Pharmacology Flashcards
Odontogenic Infection
PEN VK –> Clindamycin (anaerobic effective)
Patient on prednisone with erythema multiform and needs an EXT. What do you do?
- AKA steven johnson syndrome
- The disease is an immune complex (IgM) deposition on superficial microvasculature on the skin and in the oral mucosa –> hypersensitivity syndrome
- Treated with steroids.
- All steroids (at 15 mg/day or 5 mg/day for a month) suppress the adrenal cortex. Thus, if undergoing an EXT an additional “stress dose” steroid should be added.
- Individuals on suppressive doses of steroids take up to 1 year to regain full adrenal cortex function and may show hyper pigmentation (due to high ACTH –> melanocytes)
- Test for adrenal insufficiency = ACTH levels
- 20 mg of cortisol released daily, with 200 mg in times of stress
Anterior pituitary –> ACTH –> adrenal cortex –> glucocorticoids. Thus, if steroids are taken, no ACTH will be produced and long term, the adrenal cortex may atrophy.
Cushing syndrome
- high cortisol (glucocorticoid) –> Fluid retention (BP) + poor wound healing (high glucose levels, low CHO metabolism)
- moon face, tranquil obesity, hair loss
- Caused by Pituitary tumor
Leukemia
Leukemia = Cancer → High WBC that do not properly function (Low RBC and platelets) = Results in gingivitis, perio problems, bruising and hemorrhaging (ecchymosis)
- ALL = childhood = normal lymphocytes become cancerous in the BM = lymphocytes are neither B or T cells and are called null cells = 80% cure rate = Dx: pallor, fatigue, infection = Most responsive to Tx (untreated, death is in 6 months due to hemorrhage or infection)
- AML = most malignant = Auer rods
- CLL = least malignant
- CML = fatal = Philadelphia chromosome 9 and 22 = spongy, bleeding gums
Enlarged lymph nodes, spleen and liver is seen in acute vs chronic leukemias
1:1 Acute: Chronic leukemias
AML, CML line (myelogenous) = higher oral manifestations
Aleukemic leukemia = Leukemia in bone marrow, but no increase in WBC
Subleukemic leukemia = Leukemia cells in the blood, but no increase in WBC
Stem Cell leukemia = too immature to classify = leukemia that are poorly differentiated precursors to lymphoblasts, monoblatsts
Erythroblastosis fetalis
Rh incompatibility → Rh (+) fetus in a Rh (-) mother → anemia form = also from blood type ABO incompatibility = Fetal teeth appear blue, brown or green due to blood pigment deposits on enamel and dentin. Enamel hypoplasia may occur.
Pernicious anemia
megaloblastic = Glossitis is common = low intrinsic factor = low B12 which is needed for RBC formation = shilling 24 hour urine test to determine Vit B12 absorption
Other low B12 = Thalessemia = hemolytic anemias = flaring of max anteriors
Agranulocystosis
low granulocytes (PMN) = caused by anti-thyroid drugs (methimazole) = causes rapid perio disease, oral ulcers, gingival bleeding, jaundice, fever, infected oral cavity = rapid onset = No inflammatory cell infiltration around the lesions!
Cyclic neutropenia is a type of agranulocytosis, with severe gingivitis
Petechiae vs purpura vs ecchymosis
Petechiae
Sickle Cell Anemia
Glutamic acid → valine = X-rays show normal lamina dura and teeth, but the marrow spaces are enlarged due to loss of trabeculae (osteosclerotic areas are seen in large radiolucenct marrow spaces)
RBC life span = 120 days (with Sickle Cell, its now 20 days)
Platelet life span = 7-10 days
Plummer Vinson Syndrome
Fe deficiency anemia association, but idiopathic
Spoon shaped fingernails
RISK: SCC of the tongue
What is the most serious and life threatening blood dycrasias associated with drug toxicity?
Aplastic anemia
Xerostomia causing medication
- Anti-psychotics (anti-depressants)
- Anti-HTN
- Anti-histamines
- Bronchodilators
- Anti-chlinergics
- Sedatives
Its not a disease, its a symptom
LA use in operative restorations decrease salivation by reducing anxiety and sensitivity
Cord packing in a person with heart conditions (including hyperthyroidism) require use of:
Alum (aluminum potassium sulfate)
- Never use ZnCl (causes necrosis, delays wound healing)
ADHD
idiopathic cause, most don’t require Rx.
