Pharmacology Flashcards
Highest abuse potential, no accepted medical use. Heroin and LSD.
Schedule I
High abuse potential, written RX w/signature only, no refills. Morphine, codeine alone, amphetamines and oxycodone.
Schedule II
Moderate abuse potential, may phone in, 5 RX in 6 months. Tylenol 3
Schedule III
Lower abuse potential, may phone in, 5 RX in 6 months. Valium (Diazepam) And Darvon.
Schedule IV
Lowest abuse potential, some available OTC. Codeine-containing cough meds (not OTC).
Schedule V
Graph of the relationship between dose of a drug and the response
Log Dose-effect curve
Where the dose is increasing sharply
Therapeutic range
Where the curve plateaus (flattens out)
Maximum response
Amount of drug necessary to produce an effect, it is greater when dose is smaller.
Potency
Maximum response of a drug, regardless of the dose
Efficacy
Time it takes for the drug to have an effect
Onset
Length of time that a drug has an effect
Duration
One measure of duration, amount of time necessary for a drug to fall to 1/2 of its original blood level.
Half life
Placed directly in GI tract, oral route and rectal route.
Enteral
Bypasses the GI tract, IV, IM, SQ, Intradermal, inhalation, topical and sublingual.
Parenteral
Safest, least expensive and most convenient, less predictable blood levels, large area for absorption (small intestine).
Oral route of administration
Occurs when orally-administered drugs initially pass through the hepatic portal circulation (liver), which reduces the amount of effective drug.
First-pass effect
Suppositories, creams, enema. Patient is vomiting, unconscious, poor and irregular absorption rectally.
Rectal route of administration
Most rapid drug response, best for emergency situations, absorption phased bypassed, disadvantages include phlebitis, irretrievability and allergy.
IV (intravascular)
Provides sustained effect, massaging muscle will increase the drugs absorption, Deltoid or gluteal muscles common injection sites.
IM (intramuscular)
Used to administer protein products, insulin is administered subcutaneously-it is activated by GI acid/enzymes, local anesthesia in dentistry is delivered this way, side effects include sterile abscess or hematoma
Subcutaneous
Injection into epidermis, example is tuberculin skin test
Intradermal
Rapid delivery across large surface area of respiratory mucosa. Includes inhalers and nitrous oxide/oxygen.
Inhalation
Applied to body surface (skin, mucosa), most effective in non-keratinized areas, require an increased concentration of the drug, contraindicated in ulcerated burned or abraded surfaces.
Topical
Study how a drug enters the body, circulates in the body, and leaves the body.
Pharmacokinetics
Transfer of a drug from the site of administration to the blood stream.
Absorption
What is most important for absorption of oral drugs?
Small intestine
Process by which a drug leaves the blood stream and enters the body systems.
Distribution
What step does IV administered drugs bypass?
Absorption
Where are drugs distributed?
To organs with highest blood flow
Breaking down of a drug for its removal from the body, also known as biotransformation.
Metabolism
What is the most important site for metabolism of drugs?
Liver
Removal of the drug from the body, terminates drug affects.
Elimination
What is the most important organ for elimination?
Kidneys
Dose-related reaction
Side effects
Occurs when the desired effect is excessive, dose-related
Toxic effects
Hypersensitivity response to a drug, NOT dose related
Allergy
Causal relationship between the drug use of a mother and congenital abnormalities.
Teratogenic effect
Functions without conscious effort.
Autonomic nervous system
“Fight or flight” Increase BP thru vasoconstriction Increase HR Dilates bronchioles and pupils Reduce saliva flow Adrenergic drugs (sympathomimetics) Preganglionic: acetylcholine Postganglionic: norepinephrine
Sympathetic (SANS)
“Rest and digest” Increased blood flow to digestive organs Accelerated peristalsis Constricts bronchioles and pupils Increase saliva Pre and postganglionic: acetylcholine Cholinergic drugs (parasympathomimetics)
Parasympathetic (PANS)
Effects mimic the sympathetic nervous system. Should be avoided with angina, uncontrolled HTN and hyperthyroidism.
Adrenergic Drugs
What are the adverse effects of adrenergic drugs?
