Pharmacology Flashcards
Function of the AMOUNT of a drug to produce an effect. Greater when dose is Smaller.
Potency
Maximum intensity that can be produced by drug Regardless of Dose. Only can increase side effects
Efficacy
Placed directly into GI tract by oral or rectal.
Enteral
Bypasses GI tract including injection, inhalation, and topical
Parenteral
Orally delivered drugs must FIRST pass through HEPATIC PORTAL CIRCULATION possibly inactivating some drugs
First-Pass Effect
Phase 1 reactions carried out by ___ (aka mixed functions oxidases) in the LIVER.
(Oral Route)
Cytochrome P-450 enzymes
Route: Safest, least expensive, convenient. Mostly absorbed in small intestine. Drug blood levels less predictable.
Oral
Route: Used if patient is vomiting or unconscious. Poorly absorbed.
Rectal
Route: Produces MOST RAPID drug response. Absorption phase bypassed. EMERGENCY situations
Intravascular
Route: Sustained effect. Massage increases absorption.
Intramuscular
deltoid or gluteal most common site
Route: Administering protein products. Insulin and LAs. Sterile abscess.
Subcutaneous
Route: Injected into epidermis. TB
Intradermal
Route: Rapid delivery across large surface area.
Inhalation
inhalers & nitrous
Route: Increased concentration of active ingredient. Local effect. May have systemic uptake.
Topical
contraindicated if surface is ulcerated, burned, or abraded
ADME
Absorption, Distribution, Metabolism, Excretion
Study of how a drug is absorbed, distributed, metabolized, and excreted by the body
Pharmacokinetics
Transfer of drug from site to blood. Active or Passive. Occurs at MANY sites. Dependent on several factors.
Absorption of drugs
Readily move across MOST biological membranes by diffusion. ONLY drugs to pass BBB
Lipid Soluble Drugs
Factors dependent on drug absorption (6)
1) Drug solubility 2) Circulation at site 3) Surface area 4) Drug pH 5) Temperature at site 6) Mechanical factors
Transfer of drug from blood to system with Highest Blood Flow. (oral-liver, sublingual-heart) Dependent on few factors.
Distribution of drugs
Factors dependent on drug distribution (3)
1) Blood flow 2) Capillary permeability (BBB) 3) Binding of drug to proteins (plasma albumin)
Major site of drug metabolism. (disease may impair metabolism)
Liver
Termination of drug effects
Elimination
Elimination is by ___ and/or ___ into urine or bile
Biotransformation ; Excretion
Routes of elimination (10)
1)RENAL (kidney) 2)Gingival Crevicular Fluid 3)Saliva 4)Liver 5)Bile 6)Lungs 7)Exhalation 8)GI 9)Sweat 10)Milk
Fluoride eliminated by ___
Excretion in the Urine
Drug altering effects (12)
1)Pt compliance 2)Psychologic factors 3)Tolerance 4)Pathologic state 5)Time 6)Route 7)Gender 8)Genes 9)Drug interactions 10)Age 11)WEIGHT 12)Environment
Child dosing determined by ___
Cowling and Young Rules
Age
Surface Area Rule determined by ___
Weight in kg
Reaction - Abnormal drug response that is usually genetically related
Idiosyncratic
Adverse Drug Reactions (7)
1) Toxic 2) Side effects 3) Idiosyncratic 4) Teratogenic 5) Local 6) Drug interactions 7) Allergic Reactions
Reaction - amount of desired effect is excessive; dose related
Toxic
Reaction - dose-related, not part of the therapeutic outcome; e.g. drowsiness with benadryl
Side effect
Reaction - hypersensitivity response to a drug that pt has been previously exposed; NOT dose related; mild to life-threatening
Allergic
Reaction - maternal drug use causing congenital abnormalities
Teratogenic
Reaction - local tissue irritation
Local