ADHD Tx (called stimulants)
- Ritalin (methylphenidate)
- Concerta (methylphenidate extended release)
- Adderral (amphetamine + dextroamphetamine)
Rx for trigeminal neuralgia
Carbamazepine (Tegretol)
Drugs metabolized via kidney
NSAIDS morphine ASA ACE meperidine
Possible steroid use!
LA needles
positive aspiration is directly correlated to needle gauge
25 gauge = largest = most accurate due to least likely to bend and not break = used when high aspiration risk.
NO
- CNS (limbic and reticular activator systems)
- Limit: 60:40 N: O2
- No degradation, thus excretion via lungs is 100%
- Correct flow rate: reservoir bag should be 1/3 to 2/3 full
- Patient must have 21% O2, which is what is in normal air
Flight or flight response
syncope
increase in catecholamines –> sweat, palpations, tacky, decrease in peripheral resistance leading to blood pooling in peripheral = vasovagal bradycardia
Ammonium irritates the trigeminal sensory nerves to wake people up
O2 is not used int he hyperventilation syndrome type of syncope.
No NO or 100% O2 for COPD
Patients on tricyclic antidepressants or non-selective beta blockers should avoid
epi
Triazolam is what?
pre-sedative drug
- Cant be taken with anti-fungals (-conazole) since they inhibit CYP 3A4, which is an enzyme that degrades triazolam. Its inhibition will increase concentration, thus toxicity.
Rx abbreviations
h. s. = at bedtime
a. c. = before meals
p. c. = after meals
p. o. = by mouth
sig. = label
Heart burn meds
proton pump inhibitors = prazole
H2 receptor blockers = inhibit histamine in stomach = tidine
antacids = neutralize acid in stomach
EtOH affects the brain centers as follows:
- cerebral cortex
- limbic system
- cerebellum
- hypothalamus and pituitary gland
- medulla (brain stem)
drugs travel through the body via
albumin plasma
immunosuppressant drug acronym
-rolimus (tacrolimus)
PEDO sedation
Chloral hydrate = most common = sedative hypnotic
Barbituate = sedative hypnotic
Pentobarbital = sedative, but non-algesic
Benzodiazepine
- most effective oral sedatives in dentistry (anti-seizure, anti-anxiety)
- potentiates GABA = increased neural inhibition and CNS depression via post-synaptic CNS nerve endings
Diazepams (valium, versed, ativan)
Drugs that prolong QT interval = torsade de pointes = arrythmia
Erythromycin
Clarithromycin
(NOT Azithromycin)
Angina Prevention
chest pain from artery occlusion
- Nitroglycerin = coronary a. (and vein) vasodilator. RISK: orthostatic hypotension, H/A
- Ca Channel blockers = dilate coronary BV to increase BF to heart
- Beta blockers = decrease work load of heart, thus less O2 is required
- Amyl nitrite
TX cyanide poisoning
Amyl nitrite
- Oxidizes hemoglobin to methemoglobin which binds to cyanide
- vasodilator
- Inhalation only
- Also tx angina
- Can be addicting due to sex and euphoria
PT test
plasma deficicnecy in clotting factors 5,7,10
Tx of C. diff
vancomycin
- used for severe staph and strep cases
- RISK: red man syndrome
Which antibiotic causes issues with bone marrow?
Chloramphenicol
- Will lead to aplastic anemia, however it is not a contraindication
Tx herpes labialis
Penciclovir (Denavir)
- DNA synthesis inhibitor of HSV-1
Drug suffixes:
- coxib
- -dipine
- -olol
- -ilol / - alol
- -onium / -urium
- -osin
- -pril
- -sartan
- COX-2
- Ca channel
- beta blocker
- alpha and beta blockers
- quarternary ammonium compounds for skeletal muscle relaxants
- Alpha 1 blocker
- ACE
- Angiotensin II
What increases PCN blood levels?
Probenecid (Gout Tx)
- inhibits renal tubule secretion
- can be given concurrently for this effect
Prophylxais main choice
Amoxicillin
Which antibiotic cause opportunistic infections easily?
Tetracycline
- Although they are used for ANUG when PCN can’t be used
Why shouldn’t tetracyclines be given with milk, antacids, or iron supplements?
chelation products (Ca, Mg, Fe, Al) prevent absorption of tetracycline in the GI
Atropine
Anti-cholinesterase
- Causes SA node increase (A fib)
- Prevents Acetylcholine on muscarinic receptors
- pulpil dilation by paralysis of the ciliary muscle, preventing lens accommodation
- CONTRAINIDECATED in glaucoma (along with any anti-cholinesterase drug and valium)