CNS(anxiety, fear, tremor, headache)
Cardiac arrhythmia
Hypertension
Xerostomia
Examples of Adrenergic Drugs.
Epinephrine (treats anaphylactic reaction, in local anesthetic as vasoconstrictor, to stimulate heart muscle)
Dopamine (treats shock, low BP and Parkinson’s)
Examples of Adrenergic-blocking Drugs?
Inderal (propranolol): non-selective bets blocker to treat HTN
Tenormin (atenolol): selective beta-blocker to treat HTN
Lopressor (metoprolol): selective beta-blocker to treat HTN
Timoptic (timolol): treat glaucoma
Effects mimic parasympathetic nervous system, contraindicated with asthma, ulcers and cardiac disease.
Cholinergic Drugs
Examples of Cholinergic Drugs?
Pilocarpine used to increase saliva flow in patient’s with Sjogren’s syndrome and can treat glaucoma.
These block the parasympathetic nervous system. Adverse reactions include blurred vision, bladder retention, constipation and dry mouth.
Anticholinergic Drugs
Examples of anticholinergic Drugs.
Atropine: decreases saliva for dental procedures
Imodium: treat diarrhea
Scopolamine: treat motion sickness
Dramamine: treat motion sickness
Nonopioid, mechanism of action is inhibition of prostaglandin synthesis. It is an analgesic, antipyretic, anti-inflammatory, and anti-platelet.
Aspirin
What are the adverse effects of aspirin?
Interferes with clotting, contraindicated with Coumadin (warfarin), GI irritation, hypersensitivity, association with Reye’s syndrome, and tinnitus
Nonopioid, NSAID, Motrin, Advil, mechanism of action is inhibition of prostaglandin synthesis. It is an analgesic, antipyretic and anti-inflammatory. Contraindicated with gastric ulcers, decrease effect of many drugs, and interferes with clotting.
Ibuprofen
Nonopioid, Tylenol, Analgesic, antipyretic NOT anti-inflammatory, drug of choice for children, patients on anticoagulants, ulcers, post-op pain after periodontal treatment and may cause hepatotoxicity and liver necrosis at high doses/overdose.
Acetaminophen
Blocks pain receptors in the brain. Analgesic, antitussive, sedation, and euphoria. May cause respiratory depression, nausea/vomiting, constipation and addiction. Codeine is most commonly used in dentistry in combo with acetaminophen
Narcotics/Opioid Drugs
Opioid antagonist that reverses the effects of opioid Drugs.
Narcan (Naloxone)
Used in the treatment of narcotic dependence and withdrawal.
Methadone
Kills bacteria
Bactericidal
Inhibits the growth or multiplication of bacteria
Bacteriostatic
Ability of an organism to be unaffected by an antimicrobial drug
Resistance
Range of activity of a drug (marrow or broad)
Spectrum
When a combo of 2 antibiotics produces greater effect than would be expected if their individual actions were added
Synergism
When a combination of 2 antibiotics produce less effect than either agent alone
Antagonism
Most commonly prescribed antibiotic in dentistry, bactericidal, produce an anaphylactic reaction, most common side effect/allergy sign is a rash, safe for pregnant patients
Penicillin
Which penicillin is preferred due to more consistent absorption?
Penicillin VK
Bacteriostatic Drugs, pre Mrs for dentistry, examples include erythromycin, aziythromycin (Zithromax), and clarithromycin (Biaxin)
Macrolide Antibiotics
Broad spectrum, bacteriostatic antibiotics, used to TX acne and penicillin resistant periodontal infections such as NUG, don’t take. During pregnancy/early childhood due to tooth discoloration, don’t take with dairy products, antacids or iron which bing with this and it concentrates in crevicular fluid.
Tetracycline
10% of patient’s allergic to penicillin are also allergic to Keflex (cross-allergenicity), action similar to penicillin, examples include Cephalexin (Keflex), Cefaclor (Ceclor), Cefuroxime (Ceftin)
Cephalosporins
Antiobiotics used to treat tuberculosis?
Rifampin
Isoniazid
Pyrazinamide
Ethambutol
What TB drugs are used as prevention ONLY.
