Pharmacology Flashcards
QD
once/day
BID
twice/day
TID
Three times/day
QID
4 times/ day
PC
After meals
AC
before meals
PO
by mouth
PRN
as needed
HS
at bedtime
Brand Name
manufactures name - first letter capitalized
Generic Name
chemical makeup of drug; all letters lowercase
Enteral Administration
uses GI tract
safest, slowest, most variable route
can be sublingual, oral, or rectal
sublingual and rectal administration avoid first pass effect
Parenteral Administration
by-pass GI tract
IV ⇒ most rapid, complete absorption
IM ⇒ high blood volume
Subcutaneous ⇒ under skin
Intradermal ⇒ in dermis
Topical ⇒ absorbed by capillaries under skin
Inhalation ⇒ nitrous, albuterol
Pharmacokinetics
(Absorption)
entry of the therapeutic agent into bloodstream
depends on: food, pH, route, solubility
IV drugs skip this step
Pharmacokinetics
(Distribution)
from bloodstream to body
oral - liver
sublingual - heart
Bioavailability
x amount of drug will be available after administration to produce a biologic effect
Pharmacokinetics
(Metabolism)
breakdown of drugs for excretion
primary site is the liver
Pharmacokinetics
(Excretion)
removal of drug from body
Primary site is kidney
drug excretion occurs through urine/respiratory system
Glomerulus in nephrons filter blood and produce urine
Sympathetic Nervous System
“Fight or Flight”
Norepinephrine and epinephrine mediate response at the adrenergic receptors
Drugs contraindicated for angina, uncontrolled hypertension, uncontrolled hyperthyroidism
Parasympathetic Nervous System
“rest and digest”
acetylcholine mediates response at cholinergic response
Drugs contraindicated for asthma
Allergic Effects
Unpredictable, not dose related
Type 1 - intermediate
Type 2 - slowest
Therapeutic Index
determines safety of a drug
LD50/ED50
Therapeutic Action
desired result
Therapeutic Range
range between dose-causing minimum effect and
dose-causing minimum adverse effect
Potency
amount needed to achieve desired effect
Efficacy
maximum response attained
(highest point on graph is greatest efficacy)
Diuretics
“water pills”
- blocks sodium reuptake in kidneys
- more water is excreted
- first line hypertensive agent
- thiazide or loop diuretic
- side effects ⇒ xerostomia, orthostatic hypotension
Beta-Adrenergic Blockers
decreases BP by decreasing cardiac output
- Beta 1: increase heart muscle contraction
- Beta 2: relax bronchial smooth muscle
Starts with B, E, A, or M
Ends in -olol
Calcium Channel Blockers
inhibit calcium (regulates muscle contractions)
- systemic vasodilation decreases BP
- side effects ⇒ xerostomia, gingival enlargement
- ends in -pine
Angiotensin Converting Enzyme (ACE) Inhibitors
blocks angiotensin II, causing vasodilation
side effects ⇒ dry cough, altered taste, orthostatic hypotension
ends in -pril
Anti-Hypertensive Drug Classes
diuretics
ACE Inhibitors
beta-blockers
Calcium channel blockers
Anti-Bacterial Agents
Penicillin: most commonly prescribed, safe with pregnancy, anaphylaxis is common
Tetracycline: bacteriostatic, concentrates in GCF
Cephalosporin: similar action to penicillin
Clindamycin: premedication in penicillin allergy, GI effects
Metronidazole: treats periodontal infections and ANUG, *avoid alcohol
Anti-Viral Agents
Herpes tx: Acyclovir, Docosanol, Valtrex
HIV/AIDS: AZT, Retrovir
Anti-Fungal Agents
occurs more in immunocompromised pt’s
Nystatin: topical or oral administration, 5ml QID for 2 weeks
Fluconazole: administered orally
Anti-TB Agents
Rifampin, Isoniazid (prophylaxis), Pyrazinamide, Ethambutol
All used in combination for tx
Acetominophin
NSAID
NOT and anti-inflammatory or an anti-platelet
