Pharmacology Flashcards
1
Q
What is the goal of drug therapy treatment?
A
1.Prevent disease
2.Cure disease
3.Decrease mortality
4.Decrease illness
5.Descrease symptoms of illness
2
Q
What is the rational drug prescribing?
A
1.Right drug
2.Right dose
3.Right frequency
4.Right duration
3
Q
What is pharmacodynamics?
A
Effect of drug on body. Body responding to the drug. Site of action.
4
Q
What is pharmcokinetics?
A
What body does to the drug. How quickly, slow, how does it stay and how does body absorb it
5
Q
What is imporatant about precribing a medication that has a lot of different commercial names?
A
Always use a generic name
6
Q
What are ACEI?
A
Angiotensis converting enzyme inhibitors
7
Q
What are two different types of inhibitors?
A
Competetive and irreversible
8
Q
Rank the quickness of receptors?
A
1.Ligand-dated ion channels – milisecond
2.G-protein-copled receptors – seconds morpheine (opiod receptors)
3.Kinase-linked receptors – hours
4.Nuclear receptors – hours to days – steroids (cortizone)
9
Q
What is a therapeutic index?
A
It is a range of concentration of drug in plasma comparative to safe range. Essentially, drugs with a wide therapeutic index are safer because they hard to overdose on
10
Q
What are the 3 most important parts of pharmacokinetics?
A
1.Absorption
2.Distribution
3.Elimination – metabolism and excretion
11
Q
Why are pharmacokientics important?
A
Altered pharmakokinetics = harmful effect of drugs. E.g. CIclosporin + St. John’s Wort = transplant rejection. Also pharmakokinetics create a dosign regimen.
12
Q
How do we determine the root of administration of drug?
A
1.Properties of the drug
2.Therapeutic objective – rapid response or chronic dosing
13
Q
What is the advantages of sublingual, transdermal, rectal and injection pathway?
A
They bypass the first pass of the drug through the stomach, small intestine and liver
14
Q
What is the pathway of gastrointestinal absorption?
A
1.Lumen
2.Enterocytes
3.Portal vein
4.Systemic circulation
15
Q
How much water can we drink to empty a stomach?
A
200mL as it will make the stomach empty into the small intestine
16
Q
Why do we use a enteric coating on aspirin?
A
Because aspirin may cause gastric bleeeding. On prescription, write swallow whole.
17
Q
What are two different types of clearance?
A
1.Renal clearance – water solubles
2.Liver – lipid soluble drugs
18
Q
What is metabolism?
A
Enymez convert one moleculue into a more water soluble one.
19
Q
What are active metabolites?
A
Sometimes drugs are broken down into more active forms, thus if you give a high dose of a drug you more likely to overdose on an active metabolite of that drug.
20
Q
How many half lives does it take to reach steady state?
A
5 half lives
21
Q
What are some of aspect that effect variability?
A
1.Disease – kidney disease (lover dose), liver disease (no paracetamol)
2.Age – children (hihg clearance) Elderly (lover excretion, polypharmacy, Start Low & Go up slow & don’t stay low)
3.Pragnancy – all drugs no, contact GP to prescribe especially first trimeste, no ibuprofen, floconazole and oral isotretinoin – reduced GI motility
4.Genetic
5.Smoking
6.Food – grapefruit juice Drug-drug interaction
22
Q
What are different type of drug-drug interaction (pharmakokynetic)?
A
Drug induction – Drug A induced Drug B increasing the sites of binding
Enzyme inhibition – Drug A blocks metabolism of Drug B resulting in accumulation of Drug B (miconazole)
Changes in renal clearance – Ace inhibitors, Nsaids and Diuretics (triple whammy)
23
Q
What are different type of drug-drug interaction (pharmacodynamic)?
A
Potentiation – Drug A and Drg B effect the same target
Same mechanism – Drug A and Drug B taerget different receptors but have the same mechanism (CNS depressants + alchohol)
c
24
Q
What do adverse drug reactions do not include?
