Pharmacology Flashcards
the _______ of the drug is plotted where the dose is increasing sharply
therapeutic range
the ________ of a drug may exhibit is plotted where the curve plateaus
maximum response
a function of the amount of a drug to produce an effect
potency
the potency is _____ when the dose is smaller
greater
maximum intensity of effect or response that can be produced by the drug regardless of dose
efficacy
what happens when you administer more of a drug? - more or less chance of adverse effects? more or less efficacy?
same efficacy, more chance of adverse effects
half life is related to what?
duration of effect
the length of drugs effect
duration
the time it takes for the drug to have an effect
onset
placed directly into the GI tract by oral or rectal administration
enteral
drug bypasses GI tract, includes injection, inhalation, and topical
parenteral
considered safest, least expensive, and most convenient drug administration
oral route
largest area of absorption
small intestine
drugs with high first pass effect needs smaller or larger dose
larger
drug blood levels are less predictable for which drug administration
oral
are drugs absorbed well or poorly rectally?
poorly and irregularly
produces most rapid drug response, absorption phase is bypassed, more predictable response, drug irretrievability, allergy, local irritation
IV route
absorption occurs due to high blood flow in skeletal mm, useful for sustained effect, massage increases absorption
IM route
places for IM injections
deltoid or gluteal
route used to administer protein products, may produce sterile abscess or hematoma, ex: insulin and LA
Subcutaneous route
provides rapid delivery of drug across large surface area or respiratory mucosa
inhalation route
drug application to body surface, most effective in keratinized tissue, used when local effect is desired, may have systemic uptake
topical
injected into dermis, ex: TB skin test
intradermal route
topical contraindicated when
ulcerated, burned, abraded skin
study of how drug is absorbed, distributed, metabolized, and excreted by the body
pharmacokinetics
readily move across most biological membranes by diffusion (only drugs to pass blood brain barrier)
lipid soluble drugs
transfer of drugs from site of administration to blood stream
absorption
absorption depends on what factors
drug solubility, circulation at deposition site, surface area, drug pH, temp at site, mechanical factors (massaging injection site)
process b which a drug reversibly leaves the blood stream and enters system
distribution
after being absorbed, drugs go where?
organ with highest blood flow,
oral- liver
sublingual- heart
distribution dependent on what?
blood flow, capillary permeability (blood brain barrier), binding drugs to protein
an abundant plasma protein that binds to a remarkably wide range of drugs
plasma albumin
major site for drug metabolism
liver
does elimination terminate drugs effect?
yes
drugs are most often eliminated by biotransformation or excretion to where
urine or bile
what excretion is most important?
renal
routes of excretion
renal, liver, lungs, bile, GI, sweat, milk, exhalation, saliva, ging crevicular fluid
drugs may be excreted or unchanged as
metabolites
major route of Fl elimination
excretion in urine
factors that alter drug effects
pt compliance, physiological factors, tolerance, pathologic state, time of administration, route of administration, sex, genetic variation, drug interactions, environment, age/weight
amount of desired effect is excessive, dose relation
toxic reaction
dose related reaction that is not part of the desired therapeutic outcome, non therapeutic action of drug such as the drowsiness that occurs with antihistamine use
side effect
abnormal drug response that is usually genetically related
idiosyncratic reaction
hypersensitivy response to a drug to which the pt has been previously exposed, not dose related!
drug allergy
casual relationship between maternal drug use and congenital abnormalities
ex: thalidomide induction fo phocomelia (shortened limbs)
teratogenic effects
local tissue irritation, ex: necrosis at site of injection
local effect
effect of one drug is altered by another
drug interactions
immune hypersensitivity reaction, mild or life threatening
allergic reactions
tx of mild allergic reactions
antihistamine with to w/ out steroids
tx of anaphylactic reaction
epi SQ w/ or w/ out steroids
meds for ging enlargement
phenytoin, cyclosporine, CCBs (nifedipine, verapamil, amlodipine)
ging overgrowth associated with phenytoin generally occurs where
ant facial region
do digoxin, beta blockers, and tegretol cause ging overgrowth?