Rifampin or isoniazid
First alternative if patient is allergic to amoxicillin
Clindamycin
Used to treat anaerobic infections, also treatment of periodontal infections and ANUG.
Metronidazole (Flagyl)
Conditions requiring premedication
Artificial heart valves, h/o infective endocarditis, heart defect repaired with prosthetic patch or device, cardiac transplant w/valve problems, renal dialysis shunt, ventriculoatrial hydrocephalic shunt
Conditions that MAY require premedication
Joint replacements less than 2 years ago, previous prosthetic joint infection, multiple joint replacements, and immunocompromised patients.
Recommended drug regimens
Amoxicillin 2000mg (2g) one hour prior to procedure.
If pen/amox allergy:
Cephalexin (Keflex) 2000 mg (2g) one hour prior to procedure.
Clindamycin 600 mg prior to procedure
Azithromycin or clarithromycin 500 mg one hour prior to procedure
Inhibit viral DNA synthesis, examples: Acyclovir (Zovirax), Penciclovir (Denavir), and Valacyclovir (Valtrex), used to treat oral herpes
Antiviral medications
How do antiviral medications use to treat HIV/AIDS effect the oral cavity?
By causing gingival bleeding and oral ulcers
TX oral candidiasis, oral dose is 5 ml QID for 2 weeks.
Nystatin (mycostatin)
Inhibit the influx of sodium ions by blocking sodium channels in the neuron membrane. Hey are weak bases, work poorly in inflamed tissues.
Local Anesthetics
What’s the best way to reduce the risk of systemic toxicity?
Aspiration
Metabolized in the liver, “i-Caines”, lidocaine most common. Mepivacaine, prilocaine, bupivicaine, And articaine.
Amides
Metabolized in blood plasma, not used as injection, benzocaine 20% topical, novocaine.
Esters
Most commonly used anesthetic in dentistry, safe in pregnancy, also available in topical anesthetic, and medium duration.
Lidocaine (Xylocaine)
Short duration, comes with vasoconstrictor or as plain solution.
Mepivacaine (Carbocaine)
Avoid this in patients with anemia and taking acetaminophen, medium duration.
Prilocaine (Citanest)
Has the longest duration.
Bupivicaine ( marcaine)
4% solution and increased risk of paresthesia especially with mandibular block, medium duration
Articaine (Septocaine)
Why are vasoconstrictors in local anesthetic solutions?
Prolong and increase the depth of anesthesia, delay absorption and decreases toxicity and hemorrhage. Examples include epinephrine and levonordefrin
MRD of vasoconstrictors.
.2mg in a healthy patient and .04mg in a medically compromised patient (about 2 cartridges)
What is NOT contraindicated in a patient with controlled HTN?
Epinephrine
Short-term treatment of anxiety and insomnia, anxiety reduction and sedation, used in dentistry to reduce pt. Anxiety and TMJ disorders. Examples include diazepam (Valium), lorazepam (Ativan), and alprazolam (Xanax).
Anti anxiety drugs-Benzodiazepines
CNS is the major system affected, raises the pain threshold, excreted through exhalation.
Anti anxiety drugs-nitrous oxide/oxygen sedation.
What color is the nitrous tank and the oxygen tank?
Nitrous-Blue
Oxygen-Green
What are the contraindications of Nitrous Oxide?
COPD, upper respiratory tract infection or stuffy nose, pregnancy, emotional or behavioral instability, communication barriers and abuse potential.
Prolonged exposure of nitrous oxide may lead to?
Tremors and other neurological symptoms, spontaneous abortion/miscarriage, numbness and tingling in the extremities.
Cause CNS stimulation and xerostomia, examples include Prozac (fluoxetine) and Zoloft (setraline).
Serotonin Reuptake Inhibitors (SRIs)
Used to treat bipolar disorder and Motrin is contraindicated when patient is taking this.
Lithium
Cause sedation and xerostomia, Elavil (amitriptyline), DO NOT use epinephrine with patients taking this.
Tricyclic antidepressants
Depresses CNS, used for epilepsy, causes gingival hyperplasia in 50% of patient’s.
Anticonvulsants-Dilantin (phenytoin)
Barbiturate used in management of epilepsy and causes sedation.