hepatoxicity and liver necrosis
drug of choice for post-op periodontal treatment , children, pts with ulcers, or pts on anticoagulants
Aspirin
Analgesic, anti-inflammatory, antipyretic, antiplatelet (7-10days)
Adverse reactions: GI, bleeding, Reyes Syndrome, hypersensitivity
Overdose: tinnitus (ringing in ears)
NSAIDS
Antipyretic, analgesic, anti-inflammatory
Ibuprofen, Acetaminophen (non anti-inflammatory), Aspirin
Adverse effects: GI irritation, ulcers
Contraindications: gastric ulcers, heart disease
- NSAIDS decrease effectiveness, of many drugs
Nitrous Oxide
analgesic and anti-anxiety
no biotransformation, wears off once mask is removed
- contraindications: respiratory issues, pregnancy, emotional illness, substance abuse
NOTE
Nitrous - blue
Oxygen - green
Opioids
Analgesic
anti-tussive (cough suppressor)
sedation
euphoria (abuse)
Adverse rxn: respiratory depression, sedation, nausea, constipation, abuse
Naloxone: REVERSES effects
Methadone: TREATS withdrawal/dependance
Anti-Anginal Agents
Angina: Chest Pain
tx: nitroglycerin (vasodilator) administered sublingually
Congestive Heart Failure Agents
Ianoxine (digoxine), Digitalis, Aldactone
- increases force of cardiac contraction
- side effects: dizziness, fatigue, headache, anxiety, GI upset, altered taste, blurred vision
- use Epinephrine (0.4mg) and Levonordephrine (0.2mg) with caution
Anti-Coagulants
Blood thinners, need INR >3
Warfarin (prevents vitamin K formation), Aspirin
- used for stroke, myocardial infarction
- use Acetaminophen with prescription, not Aspirin to avoid access bleeding
Anti-Arrhythmia Agents
treats irregular heart rhythms
SA node controls heart contractions
- Class 1: Sodium channel blockers slow impulse in heart muscle
- Class 2: beta-blockers slow impulses at SA node
- Class 3: potassium channel blockers slow impulses in all heart cells
- Class 4:Calcium channel blockers slow conduction at SA and AV nodes
Tx: pacemaker, Lidocaine, beta-blocker, calcium channel blockers
Antidepressants
xerostomia is most common side effect
- SSRI’s stimulate CNS, inhibit serotonin reuptake
- TCA’s increase serotonin and norepinephrine
- MAOI’s: first antidepressant, since replaced
- NDRI’s
- Lithium: tx for bipolar disorder, interact with NSAIDS
Antipsychotics
xerostomia common side effect
ends in -zine or -apine
Antianxiety
Induce sleep, causes xerostomia
benzodiazepines enhance GABA
ends in -zepam or -zolam
Organ Transplant Agent
Cyclosporine
Causes gingival overgrowth
Corticosteroids
decreases inflammation and allergic reactions
side effects - infection, ulcers, osteoporosis
causes buffalo hump and moon face by fat deposition in those areas
ends in -asone or -alone
Anti-Allergy Agents
A
Antihistamine
- blocks H1 receptors (causes vasodilation, broncoconstriction, pain, itching) and H2 receptors (gastric acid secretion)
Corticosteroids
- suppresses allergy inflammation
Epinephrine
- used for severe reactions (epi-pen)
Anttihyperlipidemics
controls high-cholesterol
ends in - statin
drugs lower LDL
avoid grapefruit juice
Thyroid Medications
(tx hypothyroidism, hyperthyroidism)
Antihypothyroidism: Levothyroxine
Antihyperthyroidism: PTU, Tapazole, surgery
caution with epinephrine
Thyroid produces thyroxine and epinephrine
Diabetes Agents
Type 1: body cant produce insulin, insulin injection needed
Type 2: cant use insulin, diet and obesity is a risk
tx is Metformin or Prandin
Anticonvulsants
seizure tx
Phenytoin (gingival overgrowth), Phenobarbital (sedative), Carbamazepine
Pregnancy Anaesthetic
Prilocaine, Lidocaine best options
When is it BEST to provide dental tx to pregnant patients?
