Pharmacology Flashcards
What is a log dose effect curve?
This is when the therapeutic range of a certain drug is plotted and shows the percent of the maximum response and effective dose.
What is a therapeutic range of a drug?
This is where the dose in increasing sharply or where the drug is working
What is a maximum response of a drug?
This is where the curve plateaus on the log dose effect curve
What is the term that describes a function of the amount of a drug to produce an effect?
potency
When is the potency of a drug greater?
when the dose is smaller
What is the term that describes the maximum intensity of effect or response that can be produced by a drug regardless of dose?
efficacy
When administering more drug than prescribed, will it increase the efficacy of the drug or will it increase the probability of an adverse drug reaction?
It will increase the probability of an adverse drug reaction, not increase the efficacy of a drug!!
Are efficacy and potency related?
No not related
What is the term that is related to duration of effect of a drug?
Half-life
What equals half the amount of time for a drug to “fall” to half of the original blood level?
Half-life of a drug
What is the term that describes the time it takes for the drug to have an effect?
onset
What is the term that describes the length of the drug’s effect?
duration
According to the route of administration, what can be affected?
the onset and duration of a drug
What are some routes of administration?
enteral or parenteral
What are some examples of enteral administration?
oral, and rectal
What are some examples of parenteral administration?
intravascular, intramuscular, subcutaneous, intradermal, inhalation, and topical
What is the difference of enteral and parenteral administration?
enteral administration is placed directly into the GI tract, while parenteral administration by passes the GI tract
What route of administration is considered the safest, least expensive, and most convenient?
oral route
Is it true that the less we ask of our patient by ways of drug administration the more effective the drug will be?
Yes; less means more
What are 3 negative aspects of oral administration route?
1) because of the large absorbing area present in small intestine it can cause slower onset of the drug’s effect and can result in stomach irritation with nausea and vomiting, 2) also the drug blood levels are less predictable, 3) and last drugs derived from proteins sources may be inactivated by GI acidity or enzymes
What is an example of a drug that is derived from proteins and are inactivated by GI acidity or enzymes?
Insulin
With orally delivered drugs where must the drug pass through first?
hepatic portal circulation
What are the terms that describes the first pass of an orally delivered drug?
first-pass effect or Phase 1 reactions
What reduces the first pass effect?
the amount of drug available to produce systemic effect
True or False, drugs with high-first past effect have a smaller oral to parenteral dose ratio?
False; larger
What is an example of a drug that has a high first-pass effect?
morphine
What does it mean when a drug has a high first pass effect?
they require a larger dose
What is another name for P-450 enzymes?
mixed function oxidases
What microsomal or cytochrome enzymes in the liver carry out the Phase 1 reaction aka: first-pass effect?
P-450 enzymes of mixed function oxidases
How can the concentration of these P-450 enzymes be affected?
they can be affected by drugs and environmental substances like smoking and alcohol consumption
What is a common example of P-450 induction?
alcohol tolerance
What does P-450 induction do to the drugs effect?
inducement increases enzymes activity and metabolizes the drug more rapidly necessitating a larger drug dose for effect,
What are 2 negative aspects of the rectal route?
drugs are poorly and irregularly absurd rectally, not frequently used for systemic effect and poor patient acceptance
What is the best route of administration for the most rapid drug response (immediate)?
Intravascular route
What are 3 advantages of using the intravascular route of administration?
absorption phase bypassed, more predictable response, and route of choice for emergency situations
What are 4 disadvantages of intravascular route?
phlebitis (local irritation), drug irretrievability, allergy, and side effects of high plasma drug concentrations
What are the most common injection sites of intramuscular route of administration?
Deltoid and gluteal regions
True or False , massage will increase the absorption of the intramuscular route of administration?
TRUE
How does absorption occur in intramuscular route of administration?
due to high blood flow in skeletal muscles
What is an advantage of intramuscular route of administration?
it provides a sustained effect
What is the route of administration used to administer protein products?
subcutaneous route of administration
What are some examples of a subcutaneous route of administration?
insulin and local anesthetics
What is a disadvantage of subcutaneous route of administration?
sterile abscess or hematomas are produced
What is an example of a Intradermal route of administration?
tuberculin skin test
What is the most shallow route of administration and the most deepest route of administration?
intradermal is most shallow and intravascular is the deepest
What is an advantage of inhalation route?
provides rapid delivery of drug across large surface area of respiratory mucosa
What is an example of inhalation route?
inhalers for asthma, nitrous oxide/oxygen sedation
What is some contraindications for the topical route?
if surface is ulcerated, burned, or abraded
When is topical route most effective?
with less keratinized tissue
can topical route have systemic uptake?
yes, but in limited doses
What is the study of how a drug is absorbed, distributed, metabolized, and excreted by the body?
Pharmacokinetics
What is a way to remember pharmacokinetics?
