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NBDHE > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

Who monitors drugs for the potential of abuse

A

DEA (Drug enforcement agency)

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2
Q

Drug schedules

A

I) Highest- No accepted medical use (heroin, LSD)
II) High- Rx required, opioid narcotics (oxycodone, morphine, hydrocodone)
III) Moderate- Rx required, codeine mixtures (Tylenol 3)
IV) Less- Rx required, anti anxiety, sleeping meds, tramadol
V) Least- No Rx required, codeine containing cough syrups
Schedule II must be typed or written, require new written script for refill
Schedule III and IV can be telephoned to pharmacy 5 times in 6 months
As schedule number increases, abuse potential decreases

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3
Q

Potency vs efficacy

A

Potency: Amount of drug needed to produce therapeutic effect
Efficacy: Maximum intensity of effect produced by drug
Potency and efficacy are unrelated, drugs may have different potencies but not the same efficacy
Efficacy- Y axis
Potency- X axis

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4
Q

Agonist

A

Drug produces an effect and has affinity for receptor on cell membrane

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5
Q

Antagonist

A

Drug counteracts the action of agonist (blocks receptor)

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6
Q

ADME: Absorption

A

Drug transfer from sight of administration to blood stream
Lipid soluble and nonionized= Easily absorbed
The absorption phase is bypassed when a drug is administered intravenously
The most important site for drug absorption of orally administered drugs is the small intestine

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7
Q

ADME: Distribution

A

Drug distributed by blood plasma
Factors that influence distribution: Organ size and amount of blood flow, drug solubility, barriers

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8
Q

ADME: Metabolism

A

Body’s way of changing a drug so it can be excreted
Excreted product is ionized and less lipid soluble (opposite so body can excrete it)
Most common location is the liver. Patients with liver disease or alcoholism may have decreased ability to metabolize drugs. Leads to increased levels in blood which increases toxicity

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9
Q

ADME: Excretion

A

Drug can be excreted unchanged or as a metabolite (modified)
Kidney (renal) excretion is most common. Can also be excreted through lungs, saliva, breast milk, crevicular fluid
Lipid soluble drugs are not excreted in urine- must be metabolized by liverinto water soluble form to be excreted into urine
Major route of fluoride excretion is in urine

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10
Q

Half life first order kinetics

A

Constant PERCENTAGE of drug is removed from body per unit of time
(Shorter half life, shorter action of duration, etc)

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11
Q

Half life zero order kinetics

A

Constant AMOUNT of drug removed from body per unit of time (alcohol and aspirin)
High doses, very long duration of action

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12
Q

Enteral route

A

Drug placed directly in GI tract- orally or rectally
Drug levels less predictable with oral administration

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13
Q

First pass effect

A

Orally derived drugs must pass through hepatic portal circulation which can inactivate some drugs.
Amount of drug available to produce systemic effect is reduced by first pass effect
Drugs with high first pass effect require a larger oral dose as high percentage will be deactivated

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14
Q

Parenteral route

A

Bypasses GI tract
Injection
Inhalation
Topical- contraindicated if surface is ulcerated, burned or abraded

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15
Q

Therapeutic effect

A

Desirable action of drug

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16
Q

Adverse reaction

A

Undesirable action of drug
- Side effect: Expected but unwanted response, dose related, non target organs

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17
Q

Toxic reaction

A

Expected response, exaggeration of therapeutic effect, dose related, target organs

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18
Q

Allergic reaction

A

Not predicatable, not dose related,
Type I: Immediate hypersensitivity- anaphylaxis
Type IV: Delayed hypersensitivity- contact dermatitis (latex, TB test, transplant)

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19
Q

Therapeutic index

A

Lethal dose divided by effective dose (LD50/ED50)
Shows safety of drug
Narrow TI: Toxicity more likely
Wide TI: Toxicity less likely, safer drug
TI>10 needed for useful drug

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20
Q

When is epinephrine contraindicated

A

Cocaine or meth abuser

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21
Q

Clonidine

A

Adrenergic agonist

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22
Q

Meth

A

Oral mucosal irritation is a result of the method of drug administration, not the drug itself

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23
Q

Adrenergic drug contraindication

A

Uncontrolled hypertension and uncontrolled hyperthyroidism- avoid epi or use cardiac dose

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24
Q

Autonomic nervous system drugs

A

Adrenergic drugs: Mimics SANS
Cholinergic drugs: Mimics PANS

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25
Q

SLUD

A

Large doses of cholinergic drugs produce SLUD
Salivation, lacrimation, urination, defecation
Pilocarpine (salagen) treats xerostomia (pillow)
Cevimeline (evoxac) treats xerostomia (evacuate)

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26
Q

Atropine

A

Anticholinergic drug used pre operatively to decrease salivary flow for dental procedures

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27
Q

Non opioid analgesics (Non narcotics)

A

Mechanism of action: Inhibit prostaglandin synthesis
Prostaglandins: Sensitize pain receptors, lower pain threshold, cause inflammation and fever