Reaction - one drug altered by another; can result in toxicity or lack of efficacy
Drug interaction
Treatment of allergic reactions: mild , anaphylactic
mild - antihistamine with or without steroids
anaphylactic - epinephrine subcutaneously with or without steroids
What can generate gingival overgrowth (5)
1) mouth breathing 2) Phenytoin 3) Genes 4) Cyclosporin 5) Calcium Channel Blockers
Med - an organ rejection preventative medication
Cyclosporine
Med - calcium channel blockers (2)
nifedipine (procardia)
dilatiazem (cardizem)
Med - drugs that do NOT cause gingival overgrowth (2)
Digoxin, Beta blockers
ANS regulates (5)
1) BP 2) Heart rate 3) GI motility 4) Salivation 5) Bronchial/smooth muscle tone
Rest and Digest
Parasympathetic
Drugs that mimic PANS (3)
Parasympathomimetics, cholinergic agents, muscarinic drugs
Drugs that mimic PANS are used for (3)
xerostomia, urinary retention, glaucoma
Cholinergic agents from plant alkaloids (2)
Pilocarpine (stimulates saliva)
Nicotine (tobacco cessation)
Contraindications to drugs that mimic PANS (4)
Asthma(bronchoconstriction) Peptic ulcer(increases GI secretions) Cardiac disease(heart rate decrease) GI/Urinary obstruction(GI motility increase)
Agent - blocks ach receptors by inhibiting ach effects
Anticholinergic
Effects of Anticholinergic agents (4)
ABCD - Anticholinergic agents, Blurred vision & Bladder retention, Constipation, Dry mouth
Examples of Anticholinergic agents (3)
Immodium(diarrhea)
Atropine(decrease salivary flow)
Scopolamine(motion sickness)
PANS neurotransmitter
Acetylcholine
SANS neurotransmitter
Norepinephrine
ach in PRE-ganglionic synapse
Fight or Flight
Sympathetic
Examples of drugs that mimic SANS (5)
Epinephrine Pseudoephedrine Albuterol Ritalin Adderall
Drugs that mimic SANS (2)
Sympathomimetics, adrenergic agents
Drugs that mimic SANS are used for (8)
Colds(decongestants), asthma(bronchodialators), anaphylactic shock, glaucoma, vasoconstrictors, cardiac arrest, CNS stimulation, ADD
Functions of SANS (4)
Vasoconstricts, dilates bronchioles, increases heart rate, dilates pupils
Functions of PANS (4)
Stimulates salivary gland secretion, dilates blood vessels, accelerates peristalsis, absorption of nutrients
Contraindications to drugs that mimic SANS (4)
Angina
Uncontrolled hypertension
Uncontrolled hyperthyroidism
Cocaine & Amphetamine Abuse
___ is contraindicated for Cocaine & Amphetamine abuser if used within ___
Epinephrine & 24 hours
Adverse reactions of adrenergic agents (4)
CNS disturbances (anxiety, fear, tension, headache, tremor)
Cardiac arrythmias
Cerebral hemorrhage
Pulmonary edema
Oral signs - rampant caries & burned mucosal surfaces
Meth abuse
How to treat meth abusers
no medications available, cognitive behavioral interventions
Adrenergic drugs to know (3)
Albuterol
Dopamine
Clonidine
Med - minimizes symptoms that accompany withdrawal from opiates and benzodiazepines
Clonidine
Med - drug of choice for shock; continuous infusion
Dopamine
Med - bronchodilator, acute asthma, few cv effects
Albuterol
Beta blockers (type/location)
Beta 1 : heart
Beta 2: lungs, muscles, arterioles
increases heart rate, BP, and oxygen needed for blood
Beta 1 receptor
Beta 1 blocker drug action
decreases heart rate, BP, and useful when heart is deprived of oxygen
Often Rx after heart attack
Beta 1 blocker
Hormone produced in kidney that constricts blood vessels; beta blockers prevent release of
Renin
Relaxing effect, Rx for anxiety, migraine, and alcohol withdrawal
Beta 2 blocker