A
Overdose or error in dosing, those are adverse drug events.
25
What are major types adver drug responses?
Type A – augmented or increase effect - usually okay
Type B – Bizarre and unpredictable – high risk of death
26
What is the aims of drug regulation?
Protect public from:
1.Unsafe
2.Ineffective
3.Poor quality drugs
27
What are two major scedules for australia?
Aust L – no therapeutic claim
Aust R – have a therapetuic claim
28
How is saliva produced?
Trough parasympathetic (cholinergic)(watery) mechanisms and Sympathetic (adrenoceptors)(mucin and thick)
29
What neurotransmitter is used for cholinergic receptros?
Acetylcholine. Store in cells in vesicles and can be released in the systemic circulation (synaptic cleft) by calcium channels. There is 3 such receptors called muscarinic M1, M2, M3 (M3 is one is for glands).
30
What drugs are use as cholinergic agonists?
1.Direct acting – bind to activate muscarinic receptors – nicotine, lobeline and muscarine (aka magic mucshroom compound)
2.Indirect acting – inducing acetylcholinesterase (breakdown of acetycholine)
Blocking clholinergic antagonists result in:
Red as a beet
Blind as a bat
Dry as a bone
Full as a flask
Stuffed as a pepper
Mad as a hatter
31
Which drugs are used as cholinergic agonists (specific)?
1.Drugs for Urinary Incontienence
2.Parkinson's disease
3.Gut motility disorders
4.Motion isckness
5.Pre-anaesthetics
6.Astham: inhalers
7.Antidepressants: Tricyclic antidepressant (not logner used much for depression but used for pain), serotonin selective reuptake inhibitors - important
8.Antipsychotics: Olanzapine, droperidol NOT CLOZAPINE that one cause hypersalivation - important
9.Antihistamines: sedating group is more common - improtant
10.Anxioklytic: anxiety drug
11.Antihypertensive
12.Benign prostatis hyper plasia
13.Appetite suppressants
14.Cytotoxic agents: radiotherapy
15.Diuretics
16Opiods
32
How can we help with xerostomia?
Efficacy in unproven:
1. Saliva substitutes – Aqueae
2. Salivary peroxidase
3. Mouth washes
4.M3 receptor agonists
5.Check prescriptions and maybe stop taking the over counter medications
6.Sip water
7. Ice blocks
8.Spray bottle
9. Suagrless lollies or sugar-free gum
10. Limit caffein & alchohol
11. Adhere to preventative dental program
33
What is a prescription?
It is a legal document, a communication tool between you and pharmacist for preparing & dispensing a medication for your patient.
34
What are prescribing requirements?
Only for dental treatment of a patient under your care. Only for the person named on prescription. Cannot prescribe to yourself (only benzodiazapines and opioids). Please use ScriptCheck SA to reduce the number of drug dependent users.
35
What should be included on a prescriptions script?
Remember ePrescriptions are preferred
1. Patient's name, address and DOB
2. Name & address of practitioner, phone number, qualifications, AHPRA reg
3. Drug name – GENERIC
4. Drug form – e.g. tablets
5. Drug strength- e.g 15 mg
6. Drug quantity in pills (word, symbol e.g Ten,10)
7. Dose & frequency of administration
8. Duration of days
9. Instruction clearly
10. Write (For dental treatment only)
11. A line to signify no other prescriptions
12. Signature of prescriber
13. Date of prescription
14. Signature
15. PBS number for prescribers
36
What is important to know about all dentist prescribe drugs?
No repeats are available
37
What is released during the brekadown of cellular wall?
Prostoglandins – long chains of fatty acids which cause vasodilation, swelling and pain. Additionally, bradykinin is released which causes intense pain.
38
What do non-steroidal anti-inflammatory drugs target?