ADME
What are the only drugs to pass the blood brain barrier?
lipid-soluable drugs
How are the lipid soluble drugs readily moved across most biological membranes?
by diffusion
What is the term that describes the transfer of drugs from site of administration to blood stream?
absorption
What are some factors that cause absorption of a drug?
drug solubility, circulation at deposition site, drug pH, temperature at site, and mechanical factors like massaging an injection site.
What is the term that describes the process by which a drug reversibly leaves the blood stream and enters the system?
distribution
After a drug is absorbed where does the drug get distributed?
organ with the highest blood flow
With the oral route where will the drug be distributed?
the liver
With the sublingual route where will the drug be distributed?
the heart
What are some factors that depends on where the drug in distributed?
blood flow, capillary permeability (blood-brain barrier), and binding of drugs to proteins especially plasma albumin
What is a major site for drug metabolism?
In the liver
True or False, liver disease or present/past substance abuse may impair drug metabolism?
TRUE
What is the term that describes to terminate the drug effects?
elimination
How are drugs most often eliminated?
by biotransformation and/or excretion into the urine or bile
What is the most important route of drug excretion?
Renal (Kidney)
What are some other routes of drug excretion?
liver, lungs, bile, GI, sweat, saliva, and gingival crevicular fluid
How are fat soluble drugs excreted?
not excreted in the urine, need to be metabolized into water soluble form by liver
What is the major route of fluoride elimination from the body?
through the urine
What are 2 factors that alter drug effects?
age and weight
What will board use when talking about weight?
surface area rule- when determine child dose of drug use in kg.
What will the board use when talking about age?
cowling rule and young rule - in determining child’s dose of drug
What is a term that describes an amount of desired effect is excessive and dose-related?
toxic reaction
What is a side effect?
a dose-related reaction that is not part of the desired therapeutic outcome
What is an example of a side effect?
When given an antihistamine it will take care of the symptom, but will get sleepy which is the non-therapeutic action of a drug.
What is a term that describes an abnormal drug response that is usually genetically related?
Idiosyncratic reaction
What is a term that describes a hypersensitivity response to a drug to which the patient has been previously exposed?
drug allergy
Is a drug allergy dose related?
No
What is a term that describes a causal relationship between maternal drug use and congenital abnormalities?
Teratogenic Effect
What is phocomelia?
shortened limbs
What is an example of a teratogenic effect?
Thalidomide induction of phocomelia
What is an example of a local effect?
tissue necrosis at site of injection
What is a term that describes an effect of one drug is altered by another?
drug interaction
What may result because of a drug interaction?
toxicity, and lack of efficacy
What is an immune hypersensitivity reaction?
allergic reaction
What is a life-threatening allergic reaction?
anaphylaxis
What do we treat for a mild allergic reaction?
antihistamine with or without steroids
What do we treat for a anaphylactic reaction?
epinephrine subcutaneously with or without steroids
What are the three types of medication that can generate gingival enlargement?
Phenytoin, Cyclosporine, and Calcium Channel Blockers
What are some examples of a calcium channel blocker?
nifedipine, verapamil, and amlodipine
What type of medication if a cyclosporine?
is an organ rejecting preventive medication
When taking phenytoin where does the gingival enlargement usually take place clinically?
on the anterior facial region
What 3 drugs do NOT cause gingival enlargement?
Digoxin, Beta Blockers, and Tegretol
What nervous system has automatic, involuntary responses?
the autonomic nervous system (ANS)
What is the ANS responsible for the regulation of?
blood pressure, heart rate, GI mobility, salivation, and bronchial/smooth muscle tone
What are the 2 devisions of the ANS?
the parasympathetic nervous system (PANS) and sympathetic nervous system (SANS)
What does the ANS require?
neurotransmitters
What in another name for the PANS?
the Rest and Digest System
What neurotransmitter does the PANS use?
acetylcholine
What is the SANS known for?
Fight or flight system
What neurotransmitter does the SANS use?
norepinephrine
What agents are used to mimic the effect of the PANS?
cholinergic or muscarinic agents
What are some function of the PANS?
Dilates blood vessels leading to GI tract, Constricts the bronchiolar diameter, and most importantly stimulates salivary gland secretion etc…
What does the cholinergic and muscarinic drugs treat?
xerostomia, urinary retention, and glaucoma
What are some examples of a cholinergic agent?
pilocarpine and nicotine
What does pilocarpine treat?
xerostomia; stimulates saliva flow
What are some contraindications for cholinergic and muscarinic drugs?
asthma, peptic ulcer, cardiac disease, and GI/Urinary obstruction
Why is peptic ulcer, cardiac disease, and GI/ Urinary obstruction a contraindication to cholinergic or muscarinic drugs?
peptic: increase GI secretion Cardiac disease: decreased heart rate, and GI/urinary obstruction: increase GI mobility
What blocks acetylcholine receptors by inhibiting acetylcholine effects?
anticholinergic agents
What are some example of anticholinergic drugs?
atropine, immodium, and scopolamine
What is Atropine used for in the dental setting?
a prototype of anticholinergic drug; used pre-operatively to decrease salivary flow in the dental setting
What is a helpful hint to remember effects of anticholinergic agents?
