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dental management > medications from all lectures > Flashcards

medications from all lectures Flashcards

1
Q

cortisone and prednisone are examples of _____.
Why are they important.

A

Steroids

Important because they can result in adrenal insufficiency and the pt is unable to mount a normal response to the stress of an infection or invasive dental procedure.

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2
Q

what drugs should be avoided for pts that use cocaine and methamphetamine

A
  • vasoconstrictors

(these agents may precipitate arrhythmias, sever hypertension, MI, and stroke)

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3
Q

you should be cautious to rx what type of meds for pts with substance use, misuse and abuse

A

narcotic and sedative meds use with great caution or not at all because want to prevent a relapse

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4
Q

what signs and symptoms should you watch out for in family hx

A
  • HTN
  • Diabetes
  • Auto imm disorders
  • Cancer
  • Other hereditary ds and syndromes
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5
Q

when getting medical hx, for medications what do pts tend to leave behind

A
  • OTC drugs or herbal medicine
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6
Q

what is this

A

clubbing of fingers

not age dependent.

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7
Q

what is this

A
  • xanthomas

due to high cholesterol and get these deposits in the skin.

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8
Q

if pt is on coumadin what is their INR

A

INR: 2-3

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9
Q

HTN: what category of drugs are used:

A
  • Angiotensin converting enzyme inhibitors (ACE inhibi)
  • Calcium-channel blockers
  • Diuretics
  • Alpha adrenergic blockers
  • Beta adrenergic blockers
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10
Q

lisinopril

category, used for what, dental implications

A
  • common ACE inhibitor for HTN
  • Dental implication: angioedema, neutropenia/agranulocytosis, taste disturbances
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11
Q

captopril

drug category, used for, dental implications

A
  • common ACE inhibitor for HTN
  • Dental implication: angioedema, neutropenia/agranulocytosis, taste disturbances
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12
Q

losartan

drug category and used for

A

Angiotensin II receptor blocker, used for HTN

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13
Q

Sodium channel blockers for HTN dental implication

A

dry mouth, gingival overgrowth, hypersentivity reaction syndrome

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14
Q

Nifedipine

drug category, what is it used for, dental implications

A

ca+ channel blockers

dental implication: gingival overgrowth, dry mouth, and taste disturbances.

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15
Q

hydrochlorothiazide

drug category, what is it used for, dental implications

A
  • diuretic for HTN
  • Dental implication: dry mouth
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16
Q

spironolactone

drug category, what is it used for, dental implications

A

diuretic for HTN

Dental implication: dry mouth

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17
Q

hydrochlorothiazide

drug category, what is it used for, dental implications

A

diuretic for HTN

Dental implication: dry mouth

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18
Q

methyldopa

drug category, what is it used for, dental implications

A

alpha adrenergic blocker for HTN

dental implication is dry mouth

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19
Q

atenolol

drug category, what is it used for, dental implications

A

beta adrenergic blockers

dental implication: dry mouth, angioedema

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20
Q

propranolol

drug category, what is it used for, dental implications

A

beta adrenergic blockers

dental implication: dry mouth, angioedema

* also used sublingually

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21
Q

post-operative meds to avoid for HTN pt

A
  • avoid long-term use of NSAIDs (2 weeks or more)
  • avoid microlide ab with ca2+ channel blocker (incr. CCB levels)
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22
Q

if a pt is on selective beta-blockers we should limit epi how

A

limit epi to 2 carpules.