They block the work of COX1 and COX2 enzymes which prevents the creation of prostoglandins
39
What is important to remember about the cyclooxygenase enzymes?
COX enzymes are present throughout the body. COX1 is abundant and it maints our function. COX2 is in very low amount and lead to inflammation & pain because it is inducible. By inhibiting COX2, we can lower inflammation.
40
What is important to understand about ibuprofen?
It is an reversible drug. It is a non-selective COX 1 & 2 inhibitor. But is an effective analgesics in presence of inflammation. It reduce the production of psotoglandisnas and make receptors less sensative to bradykinin.
41
Do NSAIDS have adverse effects?
1.Gastrointestinal ulcers
2.Reduce platelet aggregation
3.Respiratory problems: increase asthma attack
4.Kidney: renal failure and water retention leading to heart failure and hypertension
5.Cardiovascular – uncommon BUT BAD
6.Neurological – headaches
7.Hematological – rare
8.Hepatic – rare
42
When should you not prescribe NSAID?
1.Kidney impairment
2.Heart failure or arterial fibrilation
3.Active GI ulcer
4.Bleeding disorder and their drugs
5.Corticosteroid or anticoagulation use
6.Multiple risk factors for increase NSAID toxicity
7.If unsure contact GP
43
What questions should you ask particularly an elderly before prescribing an NSAID?
1. Have you experience recent changes in your bowel habits, such as black or tarry stools?
2. Any episodes or recent nausea, vomiting or abdominal pain?
3. Have you noticed any changes in your urine output or color?
4. have you experienced any shortness of breath, chest pain or swelling?
5. Do you have a care giver or support group that may aid you or remind you about taking the medication?
6. Do you take any over the counter medications recently that are beyond the once in your medical history?
7. Do you take a deuretic or an ACE inhibitor?
44
What can we use an NSAID for?
Mild-moderate acute inflammatory pain. Usually 1200mg/day, 400 mg per 6 hours for 2-3 days if pain persists you should go to GP.
45
What is an opiod?
It refers to a generic sense to all drug with morphine-like actions. Please use this term
45
What is a good combination of medication to ue post 3rd molar extractions?
150mg of ibuprofen + 500mg of panadol x6 times a day.
46
What can be used in temporary relief of painful inflmmatory oral mucosal conditions like mucositis?
Benzydamine, an NSAID in a spray form.
47
What receptor does the opioid bind to?
It is the mu receptor pre- and postsynaptically causing the reduction in pain transmission pain impulses. Resulting in lower feeling of pain.
48
What are opioids are used for in dental?
1.Acute pain
2.Persistent cancer pain
49
What is the most important side effect of opioids?
Respiratory depression. Additionally, sedation, nausea, euphoria, constipation and dry mouth.
50
Why are opiods good?
Great analgesia. Relief of anxiety. Reliable and rapid onset.
51
Why are opiods bad?
Side effects, dependence, tolerance
52
What can dentist prescribe?
1. Morphine – not recommended in dentistry as it is not for acute pain
2. Codeine – less potent for gram then morphine about 1/10 - not good for dental pain
3. Oxycodone - not that good
4. Tramadol – not a drug of dependence – a lot of tummy aches - go with this first!
53
What can you use to reverse the effects of an opioid?
Naloxone
54
What is conscious sedation?
It is a drug-induced depression of consciousness during which patient are able to respond purposefully to verbal command or light tractile stimulation. All conscious sedation techniques should provide a margin of safety that is wide enough to render loss of consciousness unlikely
55
What is deep sedation?
When consciousness is lost, airway is lost and only pain can be responded to. This is more dangerous.
56
What is the triad of sedation?
1.Unconsciousness
2.Analgesia
3.Muscle relaxation
57
What are the tree major drug groups use for sedetation?
1.Sedatives/hypnotics - IV – most important is brain concentration and elimination of the drug – diazepam (very fast 1-2minutes, half-life of 4-8hours), nidazolam(fast onset 4minutes, half-life 90 minutes)
2.Analgesiscs
3.Muscles relaxants
58
What are the profiles of benzodiazapines?