no
ANS system controls what?
automatic, involuntary responses
ANS responsible for
BP, HR, GI motility, salivation, bronchial/smooth mm tone
two divisions of ANS
parasympathetic and sympathetic
NTM for rest and digest system
ACH
used to mimic the effects of the PNS, also known as cholinergic agents or muscarinic drugs
parasympathomimetics
parasympathomimetics used to tx what?
xerostomia, urinary retention, glaucoma
cholinergic agents derived from plant alkaloids
pilocarpine- stimulates saliva
nicotine
contraindications for parasympathomimetics
asthma, peptic ulcer, cardiac disease, GI/urinary obstruction
inhibits ACH effects by blocking ACH receptors
anticholinergic agents
examples of anticholinergics
atropine, immodium, scopolamine
prototype of anticholinergic, use pre-op to decrease salivary flow in dental setting
atropine
used for motion sickness, anticholinergic
scopolamine
SNS NTM
NE
sympathomimetics, or adrenergic agents, mimic effects of SNS
epi, albuterol, ritalin, adderal, dopamine, clonidine (opiate and benzo withdrawal)
adverse effects of adrenergic agents
CNS disturbances (anxiety, fear, tension, headache, tremor), cardiac arrhythmias, cerebral hemorrhage, pulmonary edema
contraindications for sympathomimetics
angina, uncontrolled hypertension/hyperthyroidism
beta receptor located mainly in heart
beta 1
beta receptor located all over body, but mainly in lungs
beta 2
action of beta 1 receptors
increase heart rate/bp, heart needs more O2
prototype of nonselective b-adrenergic blockers, lowers BP by lowering CO, adverse reactions- bronchoconstriction, arrhythmias
propranolol
reduces aqueous humor in the eye, used topically in the tx of glaucoma
timolol (timoptol, timoptic)
cardioselective b-blocker, eliminates bronchoconstrictor effect, used in tx of hypertensive asthmatic pts
atenolol
cardioselective beta blocker, used for hypertension, prevention of MI and angina
metroprolol (lopressor)
limit epi containing LA to ___ carpules in pts taking non selective beta blockers due to potential increase in BP
2
prototype of non-narcotic analgesias, considered a NSAID, analgesia, antipyretic, anti-inflammator, inhibits PG synthesis, fever reduced through action on hypothalamus
aspirin
side effects of aspirin
interferes with clotting, GI irritation, hypersensitivity, Reye’s syndrome, toxicity (salicylism)
symptoms of aspirin toxicity
GI upset, vomiting, dim vision, tinnitus, coma, respiratory and metabolic acidosis, death from respiratory failure
Considered a NSAID, inhibits PG synthesis, analgesic, antipyretic, anti-inflammatory, side effects- interferes with clothing, GI irritation
Ibuprofen (advil, motrin, nuprin)
can you take ibuprofen with aspirin?