Second trimester
Pregnancy Drug Classes
A: best, no risk to fetus
B: good in animal studies
C: animal studies show adverse effects on fetus
D: human fetal risk
X: fetal abnormalities
Local Anaesthetic
Esters
Drug names have 1 “i”
- metabolized in plasma
- more likely to cause allergy than amides
- eg. Procaine, Cocaine, Benzocaine, Tetracaine
Local Anaesthetic
Amides (5)
Drug names have 2+ “i”s
- Lidocaine: metabolized in liver, treats cardiac arrhythmia
- Mepivacaine: metabolized in liver, used for epinephrine contraindication
- Articaine: metabolized by plasma, used with liver disease
- Prilocaine: metabolized in liver, used for pts with liver disease
- Bupivacaine: metabolized in liver, long (12hr) relief
Local Anaesthetics
Blocks influx of sodium through channels
Vasodilation
Epinephrine decreases bleeding
Best LA for Cardiovascular Disease
0.04mg Epinephrine
LA Contraindication for Hyperthyroidism
Epinephrine
LA Contraindication for Plasma Cholinesterase
Esters
LA Contraindication for Methymoglobinemia
benzocaine
prilocaine
Street Drugs LA Contraindication
Epinephrine
Laxatives
Constipation tx (IBS)
abuse causes hypokalaemia
Consists of: bulking agents, lubricants, stool softeners
Antisecratory Drugs
decreases acid secretion in stomach
- Histamine H2 Receptor Agonists
- protein pump inhibitor
- prostiglandin analogue
- antimuscanaric drugs
- mucosal protectants
Antidiarrheal Drugs
rehydrating, antibacterial, anti-motility, antispasmodic
-opioid analgesics slows peristalsis
Antispasmodic Drugs
decreases pain and cramping from IBS
Antacids
Causes halitosis, xerostomia, taste alteration
- aluminum and magnesium
- sodium bicarbonate (additive)
- bismuth and calcium NOT recommended
Antiemetics
tx for nausea and vomiting
Side Effects of Bismuth-Salicylate
dark tongue and stool
Side Effects of Antihistamines
drowsiness, xerostomia
Side Effects of Dopamine Antagonist
xerostomia, tinnitus, fatigue
Side Effects of Neurokin Agonist
xerostomia, decreased urination, GERD
Side Effects of Serotonin Agonist
xerostomia, fatigue, constipation
Side Effects of Corticosteroids
indigestion, acne, increased appetite, thrush
Side Effects of Cannibinoids
dizziness
COPD Tx
Short acting: (emergency); Albuterol, Ipratropium
- causes xerostomia, headache, cough
Long acting: (1-2x/day); Formeterol, Aclidinium
- causes cerostomia, headache, dizziness
Corticosteroids: Fluticasone, Prednisone
- Decreases inflammation
- causes thrush, cold-like symptoms, headache, weight gain, stomach upset
Antitussive Agents
Bronchodilator (Albuterol)
Corticosteroid (long term, causes xerostomia, candidiasis)
Long-acting Beta antagonists (Salmeterol, inhaled)
Leukotriene Modifiers (anti-inflammatory)
Combination Drug (bronchodilator + corticosteroid)
Premedications
Amoxycillin 2.0g (50mg/kg for children)
Clindamycin 600mg (20mg/kg for children) for PCN allergy
Ampicillin 2.0g IM or IV (50mg/kg for children) if unable to take oral medications
Administer 30-60 mins BEFORE tx OR 2 hours after
Heart Conditions Requiring Antibiotic Premedication
Artificial heart valve
History of infective endocarditis
Congenital heart conditions
Cardiac transplant with issues with heart valve
Antibiotic Premedication
Joint Replacement
Artificial joints do not require antibiotic premedication prior to dental procedures
*If complications with procedure occurred, consult with physician before invasive procedures
Heart Conditions not Requiring Antibiotics
mitral valve prolapses
rheumatic heart disease
bicuspid valve disease
calcified aortic stenosis
congenital heart conditions such as ventricular septal defect, atrial septal defect, and hypertrophic cardiomyopathy
US DEA Drug Schedule
Schedule 1: Drugs with no currently accepted medical use and a high potential of abuse
Cannabis, Heroin, LSD
Schedule 2: High potential for abuse with use potentially leading to severe psychological or physical dependance
Vicodin, Cocaine, Methamphetamine
Schedule 3: A moderate to low potential for physical and psychological dependance. Abuse potential is less than schedule 1 or 2 drugs
Ketamine, Anabolic steroids, Testosterone
Schedule 4: drugs with a low risk of abuse and dependance
Xanax, Ambien, Valium
Schedule 5: drugs with a lower potential for abuse than schedule 4 and consist of a preparation containing limited quantities of certain narcotics. Usually used for antidiarrheal, antitussive, and analgesic purposes
Lyrica, Motofen, Robutissin A-C
