MEDICATIONS RELEVANT IN MH Flashcards
What is methotrexate and what is it used to treat? What relevance does it have?
Non-biological disease modifying anti-rheumatic drug (DMARDs)
Treats rheumatoid arthritis
It is an anti inflammatory and an immunosuppressant
- consider antibiotic prophylaxis (drug not routinely stopped for dental treatment)
- consider they have RA so risk of Sjögren’s syndrome or osteoporosis
What are corticosteroids, give an example of one and what they treat. Any risks or possible issues with MH and dental treatment?
Cortisone, prednisone, hydrocortisone
Anti-inflammatory and immunosuppressant
Treat hay fever, asthma, arthritis etc
- reliance on these can cause hypothalamus-pituitary-adrenal axis suppression
This leads to inadequate production of cortisol leading to inadequate responses to body stress, invasive surgery or infection.
What is apixaban? What used for? Any issues with regards to dental treatment?
DOAC - Anticoagulant used to inhibit factor Xa
Used to prevent blood clots and prevent strokes
For low bleeding risk procedures - no change to treatment or to drug regime
For higher risk bleeding procedures - delay drug (1 daily pill) or miss morning dose (2xdaily pill)
What is miconazole? Dose? Any interactions?
Used to treat oral candidiasis or prevent oral candidiasis
Pea sized shaped twice daily and continue for ten days post clearing up
Heighten anticoagulant effect of warfarin, so should not be used
What does Simvastatin do?
treat hypercholesterolaemia
Furosemide?
loop diuretics, used with other hypertension drugs to reduce hypertension
Carvedilol?
beta blocker to manage hypertension. Not a first line treatment, should consider hypertension in the treatment plan if patient is on this.
Metformin
Anti-hyperglycaemic affect
- sensitise tissues to insulin
First choice treatment for all patients with diabetes
Can reduce vit b12, resulting in anaemia
Sulfonylurea?
augment insulin production. Used as part of triple therapy.
This indicates patient has had trouble controlling their diabetes.
What is warfarin? How does it work? What relevance to dentistry?
Inhibits blood clotting
- through inhibition of vitamin K dependant clotting factors
Patients INR should be checked no more than 24 hours before bleeding risk dental appt, it should be within 2-4 range
What are apixaban, rivaroxiban and edoxaban and dabigatran?
How do they function?
Are there any considerations with dental tx?
All are direct oral anticoagulants that work through factor Xa inhibition
Dabigatran however is a direct thrombin inhibitor
For high bleeding risk procedures, patients should:
Miss morning dose of apixaban and dabigatran
Delay morning dose of rivaroxiban
Take normal evening dose of edoxaban
How do statins work? What do they do?
Inhibit cholesterol synthesis in the liver by inhibiting HMG-coA reductive enzyme in early cholesterol synthesis
What dental considerations must be made with statins?
Can interact with all dental antifungals
Stop statin while on dental antifungal
- resume once fungal course is finished
How do beta blockers work? Any side fx?
Block effects of epinephrine to reduce blood pressure and heart contractile force
Fatigue, dizzyness, dry mouth
Dental considerations of beta blockers?
They can mask the symptoms of hypoglycaemia in diabetic patients
Postural hypotension when sitting up, so move dental chair slowly
Epinephrine in LA probably not ideal for someone who wants to reduce epinephrine
Can enhance bronchospasm or asthma fx
What are calcium channel blockers and how do they work?
Cause vasodilation and slow the heart rate
Act on the smooth muscle cells lining vessels and block calcium causing muscles to relax
Also affect heart conduction system to decrease frequency of heart beat
Dental considerations of calcium channel blockers?
Any side fx?
Side fx - nausea and dizziness, swollen ankles and legs
Postural hypotension issue
Gingival hyperplasia - especially in amlodipine
Avoid giving LA worth adrenaline
What are ace inhibitors? How do they work?
Inhibit conversion of angiotensin 1 to angiotensin 2 - a substance that narrows blood vessels
This leads to wider blood vessels and a decrease in blood pressure
Dental considerations of ace inhibitors?
Postural hypotension again
Patients can have a persistent cough
MOA ibuprofen
Inhibits COX1 and COX2 enzyme pathways, thus reducing the production of prostaglandins and reducing inflammation.
MOA paracetamol?
COX1&2 enzymes metabolise arachidionic acid, creating hydroperoxides
These HPs further upregulate metabolism of arachidonic acid and release of prostaglandins.
Paracetamol blocks this feedback loop resulting in
Analgesia,
Antipyrexia
MOA chlorhexadine
Binds to negatively charged components of the cell wall of the microorganism
Alters permeability of cell membrane, thus causing leakage of intracellular components leading to cell death.
MOA PenV?
Primarily against gram+ - narrow spectrum
Binds to penecillin binding proteins in bacterial cell wall inhibiting synthesis of peptiodglycan
This results in weakening of the cell wall, and an inability of the cell to synthesise and maintain its cell wall, leading to lysis.
MOA metronidazole?
Anaerobic bacteria - low O2 environments
Taken up by anaerobic MOs
Metronidazole is reduced within the cell producing free radicals and toxic metabolites
These disrupt DNA structure of the MO and can break DNA strands and thus inhibits synthesis of proteins and further DNA essential for cell function
MOA fluconazole?
Used for systemic fungal infection
Inhibits synthesis of ergestorol - essential component of cell membrane of fungus
Disrupting integrity of cell membrane leads to lysis
MOA nystatin?
Binds to ergestorol and forms pore in cell membrane of fungus, leading to cell lysis.
Different to Azoles and binds to ergestorol does not inhibit its production
MOA miconazole?
Topical fungal
Inhibits synthesis of ergestorol at the site of application. Ergestorol essential component in fungus cell membrane, leading to lysis.