no
considered NSAID, reversible inhibits COX 1 and @ enzymes, analgesic, antipyretic, anti-inflammatory, prolongs bleeding time, increased risk for CV thrombotic events
Naproxen (aleve)
taking an NSAID and phenytoin can do what
increase phenytoin levels
analgesic, antipyretic, prototype- Tylenol, side effects and interactions are rare, drug of choice for pts on anticoagulants or with PUD
Acetaminophen
drug of choice following SRP
acetaminophen
acetaminophen overdose can result in
hepatotoxicity, liver necrosis, death
used for pain when non opioids fail, block pain receptors in the brain without loss of consciousness
narcotic/opioid analgesics
narcotic/opioid prototype
morphine
most commonly used opioid in dentistry
codeine
sign of overdose/addiction of opioid is ___ pupils
pinpoint
overdose of narcotics
respiratory depression and death
emesis is a ___ of codeine
side effect
does codeine cause constipation
yes it can
opioid antagonist, used to tx opioid overdose
narcan
tx of narcotic withdrawal and dependance, taken orally for once a day, heroin, morphine, other opioids,
methadone
things to note for heroin users
pinpoint pupils, discolored tongue, use NSAIDs for pain relief
the ability to kill bacteria, irreversible action
bactericidal
the ability to inhibit or slow the multiplication or growth of bacteria
bacteriostatic
lowest concentration needed to inhibit visible growth of an organism
minimun inhibitory concentration (MIC)
natural or acquired ability of an organism to be immune or to resist the effects of an anti-infective agent
resistance
range of activity of a drug
spectrum
occurs when the combo of 2 antibiotics produce more effects that if their individual effects were added
synergism
occurs when a combo of 2 agents produce less effect than either agent alone
antagonism
most commonly prescribed antibacterial in the dental profession
penicillin VK
penicillin inactivated by gastric acids
penicillin G
work by destroying bacterial cell wall integrity which leads to lysis, most effective against rapidly goring organism (logarithmic phase)
penicillin
antibiotic most likely to produce anaphylactic reaction
penicillin, usually rash
______ in combo with amoxicillin (known as augmentin) prevents penicillinase from breaking amoxicillin down
clavulanic acid
may be used systemically to tx NUG/NUP, mixing this with other antibiotics usually results in antagonism, bacteriostatic, work by inhibiting protein synthesis
tetrecycline
inhibit collagenase production- may be used in chronic perio
tetracyclines
effective against obligate anaerobes only, has anabuse like reaction- alcohol should be avoided (even mouth rinse)
nitromidazoles (metronidazole)
antiTB drugs
rifampin, isoniazid, pyrazinamide, ethambutol (all 4 drugs need to be taken at same time to tx active TB)
TB, red urine, tears, saliva
rifampin
TB, may lead to hepatotoxicity
Isoniazid, Pyrazinamide
TB, decreased red/green color discrimination, decreased visual acuity
ethambutol
if taking only isoniazid and rifampin only, what does this mean?
preventative
___ consecutive neg sputum tests needed to determine someone with TB is no longer contagious
3
antigen used to aid in the diagnosis of TB, known as mantoux skin test
purified protein derivative
topical, most frequently used anti fungal in dentistry
nystatin
diflucan, systemic med used in tx of oral candidiasis
fluconazole, anti fungal
clotrimazole
mycelex, anti fungal
ketoconazole
Nizoral, anti fungal
cardiac conditions you need premeditated for to precent IE
artificial heart valves, history of IE, congenital heart defects
cardiac conditions that no longer need premedicated for IE
mitral valve prolapse
what to administer for pre med if not allergic to penicillin
amoxicillin 2000 mg 30 min to 1 hr before
what to use for premed if allergic to penicillin
Cephalexin 2000 mg 1 hr before, clindamycin, azithromycin, clarithromycin, cephradine 2000mg 1 hr before for joint replacement
non cardiac conditions for pre med
renal dialysis shunt, ventroculoatrial hydrocephalic shunt, NOT STENTS
preservative/antioxidant for vc in LA
sodium metabisulfite or sodium bisulfate
how does LA work?
inhibit the influx of sodium ions
metabolized in blood, greater potential for allergic reactions, not available in carts
esters
examples of esters
procaine, benzocaine, tetracaine, proproxycaine
metabolized in liver, allergic reactions uncommon
amides
LA, most commonly used anesthetic solution in dental offices, profound anesthesia, medium duration, MRD 300mg, safe for lactation, can also have topical, comes in 1:100,000
Lidocaine (Xylocaine)
LA, not effective topically, can have with Lev, shorter duration than Lido, max dose 300 mg
Mepivacaine (Carbocaine)
LA, longer duration, 1:200,000, don’t use in pts with O2 problems, can cause methomoglobinemia
Prilocaine (citanest, citanest forte)
LA, longest duration, max dose 90 mg
Bupivacaine (Marcaine)
new LA, 4% 1:100,000, increase potency, max dose 500 mg
Articaine (Septocaine)
LAs you can get w/ out vc
lido, mepivacaine, citanest
LA that always have vc
articaine, bupivacaine
maximum quantity of a drug that can be safely administered during an appt
MRD-max recommended dose
to determine MRD do what?