1. Relatively fast onset
2. Offset can be slow with diazepam
3. Dose-response relationship is very variable
4. CNS – cause convetional sedation, amnesia and anxiolysis
5. Respiratory – ventilatory depression and airway obstruction
6. CVS – mild hypotentison
59
When do you give a second doze of benzodiazepines if does not work?
Give it 10-15 minutes and then reassess after the first dose.
60
What are the profiles of phenols (like propofol)?
1.Slow onset
2.Offset is fast due to redistribution but then is slow for full clearance
3.Dose-dependent relationship is less variable
4.CNS sedation and anxiolysis
5.Ventilation depression and airway obstruction
6.Moderate-sever hypotension
61
What are the profile of nitrous oxide?
1.Onset is quick
2.Offeset is fast
3.Less varaible dose-response relationship
4.Sedation and analgesia
5.Ventilatory depression and airway osbtruction
6.Moederate hypotension
62
Why are antibiotics different to other medications?
Because they don’t just include the body and drug but also the pathogen!
63
When do we use antibitotics?
1. Only use when there are demonstrated benefits
2. In general, the narrower the spectrum you can use the better
3. Single agents unless combination has been proven superior
64
What are the major classses of antobiotics in dentistry?
1.Beta-lactams – inhibit bacterial walls and interference of bacterial wall synthesis. Beta lactamase can build resistance to beta lactams. Good spectrum of action, safe and wide therapeutic index. Generics: benzyl penicillin or phempxymethyl penicillin. Act on gram positive cocci thus can affect oral flora. Could be short spectrum or moderate spectrum (amoxycyllin). Can be used with clavulanate (inhibitor of beta lactamase) making it target anaerobes, good for elderly. Main side effects: allergy, GI issues and hepatoxicity.
2. Cephalsporins – also beta lactam but not pencillins. Broader spectrum. Not very much used.
3. Nitromidazole – metronidozole. Inhibits DNA synthesis and covers anaerobes. Adverse reactions: GI problems, dizziness, bitter and metalic tase. No alcohol as metronidozole inhibits the brekdown of alchohol. Need to wai 72 hours after finishing a script
4. Lincosamides – clindamycin. Inhibits bacteria protein synthesis. Good for Gram positive and anearobic bacteria. Adverse reactions: GI problems (bad ones), allergy
5. Macrolieds – erythromycin. Good for gram positive but not for anaerobes. Adverse effects: GI issues, a lot of drug interactions
65
What is the use of sedative and hypnotics in dentistry?
Majority will be used to reduce anxiety before/during dental procedures
66
What is effect of benzodiazapines?
1.Anxiolytic
2.Sedative
3.Hypnotic
67
What are adverse effects of benzodiazapines?
1.Drowsiness
2.Impaired performance
3.Respiratory depression ESPECIALLY WITH OPIODS
4.Paradoxical excitation
5.Retrograde amnesia
6.Fantasy
7.Dependence – give 1-2 tablets only
68
What are the benzodiazepines avaliable for dentist?
1.Oxazepam
2.Temzepam
3.Nitrazepam
4.Diazepam – please only prescribe 1-3 tablets
69
What is epilepsy?
Discrete episodes of movement, sensation, behaviour or perception. Can be general or partial. Usually take valproate, which hepatically-cleared, half life of 9-15 hours. Carbamazepine can be used for trigeminal neuralgia, but has a lot of drug interaction. Phenytoin is another drug but a lot of gignival hyperplasia. Remember, many anticonvulsatn have a narrow therapeutic index.
70
What is dementia?
Memori imparement in older people leading to problem with processing the information. Consent of carer's is important.
71
What is serotoninergic syndrome?
It is when mutliple drugs that increase serotonin are used.