Should not be used in pt with asthma or any reactive airway disease
Non-selective beta blockers
Beta blockers are used for (6)
Cardiac arrhythmias, angina pectoris, hyperthyroidism, M.I., glaucoma, migraine prevention
Beta adrenergic drugs to know (4)
Propranolol
Timolol
Atenolol
Metoprolol
Med - lowers BP by lowering cardiac output; adverse reaction bronchoconstriction & arrhythmias
Propranolol
Inderol
Med - reduces aqueous humor in the eye, tx of glaucoma
Timolol
Timoptol, Timoptic
Med - eliminates bronchoconstrictor effect, tx of hypersensitive asthmatic pts; cardioselective
Atenolol
Med - tx of hypertension, prevention of M.I. and angina
Metoprolol
Lopressor
Nonopioid Analgesics (3)
Aspirin, NSAIDs, Acetaminophen
Med - used for Analgesia, Antipyretic, Anti-inflammatory; inhibition of prostaglandin synthesis
Aspirin & NSAIDs
Med - used for Analgesia & Antipyretic
Acetaminophen
Med - fever reduced through hypothalamus
Aspirin
Contraindications for Aspirin & NSAIDs (2)
Coumadin (warfarin) - blood clotting effect
Peptic ulcer
Med - children with hx of chicken pox or influenza should NOT use ___ due to what metabolic disorder
Aspirin; Reye’s Syndrome
Term - overdose of Aspirin
salicylism
Define - ringing of the ears
Tinnitus
Ibuprofen can decrease effects of drugs including (7)
ACE inhibitors, Aspirin, Beta blockers, Corticosteroids, Cyclosporine, Lithium, Loop diuretics
Acetaminophen overdose (3)
Hepatotoxicity
Liver necrosis
Death
Med - for post-operative pain, drug of choice after root planning
Acetaminophen
Narcotic / Opioid Analgesics (4)
Morphine, Codeine, Demerol, Dilaudid
MOA of narcotics and opioids
Blocks pain receptors in brain w/o loss of consciousness
Most commonly used opioid in Dentistry
Codeine in conjunction with Acetaminophen (schedule 3 narcotic)
Sign of OD or addiction to ANY opioid
Pinpoint pupils (<2.9mm)
Med - antitussive; may cause constipation, emesis (vomiting); OD leads to respiratory depression & death
Codeine
Med - opioid antagonist, used for tx of opioid OD; should be in Dental Emergency Kit
Narcan
Med - tx of narcotic withdrawal/dependence; 1x day, works for 24-36 hrs, only effective for opioid addictions
Methadone
Pain meds for heroine addicts
NSAIDs
Type of drug abuser needs pre-med with antibiotics
IV
Define - substance acts against/destroys infections
Anti-infective/antibiotic
Define - substance that destroys/suppresses growth of bacteria
Antibacterial
Define - Kills bacteria; irreversible
Bactericidal
Define - Inhibits bacterial growth
Bacteriostatic
Lowest concentration needed to inhibit visible growth of an organism
MIC - minimum inhibitory concentration
Range of activity to drug
Spectrum
drug combo for better effect
Synergism
drug combo lessens effect
Antagonism
Antibiotic types (3)
Penicillins, Tetracyclines, Nitromidazoles
Penicillin derivatives (3)
Amoxicillin, Augmentin, Ampicillin
Most common Rx in dentistry; effective in 90% of bacteria in dental infections
Pen VK
MOA of penicillin
destroys bacterial cell wall integrity; lysis
Med - Not effective against penicillinase (beta lactamase)
Amoxicillin
Med - Clavulanic acid combined with Amoxicillin; prevents penicillinase from breaking down Amox.
Augmentin
Med - avoid use in early pregnancy and childhood; tooth discoloration
Tetracycline
Do Not take tetracycline with ___ (3)
dairy, antacids, iron tablets
Med - topically used for aggressive perio; systemically for NUG/NUP
Tetracycline
Med - NO Alcohol Mouth Rinse! Effective against obligate anaerobes only; alcohol should be avoided.