Phenobarbital
Treats partial seizures and used in dentistry to treat trigeminal neuralgia.
Carbamazepine (Tegretol)
Most common to treat mild allergic reactions, side effects are xerostomia and sedation, works by blocking histamine receptors in the body.
Antihistamines- Diphenhydramine (Benadryl)
what does H1 receptors cause?
Vasodilation, bronchoconstriction, pain and itching when stimulated.
What does H2 receptors cause?
Gastric acid secretion when stimulated.
Treats type 1 DM, subcutaneous injection, and hypoglycemia is the most common side effect.
Insulin
Oral hypoglycemic drugs that increased the body’s sensitivity to insulin
Metflrmin (Glucophage)
Oral hypoglycemic drug that stimulates the release of insulin from the b-cells of the pancreas.
Glyburide (Micronase, Diabeta)
What meds should be avoided in asthma patients?
Aspirin
Adrenergic drug, bronchodilator (opens air passages), inhaler form for immediate relief, and may cause insomnia.
Ventolin (albuterol)
Ends in sone or lone, used long term to prevent asthma attacks and not used for immediate relief.
Corticosteroids.
Combines a corticosteroid and a bronchodilator
Advair Diskus
Oral Med to treat asthma, emphysema and chronic bronchitis, combined with erythromycin can cause toxicity.
Theophylline
Systemic antacid, contraindicated in cardiovascular patients due to sodium content.
Sodium bicarbonate
Treats GERD and gastric ulcers, has prazole ending.
Proton-pump inhibitors
Block H2 histamine receptors which reduces acid secretion, has dine ending.
Histamine blocking agents
Used to treat cancer, often IV administered, also treats osteoporosis, associated with osteonecrosis of jaw
Biphosphonate drugs
Used for contraception, menopause therapy and menstrual disturbances. Steroid hormone. May cause gingival inflammation, nausea and vomiting, and may promote endometrial and breast cancer
Estrogen
Intermediate-acting steroid, used to TX autoimmune and inflammatory disorders: addisons and allergy. Reduces body’s inflammatory response, suppressed immunity, increased risk of infection and delays healing.
Prednisone
Drugs that cause gingival hyperplasia/overgrowth.
Dilantin (phenytoin), Procardia (nifedipine) and other CCBs, cyclosporine.
Drugs that cause gingival bleeding.
Coumadin (warfarin), Plavix (clopidogrel), Aspirin-contraindicated in patient’s taking Coumadin.
Drugs that cause Xerostomia.
Diuretics, CCBs, antihistamines and many others.
Drug used to treat Angina Pectoris/chest pain.
Nitroglycerin, works as vasodilator, administered sublingual.
Drugs used to treat CHF.
Cardiac glycosides, examples are digitalis and Lanoxin (digoxin).
Drugs used for anticoagulant therapy.
Used to prevent stroke and heart attack, patients are at increased risk of gingival hemorrhage, examples are Coumadin (warfarin), Plavix (clopidogrel), Aspirin, And heparin.
Drugs used for high cholesterol.
Known as antihyperlipidemics, -statin Drugs, examples are Lipitor (atorvastatin), Mevacor (lovastatin), Zocor (simvastatin), and Crestor (rosuvastatin)
Drugs used to treat HTN
Diuretics, beta adrenergic blocking agents, CCBs, ACE inhibitors.
Promote excretion of sodium and water from the body, side effects include xerostomia and orthostatic hypotension.
Diuretics
-olol meds, avoid epinephrine with these, Inderal (propranolol) non-selective beta blocker.
Beta-adrenergic blockers
Causes systemic vasodilation, side effects include gingival enlargement and xerostomia.
CCB
-pril meds, adverse reactions include altered taste (dysgeusia), orthostatic hypotension and dry cough.
ACE inhibitors
CNS stimulant, causes vasoconstriction and dilation of pupils, present with active dental decay
Cocaine
CNS and respiratory depression, causes sedation and “pinpoint” pupils.
Heroin
CNS stimulant, brain damage and severe oral effects, males aged 19-40 most common affected, rampant caries, xerostomia, And soda consumption.
Methamphetamine