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28
Q

Aspirin

A

NSAID, analgesic, antipyretic, anti-inflammatory, antiplatelet
Adverse reactions: GI irritation, can cause Reye syndrome in kids, contraindicated with warfarin, can cause white wrinkle of mucobuccal tissue where a patient might hold it in their mouth (aspirin burn)

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29
Q

Ibuprofen (Naproxen)

A

NSAID, most useful pain med in dentistry, analgesic, antipyretic, anti inflammatory, NOT antiplatelet
GI irritation. Contraindicated with warfarin, can decrease effects of many drugs such as ACE inhibitors, beta blockers, loop diuretics, corticosteroids, cyclosporine, lithium

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30
Q

Is taking NSAIDS with phenytoin (Dilantin) contraindicated?

A

Yes! Can increase phenytoin levels
(Seizure meds)

31
Q

Acetaminophen (Tylenol)

A

No anti inflammatory action, NOT an NSAID
No effect on GI irritation, no effect on clotting
Analgesic, antipyretic
Patients with liver disease should avoid
Is drug of choice for patients on warfarin or peptic ulcers

32
Q

Naloxone (narcan)

A

Parenteral opioid antagonist
Drug of choice for treating overdose

33
Q

What is most common opioid used in dentistry

A

Codeine (Tylenol 3)
Codeine cannot be used in pregnant women (repiratory depression for neonatal fetus)
Sign of overdose or addiction: Pinpoint pupils
All opioids lead to constipation

34
Q

Antiinfective agents

A

Stage 1: Initial stages of infection- Penicillin/amoxicillin
Stage 2: Mixed infection- Metronidazole or Clindamycin
Stage 3: Advanced infection- Metronidazole or Clindamycin
Mean Cleaners

35
Q

Are antibiotics effective against bacterial or viral infections?

A

Bacterial

36
Q

Antibiotic tips

A

Penicillin: High incidence of allergies
Antibiotics decrease the effectiveness of birth control pills
Increase effects of anticoagulants (warfarin)
Erythromycin: Highest incidence of GI complaints
Tetracycline: Contraindicated during pregnancy
Liquid forms have higher sugar content- advise kids to brush after
Most common allergic reaction is rash

37
Q

Is penicillin VK preferred over penicillin G?

A

Yes! Penicillin G is inactivated by gastric acids

38
Q

Augmentin

A

Augmentin= penicillin with clavulanic acid
Penicillin is not effective against penicillinase producing bacteria… BUT Augmentin is effective… it prevents penicillinase from breaking down amoxicillin

39
Q

Cephalosporins

A

Very similar to penicillin but more expensive. If pt is allergic to penicillin they’re allergic to cephalosporins

40
Q

Macrolides (-mycins)

A

Erythromycin: Increase effect of warfarin, most common side effect is GI upset
Azithromycin and clarithromycin: Both can be used for premedication if there is a penicillin allergy

41
Q

Tetracycline (cyclines)

A

Don’t take with milk (binds with calcium)
Used to treat NUP/NUG and aggressive perio due to their excretion into the crevicular fluid where they have an anti collangenase effect
Photosensitivity
All tetracyclines cross placental barrier and are excreted in breast milk

42
Q

Clindamycin

A

Can lead to C diff and severe persistent diarrhea

43
Q

Nitroimidazoles

A

Effective against obligate anaerobes only
If alcohol is ingested, it will make you very sick, avoid listerine

44
Q

Anti tuberculosis agents

A

Tx is difficult, treat with multiple drugs at the same time (RIPE)
Rifampin, isoniazid, pyrazinamide, ethambutol
If pt indicated they are taking rifampin or isoniazid only they are likely taking it as a preventative agent

45
Q

Suggested premed

A

Single dose of 2000mg of amoxicillin 30-60mins before appt
If allergic- cephalexin 2000mg, macrolides or tetracyclines

46
Q

Anti fungal agents (-azole)

A

Nystatin: Most commonly used in dentistry, topical drug used to treat candidiasis
Fluconazole (diflucan): oral drug to treat systemic infections

47
Q

Anti viral drugs (-vir)

A

Most viruses do not require drug therapy and should “run their course” beside HIV
Aclovir topical

48
Q

Local anesthetic preservative

A

Sodium bisulfate/sodium metabisulfate is the preservative (only is vasoconstrictor is present)
Contraindicated in patients with sulfite allergies or sensitivities

49
Q

Local anesthetic mechanism of action

A

Inhibit influx of sodium ions
Function is lost in this order: Autonomic, temperature, pain, touch/pressure, vibration and motor, regain function in reverse order

50
Q

Esters

A

No i before Caine
Metabolized in plasma/blood
High potential for allergic reactions
Not available in dental cartridges anymore
Benzocaine is an ester and available as a topical