ABCD= Anticholinergic, Blurred vision and bladder retention, Constipation, and Dry mouth
Where else is acetycholine a neurotransmitter besides in the PANS?
at the sympathetic preganglionic synapses, some sympathetic post-ganglionic synapses, and at some sites in the CNS
What are some functions of the SANS?
vasoconstriction, Dilates bronchioles of the lung, increase heart rate, and dilates pupils
What agent mimics the SANS?
adrenergic agents; sounds like adrenalin for fight of flight
What are some examples of adrenergic agents?
epinephrine, albuterol, pseudoephedrine, ritalin, and adderall, dopamine, and clonidine
What are the adrenergic agents used for?
colds (decongestant), asthma, anaphylactic shock, glaucoma, cardiac arrest, and vasoconstrictors
What are some adverse effects of adrenergic agents?
CNS disturbances like anxiety, fear, tension, headache, and tremor, also cardiac arrythmias, and cerebral hemorrhage
What are some contraindications to adrenergic agents?
angina, uncontrolled hypertension, and uncontrolled hyperthyroidism
How long should we wait to use epinephrine on a patient if they are taking cocaine or methamphetamines?
The patient needs to be off of it for at least 24 hrs before use
What is the only local anesthetic with vasoconstrictive properties?
Cocaine
What are some oral sign of a methamphetamine abuser?
rampant caries and burned mucosal surfaces
True or False; the burned mucosal surfaces from methamphetamine abuse is from the actual drug?
False; it is from the method of administration
Is there currently any medications to treat meth addiction and what is the best way to go about treating meth addiction?
No medications are available, the only avenue is to use cognitive behavioral intervention that helps modify harmful actions and teach coping skills
Are there any cardiovascular effects of using the adrenergic drug albuterol?
very few cardiovascular effects
What is the adrenergic drug dopamine used to treat?
to treat shock and low blood pressure, and often used to treat Parkinson’s Disease
What is the adrenergic drug Clonidine used to treat?
this minimizes symptoms that accompany withdrawal from opiates and benzodiazepines
Where are Beta 1 and Beta 2 receptors mainly found?
Beta 1 in the heart and Beta 2 mainly in the lungs, muscles and arterioles
How can we remember where Beta 1 and Beta 2 are found?
We have on 1 heart and 2 lungs
What happens when there is action on the Beta 1 receptors?
it will increase the heart rate and blood pressure, and the heart itself will require more oxygen
What type of drug do we use to block the action on a beta 1 receptors?
B-adrenergic blocking agents
What do the B-adrenergic blocking agents do to the beta 1 receptors?
they will lower the heart rate and blood pressure and are useful when the heart itself is deprived of oxygen
true of false B-adrenergic blocking agents are often prescribed after a heart attack?
true, allows for more oxygen flow to the heart
do the non-selective beta blockers affect both the beta1 and beta 2 receptors?
yes
Why are non-selective beta blockers contraindicated for patients with asthma or any restrictive airway disease?
they can block the effects of Beta 2 agonists, such as albuterol leading to airway and vascular restriction
What are B-adrenergic blocking agents effective in treating?
Cardiac arrhythmias, angina pectoris, hyperthyroidism, myocardial infarction, glaucoma, migraine prevention, anxiety
What are 3 drugs used to prevent hypertension?
Propranolol, Atenolol, and Metoprolol
What does the medication Timolol treat and prevent?
reduces aqueous humor in the eye and is used topically to treat glaucoma
What are some other names of Timolol?
Timoptol and Timoptic
What are 2 cardioselective beta blockers?
Atenolol and Metoprolol
What is another name for Metroprolol?
Lopressor
What is Atenolol used to treat?
eliminates bronchoconstriction effect and used to treat hypertensive asthmatic patients
What medication is a prototype of a non-selective B- adrenergic blockers?
Propranolol
What are some adverse reactions of Propranolol?
Bronchoconstriction and arrhythmias
What is Metroprolol used for?
hypertension, prevention of myocardial infarction and angina
How should we treat patients taking non-selective B blockers when considering epinephrine and why?
limit epinephrine to 2 carpules because of potential increase in blood pressure
What are some examples of nonopioid analgesics?
aspirin, ibuprofen, acetaminophen
What does analgesia mean?
reduces pain
What does antipyretic mean?
reduces fever
What 2 nonopioid analgesics are considered an NSAID?