This features:
Bahvioural changes
Altered muscle tone
Autonomic isntability
Hyperpyrexia and diarrhoea
Death
72
What is a dental implication of Parkinson's disease?
Dry mouth
73
What are usualy drugs of inflammation?
Corticosteroids.
74
If a patient is on steroid, what would be some of the side effects?
1. Delayed wound healing
2. Increased susceptibility to infection
3. Masking of signs of infection
4. Adrenal suppression
75
What are small moluce immunosupressants?
Cyclosporine and tacrolimu for example. They can potentially interfere with healing and immunity. Can also cause gingival hyperplasia.
76
What are biological immunomodulators?
Something like monoclonal antibodies like interferon. Patient will receive an infusion or an injection periodically.
77
What are some medication that can be used for herpes simplex and varicella??
Aciclovir available orally, IV and topically. Or vallaciclovir or famciclovir.
78
What are some drugs for treatment of HIV?
Chronic antiviral therapy for life. Just remember to ask a aptietn to bring the tablets and check for drug interactions. Such drugs are for example ritonavir. Do not prescribe carbamazepine.
79
What are some topical antifungals?
Amphotericin B. Not obsorbed orally so very good. Nystatin. Not absorbed orally so also very good. Miconazole. Non-pbs but cheap as a cream. Anything azole is a antifungal
80
What are the 2 different types of bronchodialators?
1.B2 adrenoreceptors agonist
2.Anticholinergic drugs
81
What are beta 2 agonists?
1.They relax smooth msucles in airways
2.And stop the mediation factors from wrecking the place up
82
What are the symport relievers available?
1.Salbutamol
2.Tobuterol
They are short acting and there duration is 3-6 hours or can be made into long acting for upto 12 hours.
83
What are adverse effect of Beta 2 adrenoreceptor agonists?
1.Muscle tremor, cramps
2.Tachycardia and palpatations
3.Headache
4.Agitation, especially in children
84
What are the actions of corticosteroid in lung disease?
1. Anti-inflammatory
2. Reduce bronchial hyperactivity
3. Increase number of beta 2 adrenpreceptors
4. Increase responsiveness to beta 2 agonsits
Example: Beclomethasone
85
What are the side effect of topical corticosteroids?
1.Oral candida
2.Hoarse voice
3.Rash
86
What are anticholinergic bronchodilators used for?
Ipratropium or Tiotropium are used in treatment of chronic COPD or acute asthma. Remember, dry mouth
87
What equipment shpudl you have at your practice for dental emergencies?
1.Oxygen source
2.Disposable plastic airways
3.Adrenaline 1in 1000 injection
4.Pulse oximeter
5.Glucose
6.Glyceryl trinitrate spray 600 mcg
7.Short-acting bronchodialator and space
8.Aspirin
9.Blood pressure monitor
10.Blood glusode monitor
11.Automated external defibrillator
88
What are some allergic reactin that may occur in chair?
1. Urticaria – red itchy patches – stop administration of any allergens and administer a less sedating oral antihistamine like cetirizine or fexofenadine (not on PBS but good to have around and they are cheap)
2. Anaphylaxis – cardiovascular collapse and bronchoconstriction – stop administration of any allergens, call 000 and lie patient flat and give intramuscular injection of adrenaline, start supplemental oxygen, support airway, start CPR if needed. Do proper documentation.
89
What to do if a patient has chest pain or angian?
1.Stop treatment
2.Pulse oximeter on, see if patient is concious, check heart rate and blood pressure – if no pulse, CPR - ask patient if they used viagra, as it can make GTN way more potent
3.Use glyceryl trinitrate spray 400 micrograms sublinguallt, repeat 5 minutes if pain persists, for total of 3 dosease if tolerated
4.If pain continues, call 000
5.Give 300mg of aspirin orally chewede before swallowing
6.Strat supplemetan oxygen and maintain oxygen between 90-96% saturation
90
What does the glyceryl trinitrate do?