Nitromidazoles
Metronidazole
Antibacterial side effects (3)
GI upset, secondary fungal infections(candidiasis/yeast infection), Allergies
Antituberculosis Agents (4); must be on all if active
RIPE - Rifampin, Isoniazid, Pyrazinamide, Ethambutol
Med - red urine, tears, and saliva
Rifampin (TB)
Med - affects vision; decreases acuity and red/green differentiation
Ethambutol (TB)
Myambutol
Med - preventative against developing TB
Isoniazid
TB - no longer contagious if…
3 consecutive negative sputum smears
Antigen used to diagnose TB, known as Mantoux skin test
PPD - purified protein derivative
Fungal infections common… (3)
after antibiotics, steroids, or immunocompromised
Most common Antifungals (4)
Nystatin, Fluconazole, Mycelex(clotrimazole), Nizoral(ketoconazole)
Med - most common antifungal used in dentistry, tx of candidiasis, topical
Nystatin
Med - systemic tx of candidiasis
Fluconazole
Diflucan
Abbreviation - ac
before meals (ahead of consumption)
Abbreviation - bid
twice a day (bi daily)
Abbreviation - gt
drop
Abbreviation - hs
before bedtime (heavy sleeping)
Abbreviation - po
by mouth (per oral)
Abbreviation - pc
after meals (post consumption)
Abbreviation - prn
as needed (per Rx need)
Abbreviation - q3h
every 3 hours
Abbreviation - qd
per day
Abbreviation - qid
4x a day (quad daily)
Abbreviation - tid
3x a day (tri daily)
Abbreviation - sig
label; instructions (see instruction guide)
Abbreviation - stat
immediately
Abbreviation - tab
tablet
Abbreviation - ud
use as directed
Schedule 1 (abuse potential/handling)
highest - no accepted medical use (cocaine)
Schedule 2 (abuse potential/handling)
high - Rx only, NO REFILLS, most abused (codeine)
Schedule 3 (abuse potential/handling)
moderate - Rx, phone in, no more than 5 refills within 6 months (tylenol with codeine)
Schedule 4 (abuse potential/handling)
less - Rx, phone in, no more than 5 refills within 6 months (alprazolam/Xanex)
Schedule 5 (abuse potential/handling)
least - OTC (ibuprofen)
Requirement for any Rx controlled substance
DEA number
Requirement for Schedule 2 drugs
written in pen or typed; some states require triplicate pads
Antianxiety agents (2)
Barbiturates & Benzodiazepines
Med - no analgesic effect, CNS depression
Barbiturates
Med - long acting; used in tx of epilepsy
Phenobarbital
Med - short acting, tx of anxiety, insomnia, and alcohol withdrawal, does not affect ANS, can be given prior to sedation
Benzodiazepines
Benzodiazepines (4)
Diazepam(Valium), Lorazepam(Ativan), Xanax(Alprazolam), Tranxene
Anesthesia Stage 1
Analgesia - remains conscious, breathes regularly, Nitrous maintains
Anesthesia Stage 2
Delirium or excitement - unconscious, involuntary movement
Anesthesia Stage 3
Surgical anesthesia - major surgery
Anesthesia Stage 4
Respiratory or medullary paralysis - stops breathing, if not reversed death will occur
Med - most common used for CHF (increases contractile strength); also increases gag reflex and salivation
Digitalis Glycosides
Digoxin (Lanoxin)
Med - increases Digoxin levels in ~10% of pts (2)
Tetracycline & erythromycin
Med - tx of angina, vasodilator, smooth muscle relaxant, sublingual, emergency kit!