MRD x pt weight
an LA is a base or acid?
weak base
2 major classes of anti anxiety agents
barbiturates and benzodiazepines
principle effect: CNS depression, no analgesic effect, anti anxiety, phenobarbital is a long acting drug of this type used in tx of epilepsy
barbiturates
useful in short term tx of anxiety, insomnia, and alcohol withdrawal, have sedative properties, no antipsychotic or analgesic activity, smoking reduces effectiveness, can be used for apprehensive dental pts, mm relaxer, used for TMJ problems, reverses status epileptics and LA overdose
Benzodiazepines
what type of drugs are these? diazepam (valium), lorazepam (ativan), xanax (alprazolam), tranxene
benzos
potent CNS depressant, produce reversible loss of consciousness and insensitivity to painful stimuli
general anesthetics
stage of anesthesia, reduced pain sensation (development of anesthesia), pt remains conscious, end of this stage is marked by loss of consciousness
stage 1- analgesia
stage of anesthesia, begins with unconsciousness and is associated with involuntary movement and excitement
stage 2- delirium or excitement
stage of anesthesia, most major surgery performed in this
stage 3-surgical anesthesia
stage of anesthesia, complete cessation of all respiration, if this stage is not immediately reversed, pt will die
stage 4- respiratory or medullary paralysis
what is normally used for IV anesthetic?
short acting barbiturates or IV benzos
most commonly used inhaled anesthetic, rapid onset/recovery, raises pain threshold, exhaustion is the route of excretion, no biotransformation
Nitrous oxide
contraindications for N2O
COPD, upper respiratory infection -including stuffy nose, emotional instability, pregnancy, cystic fibrosis, language barrier
N2O abuse symptoms
vitamin B12 deficiency, dementia and parkinson symptoms
CV contraindications for dental tx
acute MI, unstable angina, uncontrolled CHF, uncontrolled arrhythmias, significant uncontrolled hypertension
most common drug used in tx of CHF (increases contractile strength), Digoxin (lanoxin) most common, increases gag reflex and salivation
Digitalis Glycosides
problems with digitalis glycosides
in combo with sympathomimetics, digoxin can lead to cardiac arrhythmias, use caution in in LA with vc, tetracycline and erythromycin increase digoxin blood levels
drug of choice for acute angina, vasodilator, smooth mm relaxant
nitroglycerin
most often pts are asymptomatic, but can experience what symptoms
headache, visual changes, dizziness
considered 1st line therapy for hypertension, promotes excretion of sodium and water, decreases blood volume and pressure
diuretics
hypertension med, hydrochlorothiazide is most common, frequently associated with xerostomia, must avoid orthostatic hypotension
thiazide diuretics
used in management of hypertensive pts with CHF, Furosemide (Lasix) most common
Loop diuretics
lowers BP by decreasing cardiac output, considered 2nd line therapy, ex: propranolol (inderol- non selective) and metoprolol (lopressor-selective)
b-adrenergic blocking agent
work by producing systemic vasodilation by blocking vasoconstriction in smooth mm of bcd, not reduced by NSAIDs, can cause xerostomia and ging enlargement
CCBs
what type of drugs are these?
Cardizem (dilitiazem), norvase (amlodipine), verapamil (isoptin, calan), nifedipine (procardia, adalat)
CCBS- know these!
BP lowered by blocking the conversion of angiotensin I to angiotensin II (causes vasodilation), adverse reactions- hypotension, allergic reactions, dry cough
Angiotensin Converting Enzyme (ACE) Inhibitors
what type of drugs are these?
Lisinopril (prinivil, zestril), Catopril (capoten), Analapril (vasotec)
*** end in -pril
ACE inhibitors
NSAIDs decrease effectiveness of what?