Aspirin and Ibuprofen
What are the uses of NSAIDS?
analgesia, antipyretic, and anitinflammatory
What is the mechanism of action of aspirin and Ibuprofen?
inhibition of prostaglandin synthesis
Where part of the brain does aspirin use in order to reduce a fever?
hypothalamus
What are the side effects of the use of aspirin?
Interferes with clotting, GI irritation, and become hypersensitive, and Reye’s syndrome in children and adolescents
What medications are contraindicated with the use of NSAIDS due to the drug interaction?
coumadin and warfarin
What is used to replace aspirin use in children and adolescents?
acetaminophen
What are some toxic reaction with taking aspirin?
GI upset/vomiting, confusion and dizziness, dim vision, and Tinnitus (ringing of the ears) etc…
What is it termed with toxicity of aspirin?
salicylism
What are some drugs that Ibuprofen can decrease there pharmacological effects?
ACE inhibitors, Aspirin, Beta Blockers, Corticosteroids, Cyclosporine, Lithium, and Loop Diuretics
Is acetaminophen a NSAID and why?
No it is not because it does not have any effect on inflammation
What is another name for acetaminophen?
Tylenol
What are the actions of acetaminophen?
analgesics and antipyretic
Does acetaminophen have any effect on clotting?
no it does not
What is the drug of choice for patients on coumadin or with peptic ulcers?
acetaminophen
What are some side effects of acetaminophen?
side effects are rare
What type of drug in coumadin?
this is an anticoagulant
What are some signs of acetaminophen overdose?
hepatotoxicity, liver necrosis, and death
If a patient has had a periodontal debridement, what is the best post operative medication to recommend for pain?
acetaminophen; not ibuprofen
What type of medication is an opioid analgesic?
a narcotic which are used to manage pain when non-opioid fail to work
What is a mechanism of action of opioid analgesic?
Blocks pain receptors in the brain without loss of consciousness
What are some examples of an opioid analgesic?
morphine, codeine, demerol, and dilaudid
What is the most common opioid used in dentistry?
Codeine
what medication is codeine usually used in conjunction with and what is it called?
acetaminophen and together it is called Tylenol 3
What type of medication is Codeine?
an antitussive which means cough suppressant
What is a sign of overdose for any opioid?
pinpoint pupils
What can an overdose of a narcotic lead to?
respiratory depression and death
What is a side effect of codeine use?
emesis (vomiting) and constipation
What is the number 1 opioid antagonist?
Narcan
What is used to treat an opioid overdose and should be located in the dental office emergency kit?
Narcan
What type of medication is used for the treatment of narcotic withdrawal and dependence?
Methadone
How often should methadone be taken and how long does it help the withdrawal of a narcotic?
once a day; 24 and 36 hrs
Why type of addiction is Methadone effective to treat?
heroin, morphine, and other opioid drugs; not methamphetamine addiction
What type of pupil will heroin users exhibit?
pinpoint pupils
What type of pupil will cocaine users exhibit?
dilated pupils
should IV users be premeditated with antibiotics prior to treatment and why?
yes because of high vascular bacteremia load
What is the best pain medication prescribed to a heroin addict?
NSAIDS
What does bactericidal mean?
the ability to kill bacteria; irreversible action
What does bacteriostatic mean?
The ability to inhibit or slow the multiplication or growth of bacteria
What does Minimum Inhibitory Concentration (MIC) mean?
lowest concentration needed to inhibit visible growth of an organism
What is the natural or acquired ability of an organism to be immune to or to resist the effects of an antiinfective agent?
Resistance
What the term that describes range of activity of a drug?
spectrum
When does synergism occur when dealing with antibiotics?
occurs when the combination of 2 antibiotics produces more effect that would be expected if their individual effects were added
When does antagonism occur when dealing with antibiotics?
occurs when a combination of 2 agents produces less effect than either agent alone
What is the most commonly prescribed antibacterial prescribed in the dental profession?
penicillin VK
What are some penicillin derivatives?
amoxicillin, augmentin, and ampicillin
Why is Penicillin VK preferred over Penicillin G?
Penicillin VK has a less erratic absorption
What does TID and QID stand for when prescribing medications?
TID is 3X a day and QID is 4X a day
Why is amoxicillin preferred?
due to TID rather than QID
How do penicillins work?
by destroying bacterial cell wall integrity which leads to lysis
What bacterial phase is the penicillins most effective against?
logarithmic phase (rapidly growing organisms)
What is the greatest danger of using penicillins in the dental office?
most likely antibiotic to produce an anaphylactic reaction
Can penicillin be given to a pregnant women?
yes
What is the most common manifestation of allergic reactions?
flat rash
Is amoxicillin effective against penicillinase?
No
What is another name for penicillinase?
beta lactamase
What is clavulanic acid in combination with amoxicillin known as?
Augmentin
What does augmentin prevent penicillinase from doing?
breaking down