Nitroglycerine
Hypertension symptoms (3)
Usually asymptomatic; occ. headache, vision changes, and dizziness
First line therapy for hypertension - why
Diuretics - excretes sodium & water/decreases blood volume & pressure
Med - Diuretics (2)
Thiazide - xerostomia, orthostatic hypotension
Loop - CHF
ACE Inhibitor drugs (3)
Lisinopril (prinivil, zestril)
Captopril (capoten)
Enalapril (vasotec)
Most common ACE inhibitor used with CHF
Enalapril
ACE inhibitors adverse reactions (3)
avoid postural hypotension, allergic reactions, dry cough; also associated with dysgeusia(taste)
Second line therapy for hypertension - why
Beta blockers - decreases cardiac output
Anticoagulants (2)
Coumarins & Heparin
Coumarin prevents inactive to active conversion of ___
Vitamin K
Med - anticoagulant for hospitalized pts, by injection only
Heparin
Consideration of Warfarin pts
Dose reduction under advising physician several days before tx
Anticonvulsants (3)
Phenytoin (dilantin)
Phenobarbital
Carbamazepine (tegretol)
Antihistamines block __ receptors
H1 (bronchospasm and vasodilation)
Most common side effect with insulin is __ ;
shortness of breath is not a sign of this
hypoglycemia
Insulin dependent
Type 1 - juvenile-onset
Non insulin dependent
Type 2 - adult-onset
Diabetes Mellitus Drugs (2)
Metformin (glucophage), Glyburide (diabeta, micronase)
Med - bronchodilator tx of asthma; reverses bronchospasm
Metaproterenol
Types of Asthma inhalers (4)
short acting, corticosteroids, corticosteroid plus long acting, long acting
inhaler type - immediate relief; albuterol and pirbuterol
short acting
inhaler type - long term to prevent asthma attack; QVAR, Flovent
corticosteroid
inhaler type - for asthma, combo; Advair
corticosteroid plus long acting
inhaler type - relieves asthma for longer time; Salmeterol (serevent)
long acting
Med - treats chronic asthma; erythromycin can cause toxicity
Theophylline
Med - can cause insomnia
Albuterol
Med - should be avoided in asthmatics (4-19% have hypersensitivity)
Aspirin
Med - tx of COPD
Atrovent (Ipratropium); anticholinergics
Med - rebound swelling can occur, do not use for more than few days
nasal decongestants
Med - removes exudate and mucus
expectorant
Med - for non productive dry cough
antitussive
Med - a systemic antacid contraindicated in cv pts due to high sodium load
Sodium bicarbonate
Antacids can inhibit absorption of (3)
Tetracyclines, Digitalis, Iron
Most prevalant GI disease in US
GERD - gastroesophageal reflux disease
GERD is treated by 1 of 2 meds
Histamine 2 blocking agent, PPI - protein pump inhibitor
Med - should not be used with antacids (disrupts absorption); ex. TagametHB (cimetidine), Pepcid AC (famotidine)
Histamine 2 blocking agents
Med - potent inhibitor of gastric acid secretion; ex. Prilosec (omeprazole)
PPI - protein pump inhibitors
Med - used for tx of gastric ulcers
*gastric ulcers do not cause gingival bleeding
TagametHB (cimetidine)
Med - commonly used for HIV protease inhibitor
AZT (zidovudine)
Med - alcohol in combo with ___ will result in dangerously low BP
nitroglycerin
Med - acceptable drugs to use during pregnancy (7)
LAs, acetaminophen, PenV, Amoxicillin, Cephalosporins, Clindamycin, Nystatin
Med - decreases effectiveness of muscle relaxants
NSAIDs
Med - SSRIs (selective serotonin reuptake inhibitors) FDA approved (2)
Prozac (fluoxetine)
Zoloft (sertraline)
Paxil (paroxetine)
Med - can promote endometrial carcinoma and breast cancer in post menopausal women, can cause gingival enlargement
estrogen steroid hormone
Med - can increase anticoagulant effect of Warfarin; HMG Co-A inhibitor
Lipitor (Atorvastatin)
Med - glucocorticoid; risk of infection & delays healing; increase hypertension; adrenal crisis possible; osteoporosis
Prednisone
Prednisone side effects (8)
edema, buffalo hump, moon face, peptic ulcer, mental disturbances, increase body hair growth, acne, insomnia
Prednisone used for (4)
autoimmune disorders, Addisons disease, inflammatory symptoms, allergies
Med - hypothyroidism; long half-life
Synthroid (levothyroxine)
Synthroid (levothyroxine) side effects (3)
nervousness, tachycardia, intolerance to heat
