meds & ddi Flashcards
What painkillers to avoid in patients with HTN taking anti hypertensives?
avoid prolonged use of NSAIDs as they decrease efficacy of the drug and increase risk for MI/stroke
What antibiotics to avoid in patients taking calcium channel blockers?
Avoid macrolides ie erythromycin and clarithro because combination can enhance hypotension.
Azithro is safe
what is daktarin oral gel
2% micanozole gel - used to treat oral fungal infections
what are the 2 classes of anti fungals
azoles and polyenes
polyenes
- amphotericin B
- nystatin
- moa: binds to ergosterol in cell membrans and creates pore in cell memb
azoles
- moa: prevent synthesis of ergosterol in cell membrane of fungi
what analgesics to avoid in patients with poor renal function
aspirin and non selective cox inhibitors
- reduced renal blood flow
- sodium and water retention causing oedema and hypertension, can cause acute kidney injury
- cox 2 inhibition can cause renal toxicity
what analgesics to avoid in patients with poor hepatic function
- not really acetaminophen because its generally still safe, but toxic dose of this can cause liver damage
what is the implication of diabetes on OMS management
- poor wound healing
- increased risk of infections
- if patient requires GA, need to use a glucose sliding scale
- try to get primary closure for any wounds to promote healing
- in order to prevent infection, can give postop antibiotics especially if its uncontrolled DM
if patient is diabetic, think about MEDS also
- if patient on drugs that lower bg levels, then need to monitor status and vitals in case of hypoglycemic attack. have IM glucagon and IV dextrose on hand JIC
what are the empirical antibiotics of choice in odontogenic infections
penicillins in combination with metronidazole
should we prescribe antibiotics for trauma cases? if so, when?
short term PREoperative and PERIoperative AB are adequate as prophylaxis
no evidence of any benefit for post op AB going beyong 24 hours in a healthy patient
what procedures require prophylactic antibiotics for IE
before dental procedures that involve
- the manipulation of gingival tissue
- manipulation of the periapical region of teeth
- perforation of the oral mucosa in patients with underlying cardiac conditions associated with the highest risk of adverse outcomes
ddi of paracetamol
1) alcohol, anticonvulsants
- risk of liver toxicity
2) warfarin
- risk of increased bleeding if dose >2g/day for >7 days
ddi of aspirin, NSAIDs
1) alcohol, corticosteroids, alendronate
- risk of GI ulcers and bleeding
- its not because alcohol slows down the clearance of nsaids, but rather both alcohol and aspirin can irritate the stomach lining and thin blood so cause ulcers and increase bleeding risk
2) anticoagulants
- increased risk of bleeding
3) antihypertensives
- reduced anti - hypertensive effect
how does taking broad spectrum AB affect warfarin
- broad spectrum antibiotics kill gut bacteria that nomrally produce vit K which is essential for making blood clotting factors. when there is less vit K = increased warfarin effect = higher bleeding risk
- some antibiotics affect cytochrome P450 enzymes which are involved in metabolizing warfarin
- eg metro, trimethoprim sulfa, macrolides all INHIBIT metabolism of warfarin, lead to higher warfarin levels
how does aspirin reduce anti hypertensive effect of antihypertensive drugs
- some antihypertensives like ACEI, and diuretics, rely on prostaglandin mediated vasodilation to help lower blood pressure and aspirin blocks that vasodilation, making drugs less effective
- because nsaids result in less prostaglandins, so kidneys hold on to more salt and water and this increases blood volume, counters antihypertensive effect
what are 2 types of meds that broad spectrum antibiotics will have adverse effect with
1) warfarin - increased risk of bleeding
2) oral contraceptives - decreased effectiveness
what are the ddis for erythro and clarithro
1) theophylline, digoxin
- risk of serious cardiac arrhythmias
2) warfarin, DOACs
- potentiation effect, increased risk of bleeding
3) statins
- increased levels of drugs
- risk of myalgia, rhabdomyolysis
4) carbamazepine, tacrolimus, cyclosporine, valproic acid
- increased levels of these drugs
- risk of drug toxicity
5) midazolam, diazepam
- increased risk of sedation
ddi of metronidazole
1) alcohol
- metro will interfere with alcohol metabolism and cause acetaldehyde build up, give disulfiram like reaction
2) warfarin
- potentiation
- increased risk of bleeding
3) statins
- risk of myalgia
- rhabdo
ddi of azoles
1) warfarin, DOACs
- potentiation
- increased risk of bleeding
2) carbamazepine
- increased drug levels
- drowsiness, ataxia
3) cyclosporine, tacrolimus
- increased drug levels
- enhanced immunosuppression, nephrotoxicity
4) statins, theophylline, midazolam
- increased drug levels
- toxicity
ddi of LA with epinephrine
1) non selective B blockers
2) tricyclic antidepressants
will give increased bp, hr
- risk of developing arrhythmia
what drugs can give candidiasis
- broad spectrum antibiotics
- corticosteroids
- cytotoxic drugs
- immunosuppressants
- drugs causing hyposalivation
what drugs can cause oral pigmentation
- minocycline
- antimalaraial
- oral contraceptivs
drugs that can cause hyposalivation
- SSRI
- antipyschotics
- bronchodilators
- antihistamines
- omeprazole
- proteases
what drugs can give lichenoid reactions
- NSAIDs
- b blockers
- ACE I
- methyldopa
- chloroquine
what drugs can give oral ulceration
- aspirin, NSAIDS
- sirolimus, tacrolimus
- carbimazole
- alendronate