It is a vasodilator, dropping the blood pressure
91
What are two types of hypoglycemia?
1. Adrenergic – release of adrenaline
2. Neuroglycopenic – damage to neural cell - common in diabetics
92
What to do in a hypoglycemic event?
1. Stop treatment
2. Give 15 g of glucose and measure glucose level in 15 minutes
3. If still low, administer 3 or more portions
4. f symptoms persist, seek medical advise and call 000 if patient is unconcious
5. IF all is good after a few protions, no dental treatment today, get some longer acting carbohydrates like a sandrwich or yogurt and observe the patient until they feel okay
93
What to do if a patient has an asthma attack?
1. Stop treatment
2. Oximeter is placed straight away moderate is above 94%, sever 90-94%, life threatening below 90%
3. f mild – give 4 puffs of salbutamor via spacer 1 puff at a time with patietbreathing in 4 times
4. Wait 4 minutes, if not imrpoving treat as sever or lifethretening
5. Call 000
6. Maximum of 12 puffs but if it is bad even after just keep giving salbutamo with 4 breaths in between before ambulance arrives
94
What should you cover in penicillin allergy history?
1. What did patient react to?
2. What was the type of rection? Is it really sever, did it limit their function or made them die? Did it have it for mono, that one can create a fake reaction to antibiotic
3. How long after start of treatment did it occur eg after a few hours or many days?
4. How long ago was the reaction?
5. How was it treated?
6. Have they had similar antibiotics since?
95
What are considered to be low risk reactions to penicilin?
1. Uknown reaction more than 10 years ago
2. Childhood exanthem, unlear details with no evidence of hospitalisation
3. Diffuse or localise rash with no other symptoms after 24 hours after strating the antibiotic more than 10 years ago. This make the risk of rash on re-exposing about 5%.
96
What are considere high risk reaction to penicillin?
1. Any previous respiratory disressm, swelling of mouth or throat
2. Any history of diffuse rash which comes immediately after starting treatment
3. Diffuse or localised rash which is delayed but occurred less than 10 yearsago
Re-exposure may cause anaphylaxis, so non-beta lactam
97
What are considered sever cutaneous reactions to penicillin?
1.Rash with mucosal ulceration
2.Oustules, blister, desquamation
3.More
These features show that the next ras could be fatal. Non-beta lactam antibiotic should be usd.
98
What is the use antiplatelets/anticoagulants?
Primarily for management of cardiac conditions, secondayr prevention of IHD, cerebrovascular, peripheral vascular disease particularly with procedure such as stents. Multiple agents are used I.e. an antiplatelet and an anticoagulant. Used fo artrial fibrilation or if a patient has a history of clots.
99
What are dental implications of aspirin?
Prevent clotes forming at low dosage. Irreversible inhibition of platelet aggregation for 7 days. Need to stop 7 days before surgery for platelet to be replaced with new ones.
100
What are clopidegrel and prasugerla?
Anitplatelets. More effective then aspirin thus more bleeding may occur. Irreversible. Needs 7 days to regenerate. Check with GP/cardiologist before asking patient to stop taking it. Usually used together with aspirin. Greate risk of thrombosis.
101
What is ticagrelor?
Reversible inhibitor. Anti-platelet. Given in high risk situtations. Check with GP/cardiologist before asking patient to stop taking it. Usually used together with aspirin. Greate risk of thrombosis.
102
What is warfarin?
Vitamin K antagonist inhibits the clotting factors II, VII, IX, X. Anti-coagulant. Bleeding risk can be measured with INR. 2-3 is manageable and is the therapeutic range. If taken off, restarting takes some time. Warfarin has a lot of drug interactions.
103
What are direct oral anticoagulants or new oral anti coagulants?
Apixaban, dabigatran, rivaroxaban. Directly acting agent which generally require a single stable dose, and do not need to monitor for effect. Can not measure the effect with INR. Patient may not know they are on anticoagulants. When to stop: dabigatran 1-4 days depending on renal function, apixaban and rivaroxaban: 1-2 days
104
What is ischemic heart disease?