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23
Q

medical management for hypertension

A

beta blockers

calcium channel blockers

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24
Q

medical managment for angina

A

nitrates (nitroglycerine) for stable angina

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25
Q

medical managment for stroke

A

antiplatelet agents like aspirin, clopidogrell (plavix) for stroke prevention

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26
Q

medical managment for revascularization

A
  • coronary artery bypass grafting (CABG)
  • PCI stent
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27
Q

medical managment for hyperlipidemia

A
  • HMG-CoA reductase inhibitor (statins)
  • Cholesterol absorption inhibitor (ezetimibe)
  • Fibrates
  • Bile acid sequestrants
  • Niacin
  • Omega-3 fatty acids
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28
Q

HMG-CoA reductase inhibitor statins used for IHD

A
  • atorvastatin (lipitor)
  • pravastatin (pravachol)
  • rosuvastatin (crestor, ezallor)
  • simvastatin (zocor)
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29
Q

what statins to avoid if have IHD

A

statins- avoid CYP inhibitors such as flucanazole and clarithromycin

CYP enzymes are a protein superfam invovled in the synthesis and metabolism of drugs, toxins and normal cellular components

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30
Q

clopidogrel (plavix)

A

inhibits platelet agglutination, but the platelet count is not affected

arrhythmia pharmacotherapy, oral anticoagulants

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31
Q

ASA (aspiring 81mg - low dose)

A

inhibits platelet agglutination, but the platelet count is not affected

arrhythmia pharmacotherapy, oral anticoagulants

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32
Q

warfarin (coumadin)

A

arrhythmia pharmacotherapy, oral anticoagulants

vitamin k antagonist

inr monitoring

highly variable

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33
Q

direct oral anticoagulants (DOACs) for arrhythmias are

A
  • direct thrombin inhibitor
  • direct factor Xa inhibitors
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34
Q

ace inhibitors and beta blocker are used for which stages:

A

stage b

stage c

stage A is ONLY ace inhibitor

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35
Q

if a pt is tkaing digitalis glycoside (digoxin)- positive inotrope- what should we avoid giving them

A

epinephrine should be avoided if possible

the combination causes an increase risk of arrhythmia.

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36
Q

if a pt has a mechanical implant what do they require

A

long term anticoagulants

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37
Q

if a pt has bioprosthetic implant what do they require

A

short term anticoagulation and long term antiplatelet therapy

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38
Q

antibiotic prophylaxis is recommended for only which group of infective endocarditis

A

high risk pateints.

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39
Q

different antibiotics for prophylaxis

A

oral- amoxicillin

if unable to take oral meds- ampicillin or cefazolin

if allergic to penicillin or ampicillin, oral- clindamycin or clarithromycin

if allergic to penicillin or amipicilllin and unable to do oral- clindamycin or cefazolin

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40
Q

if a pt is already taking a beta-lactam (penicillin, amoxicillin) for an active infection and urgent dental tx is necessary rx:

A

azithromycin ro clarithromycin

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41
Q

if a pt is already taking a beta-lactam (penicillin, amoxicillin) for an active infection and urgent dental tx is elective:

A

wait 10 days after completion of the ab for their active infectin and then rx: amoxicillin according to AHA guidlines

42
Q

should you give ab prophylalxis if pt has a heart murmur?

A

typically no, not required HOWEVER if any murmur is due to endocarditis, prosthetic heart valve, complex congenitary cyanotic heart ds, AHA continues to recommend ab prophylacis for most dental procedures.

43
Q

when measuring BP:
if the cuff is too small-
if the cuff is too large-
arm too high-
arm too low-

A

small - false elevated values
large- false low value
high- arm is above heart level - it under-estimates systolic and diastolic pressures

low- below the heart level- over estimates systolic and diastolic pressures reading

44
Q

white coat HTN values:

A

it will ELEVATE BP by 30 mmHg

45
Q

Pregnant pt BP

A

if a pregnant pt has equal to or more than 10 mmHg increase in systolic BP from baseline

we are at risk of eclampsia –> immediate referral

46
Q

what is korotkoff sounds

A

the first audible ‘beating sound’’

the systolic pressure

47
Q

how can we tell diastolic

A

once the sound completely dissapears

48
Q

normal bp

A

<120/80 mmHg

49
Q

elevated bp

A

120-129/ <80 mmHg

50
Q

stage I

A

130-139/or 80-89 mmHg

51
Q

stage II

A

> or equal to 140/or 90 mmhg

52
Q

hypertensive crisis

A

greater than or equal to 180 and/or >120

urgent referral –> see dr ASAP
if pt is symptomatic –> ER

53
Q

rapid weight loss may be a sign of:

A

malignancy, diabetes, tuberculosis, neoplasm or other wasting ds

54
Q

rapid weight gain can be a sign of

A

heart failure, edema, hypothyroidism or neoplasm

55
Q

what is cyanosis

A

a bluish discoloration of the skin resulting from poor circulation or inadequate oxygenation of the blood.

it can indicate cardiac or pulmonary insufficiency

56
Q

pigmentation on skin and nails can be use to

A

hormonal abnormalities

57
Q

alterations in fingernails usually seen in chronic disorder: clubbing

A

cardiopulmonary insufficiency

58
Q

alterations in fingernails usually seen in chronic disorder: white discoloration

A

cirrhosis

59
Q

alterations in fingernails usually seen in chronic disorder: yellowing

A

malignancy

60
Q

alterations in fingernails usually seen in chronic disorder: splinter hemorrhages

A

infective endocarditis

61
Q

where are common areas for actinic keratosis and basal cell carcinomas

A

the dorsal hand surface

62
Q

a raised, darkly pigmented lesion with irregular borders could be a

A

melanoma

63
Q

what can you do to inspect for the eyes and nose

A

a cranial nerve exam

64
Q

eyes and nose indicators of systemic ds: lid retraction

A

hyperthyroidism

65
Q

eyes and nose indicators of systemic ds: xanthomas of the eyelids

they look like yellowish

A

hypercholesterolemia

66
Q

eyes and nose indicators of systemic ds: yellowin gof the sclera

A

liver ds

hepatitis, alcoholics

67
Q

eyes and nose indicators of systemic ds: conjuctive reddening

A

allergy or sicca syndrome

68
Q

what pre-dental tx sedation can you give an anxious and stressed pt

A

benzodiazepines (triazolam .25mg) 1 hour before

69
Q

mavyret

epclusa

harvoni

are used for what

A

mavyret (glecaprevir/pibrentasvir)

epclusa (sofosbuvir/velpatasvir)

harvoni (ledipasvir/sofosbuvir)

for hep C protease inhibitor therapy

70
Q

for post op tx what do we NOT give pts with liver ds

A

NSAIDS

can give up to 2mg per day of acetominophen for pain managment

71
Q

LA to avoid for liver ds pts bc metabolized by the liver

A

lidocaine

mepivacaine

prilocaine

bupivacaine

72
Q

analgesics to avoid for liver ds pts bc metabolized by the liver

A

aspirin

acetaminophen (tylenol, datril)

codeine

meperidiene

ibuprofen (motrin)

73
Q

sedatives to avoid for liver ds pts bc metabolized by the liver

A

diazepam

barbiturates

74
Q

antibiotics to avoid for liver ds pts bc metabolized by the liver

A

ampicillin

tetracycline

metronidazole

vancomycin

75
Q

if opiods are necessary for dental tx on a liver ds pt what should you use

A

hydromorphone is the preferred choice

avoid hydrocodone, oxycodone.

76
Q

if need a sedative for a liver ds pt what would you use

A

lorazepam - because it has a short, like about half of the half time of the others. so its less risk of it having an affect on the body because there for a shorter period of time.

