48

why is diclogenac prescription only

Answer 48

higher incidence of gastric bleeding, higher incidence of asthma triggering, allergic reaction (rash) have to risk assess

Question 49

what is given in a diabetic emergency

Answer 49

glucagon

Question 50

How does aspirin work

Answer 50

inhibits platelet aggregation by altering the balance between thromboxane A2/prostacyclin