Less oxygen to the heart then requires, lead to pain (angina) and infarction because of the plaque. Therapeutic objective: rebalance supply of oxygen. Acutely reduce myocardial need for oxygen and chronically: improve coronary blood flow
105
What is the ending of medication for beta blockers? WHat is bad about them?
Lol. They masking symptoms of hypoglycemia in a fasting diabtetic. Also may need more adrenaline in case of hypersensativity.
106
What are the most common lipid lowering drugs?
HMG-CoA reductase inhibitors. Like atorvastatin or other statins. Do not use with erythromycin or antifungals)
107
WHat is an ace inhibiotr?
Vasodialator. Can cause cough or angioedema (swelling of face). Drug interactions: do not use with NSAID as it can cause acute renal failure or hyperkalaemia especially a diuretic
108
What are angiotensin II blockers?
End in sartan. Similar to ACE inhibotrs but do not cause cough or angiodema.
109
What are diuretics?
End in thiazide. Have a diuretic and vasodilator effects. Have a risk of postural hypotension after prologned supine rest or with nitrates.
110
What is heart failure?
Heart incapable of pumping sufficient output for needs of the peripheral tissues at usual filling pressure. Result in fluid accumulation, shortness of breath (pulpmonary oedema) from lying down and ankle swelling. Do not take NSAID's please (remember tripple whammy).
111
What are loop diuretics?
Furosemide. Very effective diuretic with repid onset. IF taken in the morning, may need to stop the procedure so they can take a toilet break.
112
What is important to remember about spironolactone?
No NSAIDs. Very common cause of renal failure. Very bad very sad. Contraindications.
113
What are the two parts of an adrenal gland?
Cortex: release of glucocorticoids (cortisol) and aldosterone
Medula: adrenalin
114
What is the action of glucocorticoids?
1. Regulation of metabolism
2. Response to physical stress eg surgery
3. Suppress immune function (block formation of different immune responses)
115
What are therapeutic roles of glucocorticoids?
1. Replacement in hypoadrenalism eg Addison's disease (Addisonian crisis hehehe)
2. Immune suppression (arthitis, skin conditions or even prevention of organ transplant rejection)
116
What happens if you use high doses of exogenous corticosteroids for a perio of time?
The cells within the cortex are not stimulated to grow by ACTH from petuitary gland. This mean when the exogenous source is depleted, there is no support coming from an endogenous source (ie natural source, self-produced by the body). For example in stress. The usual amount is more than 5mg/day of prednisolone for more than 2 weeks will require more corticosteroid.
117
How to manage a patient with corticosteroids?
1. Find out how long they have been on steroids
2. Reduce stresses
3. If extraction or other steroids, to prevent an Addisonia crisis start teatment in the morning and get more steroids the day before (double the dose) and the day of treatment (double the dose) - contact GP prior.
118
What are sulphonylureas?
They stimulate the release of insulin from pancrease. Can cause hypoglycemia. Abuse pancrease so no good. Causes weight gain.
119
What are SGLT inhibitors?
Gliflozins. Inhibits glucose transported in renal tubules. Associated with weight loss. Can cause dehydration and infection in the urinary tract.
120
What are incretin analogues?
Syntehtic substitution to incretin. As injections. Liraglutide. Can cause nausea and vomiting.
121
What should you have available for a patient with diabetes during the treatment appoitment?
1. Their medication
2. Glucose monitor
3. Food if needed
4. If no food, need to reappoint
5. Always need to let the patient know to keep the same carbohydrate intake
122
What are dental implications of thyroid disease?
Stable: all g but higher risk of cindidisis
Unstable: delayt treatment until stabilised because LA may cause cardiac problems
123
What is important to understand about the oral contraceptive pill?