77
Q

methylprendisolone is used for what

A

this is an intermediate-acting glucocortisoid used in a topical form to decrease post op inflammation

78
Q

dexamethasone is used for what

A

it is a long-acting glucocorticoids that is used for oral ulcerations

79
Q

prednisolone

triamcinolone

methylprednisolone are what type of drugs

A

intermediate acting glucocorticoids

used topciallly (methyprednisolone)

80
Q

bexamethasone

betamethason are what type of drugs

A

long-acting glucocoritcoids

used for oral ulcerations ( dexamethesome)

81
Q

what drugs to avoid for pts with hyperadrenalism

A
  • avoid NSAIDs and aspiring –> can result in peptic ulcers and GI bleed
  • If pt also has osteoporosis and osteopenia
    • may have history of bisphosphate use.
82
Q

if a pt is having a thyrotoxic crisis/storm for hyperthyroidism what should you administer

A
  1. cpr and vital signs
  2. ice or wet packs
  3. administer hydrocortisone 100 to 300 mg
  4. IV glucose
  5. Administer propylthiouracil
  6. send to ED
83
Q

if a pt is having a myxedema coma for hypothyroidism what should you administer?

A
  1. CPR and vital signs
  2. conserve body heat - blanket
  3. administer hydrocortisone 100 to 300 mg
  4. IV saline and glucose
  5. Administer thyroxine
  6. Send to ED

myXedema with thyroXine and… hydrocortisone(the same for hyperthry)

84
Q

drug interactions/side effects seen in hyperthyroidism

A
  • caution w aspirin, NSAIDS (can incr. T4)
  • contraindicated to use ciprofloxacin because it decreases the absorption of thyroid hormone
  • avoid LA with epi and gingival retraction cord w epi
85
Q

drug inteactions/side effects in hypothyroidism

A
  • avoid CNS depressants (narcotics, babituates, sedatives)
  • Cytochrome p450 inducers (phenytoin, carbamazepine, and rifampin) should be avoided bc it increases metabolism of levothyroxine.
86
Q

biguanide - metformin

insulin

A

decrease in gluconeogenesis

main one for type 1: insulin

main one for type 2: biguanide-metformin

87
Q

sulfonylureas

glucagon-like peptide 1 receptor agonsit

in DM

A

increase in insulin secretion

to help the insulin pathway

88
Q

thiazolidinediones

in DM

A

sensitzation to insulin

to help the insulin pathway

89
Q

DPP4

GLP1 receptor agonist

in DM

A

decrease in glucagon secretion

to help the insulin pathway

90
Q

sodium-glucose cotransporter -2 inhibitors

alpha-glucosidease in DM

A

use it for intestinal and renal absorption of glucose.

to help the insulin pathway

91
Q

DM avoid:

A
  • tetracyclines (doxycycline too) with insulin
  • fluroquinoles cirpofloxacin (Cipro), levofloxacin (levaquin) with insulin
  • aspirin with sulfonylureas
  • all of these can cause hypoglycemia
92
Q

analgesic of choice for pregnant pts

A

acetaminophen

93
Q

Which two antibiotics are contraindicated in preg pts

A

tetracycline and doxycycline CONTRINDICATED

teratogenic

94
Q

which sedation should be used on a preg pts

A
  • no pharmacologic sedation is preferred

if ABSOLUTLEY necessary then nitrous oxide for less than 30 mins and with at least 50% oxygen.

95
Q

if pt has sickle cell anemia what should you avoid

A
  • avoid prilocaine
  • consider giving LA without epi.
  • epi given can be 1:100,000 no stronger []
96
Q

anesthesia for thrombocytopenia, von willebrand ds, hemophilia,

A

avoid block injections and implement local hemostatic measures for dental tx.

97
Q

how do you treat von willebrand ds

A

desmopressin DDAVP

98
Q

how do you tx hemophilia

A

desmopressin DDAVP for Hemophilia A

99
Q

medical related bleeding disorders:

A
  1. Plavix (clopidogrel)
  2. Coumadin (warfarin)
  3. Direct Oral Anticoagulants (DOAC) and direct thrombin inhibitors
100
Q

coumadin (warfarin)

A

vit k antagonist

side effect is bruising

usef for a lot of pts with hear probs.

monitor INR to keep around 2-3

INR for pts with prosthetic heart vales is (3-3.5)

Antidote is vit k

dental management (8 decks)

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