51
Q

Amides

A

Metabolized in liver
Lidocaine: Most commonly used in dentistry, safe in pregnancy and during lactation
Mepivacaine (carbo): Similar to lidocaine, plain or with epi
Prilocaine: Longer duration and lower epi content than lido, associated with methemoglobinemia
Bupivacaine: Greatly prolonged duration of action, indicated for lengthy procedures
Articaine (septo): Partially metabolized in liver (5-10%) and partially in blood (90-95%) can cause paresthesia after mandibular block, no absolute max

52
Q

Duration of action of anesthetics (shortest to longest)

A

Mepivacaine
Lidocaine
Prilocaine
Articaine
Bupivacaine

53
Q

Choosing your anesthetic

A

PKa (Onset of action): lower pKa=better absorbed
Protein binding capacity (duration of action): Stronger binding=longer duration
Lipid solubility (potency): more lipid soluble=more potent
Vasodilating properties (potency and duration of action): Less vasodilation=more potent and longer duration

54
Q

Vasoconstrictors are added to anesthetics for:

A

Decreased systemic absorption- Lower risk for toxicity
Decreased absorption
Increased duration of action
Decreased bleeding

55
Q

Healthy and cardiac dose of epi

A

Healthy: 0.2mg epi per appt
Cardiac: 0.04mg epi per appt (pregnancy, diabetes, hypertension)

56
Q

Which anesthetics are available without a vasoconstrictor

A

Lidocaine (not available in US)
Mepivacaine
Prilocaine

57
Q

Benzodiazepines (-Pam, -lam)

A

Anti anxiety drug, fast acting, wide TI, causes sedation, no analgesic effect

58
Q

Barbiturates (-tal)

A

Long acting and narrow TI, produces CNS depression, no analgesic effect, used for anticonvulsant and to induce general anesthesia

59
Q

Nitrous oxide

A

Low solubility in blood, nitrous tank is blue while oxygen tank is green, excreted by inhalation, no biotransformation (inhaled and exhaled in same form), place pt on 100% oxygen for 5 mins following procedure to prevent headache, nitrous maintains pt in stage I anesthesia, can reduce orofacial muscle tone in cerebral palsy patients, can lead to neurological symptoms similar to Parkinson’s/demetia

60
Q

What symptoms accompanies all antidepressant drugs

A

Xerostomia

61
Q

Antidepressant drugs

A

SSRIs
SNRIs
TCAs, (Do not use epi in patients taking TCAs- may lead to hypertensive crisis. If must, use cardiac dose)
MAOIs
Other: bupropion (Wellbutrin) and lithium

62
Q

Anticonvulsant drugs

A

Phenytoin (Dilantin): gingival enlargement in 50% of chronic users
Benzodiazepines: Diazepam (Valium) is drug of choice for status epilepticus which can be caused by local anesthetic overdose

63
Q

Antihypertensive drugs

A

Diuretics:
Thiazide diuretics: HCTZ is most common, causes xerostomia and treats high bp
Loop diuretics: furosemide most common

64
Q

ACE inhibitors (-pril)

A

Antihypertensive drugs, blocks ACE, dry hacking cough, effectiveness reduced by NSAIDS

65
Q

Angiotensin receptor blockers (ARBs) (-sartan)

A

Antihypertensive drug, more specific than ACE so less side effects, effectiveness reduced by NSAIDS

66
Q

Calcium channel blockers

A

Antihypertensive drug, effectiveness NOT reduced by NSAIDS, gingival enlargement
Ex: AMlodipine, verapamil, nifedipine (HIGH probability of gingival enlargement), diltiazem
Always Very Nice Day… except with gingival enlargement

67
Q

Beta blockers (-olol)

A

Antihypertensive drug. Epi should not be used on patients taking non specific beta blockers such as propranolol, can result in greatly increased vasopressor response causing hypertension. Avoid epi or use cardiac dose

68
Q

Alpha blockers (-zosin)

A

Orthostatic hypotension does NOT cause blood pressure to quickly rise, the BP drops

69
Q

When is nitroglycerin contraindicated in an angina attack

A

If pt has taken erectile dysfunction drug in last 24 hrs

70
Q

Antihyperlipidemic drugs (-statin)

A

Lowers levels of cholesterol

71
Q

Anticoagulation drugs

A

Reduce intra vascular clotting
Antibiotics can increase bleeding effects of warfarin (due to effects on vitamin K)
Plavix is used to prevent blood clots after MI or stroke
Heparin is one of most used anticoagulants used in Hospitalized patients (injection)

72
Q

GI drugs board alerts

A

Pt on Tagamet likely being treated for gastric ulcers
Gastric ulcers do not cause gingival bleeding
Enamel erosion on ant max linguals indicate GERD

73
Q

Respiratory drugs board alert

A

Aspirin should be avoided in asthmatics- increased risk of aspirin hypersensitivity
Albuterol can cause insomnia
Corticosteroid inhalers can lead to thrush- rinse with water after

NBDHE (3 decks)

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