It may interact wirh erythromycin
124
What is the use of gastric acid blockers?
1. Assist in healing of oesophageal mucosa and ulcers
2. Reduce dental erosion
125
What are histamine 2 antagonist?
Renitidine. Very safe. Very good. Over the counter.
126
What are the proton pump inhibitors?
Omeprazole or other. Irreversibly inhibit the proton pump stopping the production of gastric acid. Very rare adverse effect.
127
What is the use of nausea and vomiting drugs?
Post-operative or drug-induced nausea. D2 antagonists, antihistamine and anticholinergic. Prochlorperazine.
128
What transmitters help to induce vomiting?
Aceetylcholine and histamine 1 at the vomiting center. Also, drugs and toxins are detected by chemoreceptor trigger zone in the brain which use dopamine 2, 5ht3 (seratonin), neurokanine 1 so you need to block the chemoreceptor trigger zone.
129
What are good antiemetics?
1. Metoclopramide – dopamine antagonist (please don’t use in Parkinson's disease) - may cause extrapyramidal effects – use 10mg 6-8 hour;y oral
2. Prochlorperazine – dopamine antagonists, also anthistamine, alpha blocker and anticholinergic – problems: drowsiness, hypotentsion, dry mouth also cardiac effect
130
What are the prescribing foundations?
1. Information gathering
2. Clinical decision making
3. Communication with all parties involved
4. Monitoring and review
131
What comes under "Information gathering" in contexrt of competent prescribing?
1. Case context and history taking
2. Extra-oral examination
3. Intra-oral examination and diagnosis
4. Investigations
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What comes under "Clinical decision making" in contexrt of competent prescribing?
1. Treatment goals
2. Non-pharmacological interventions
3. Over-the-counter products
4. Preferred drugs
5. Patient ID
6. Patietn allergies and general adverse drug effects
7. Appropriate pharmacological interventions
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What comes under "Communication" in contexrt of competent prescribing?
1. Write a perscription
2. Review prescriptions
3. Communication with patient and healthcare providers/teams
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What comes under "Monitoring and review" in contexrt of competent prescribing?
1. Appropriate follow up and monitoring with the patient
2. Appropriate review and adjustment of approach to achieve treatment goals and patient satisfaction and safety
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What is the definition of MRONJ?
Medication-related osteonecrosis of the jaw (MRONJ) is defined as an area of exposed bone in the maxillofacial region that has persisted for more than eight weeks, in a patient receiving bisphosphonates, denosumab or antiangiogenic therapy for cancer, and where there is no history of radiation therapy to the jaws or obvious metastatic disease to the jaws.
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What are the 5 questions you can ask yourself when deciding on treatment for the patient?
1. Is the test, treatment or procedure really necessary?
2.What are the risks?
3.Are there simpler, safer options?
4.What will happen if we don't do anything?
5.What are the costs?
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What is chlorhexidine?
Chlorhexidine is an antiseptic that is effective against a wide range of Gram-positive and Gram-negative vegetative bacteria, some viruses and some fungi. It is important when using chlorhexidine to keep the solution intra-oral for at least 1 minute.
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What is benzydamine?
Benzydamine is an NSAID with anti-inflammatory and analgesic properties. It is available in mouthwashes, mouth gels and throat sprays and in combination with chlorhexidine or cetylpyridinium.
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What is a good acronym to remember high risk medicines?
APINCHS
Antimicrobials
Potassium and other electrolytes
Insulin
Narcotics
Chemotherapeutic agents
Heparin
Systems
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What kind of medication can we use for treatment of oral lichen planus?
1. Difflam Anti-Inflammatory Antiseptic Mouth gel containing benzydamine hydrochloride 1% 2-3 hours, for 7 days for no more then 12 times a day. Do not eat 15 minutes after
2. Chlorexedine and benzydamine mouthwash
3. Cepacaine oral solution - cetylpyridinium chloride, benzocaine and ethanol solution
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