ACE inhibitors
one of most commonly employed anticoagulant agent used in hospitals, injection only
heparin
often used to prevent blood clots after a recent heart attack or stroke, and in people with certain disorders of the heart or bvs, into coagulant
plavix (clopidogrel)
most serious drug reaction of warfarin
aspirin- increase bleeding tendencies, antibiotics also effect them
anticonvulsant, ging enlargement occurs, often used with phenobarbital
Phenytoin (dilantin)
most common barbiturate used in tx if epilepsy, most common side effect- sedation
phenobarbital
used for partial seizures, tx trigeminal neuralgia, anticonvulsant
carbamazepine (tegretol)
benedryl most common, mild allergic reactions, cause xerostomia and sedation, block antihistamine receptors (involved in respiratory function- vasodilation and bronchospasm)
antihistamine
common examples of oral hypoglycemics
metformin (glucophage) and glyburide (diabeta, micronase)
diseases tx with drugs include?
asthma, COPD, upper respiratory tract infections
midl asthma, use what?
inhaled b agonist- usually albuterol
rapidly alleviates an acute attack of asthma when taken by inflation but is rarely used as a bronchodilator
isoproterenol
produces dilation of the bronchioles and improves airway function, useful as bronchodilator in the tx of asthma and for reversal of bronchospasm
metaproterenol (alupent)
type of asthma inhaler, provide immediate relief, albuterol (proventil, ventolin) and pirbuterol (maxair)
short acting bronchodilators
used in long term to prevent asthma attacks
corticosteroids
oral medication used to tx chronic asthma and the bronchospasm associated with emphysema and chronic bronchitis
theophylline
what asthma drug can cause insomnia
albuterol
what should you avoid in asthmatics?
aspirin
1st line tx for COPD
anticholinergics
drug of choice for long term management of COPD
ipratropium (atrovent)
b-adrenergic agonists that act to constrict the BVs of the nose, font use for more then 3-5 days
nasal decongestants
drugs that promote removal of exudate or mucus from respiratory passages
expectorants
may contain opioids or related agents used for the symptomatic relief of a nonproductive cough
antitussives
partially neutralize hydrochloric acid in the stomach, can inhibit absorption of tetracyclines, digitalis, iron, GI drug
antacids
most prevalent GI disease in US
GERD
2 ways GERD is tx-
histamine blocking agents (don’t use with antacids), and PPIs (potent inhibitor of gastric acid secretion)
name PPIs
omeprazole (prilosec)
name histamine blocking agents
cimetidine (tagametHB), famotidine (pepcid AC)
if taking tagamet, what does that mean?
usually being tx for ulcers
what type of drugs are these?
lipitor (atorvastatin), mevacor (lovastatin)
statin drugs used to lower cholesterol
what are these used for?
Zidovudine (AZT), Didanosine (ddl), Zalcitabine (ddC), Stavudine (d4T), Laninvudine (3TC)
HIV protease inhibitors
what is levothyroxine?
synthroid, thyroid hormone replacement
if sythroid use is too low, pt might be
cold intolerant, if taken off too soon can cause myxedema coma
may cause ging enlargement, steroid hormone, nausea, vomiting, can promote endometrial carcinoma, lowers LDL, increase HDL
estradiol
exogenous thyroid hormone used in tx of hypothyroidism, give once daily because of long half life, toxicity- nervousness, heart palpitations, tachycardia, intolerance to heat
synthroid
antihyperlipidemic agent which limits cholesterol synthesis and increases catabolism of LDL, decrease triglyceride levels, GI upset common, don’t take with Warfarin
Lipitor (atorvastatin)
another antihyperlipidemic drug increases catabolism of LDL, inhibits HMG Co-A
Mevacor (lovastatin)
intermediate acting glucocorticoid, reduces inflammatory response, suppresses immunity, can exacerbate hypertension, osteoporosis with long use
Prednisone
