Pharmacology Flashcards
What does ADME stand for?
Absorption
Distribution
Metabolism
Excretion of drugs
What is pharmacokinetics
the study of ‘ADME’ the absorption, distribution, metabolism and excretion of drugs.
What phase is bypassed when a drug is administered intravenously
absorption
What is absorption
the transfer of a drug from the site of administration to the blood stream
What is the most important site for drug absorption for orally administered drugs?
the small intestine
what mechanical factor can increase absorption
massaging the injection site
what is distribution
the pattern of distribution of drug molecules by various tissues ~after the chemical enters the circulatory system~
After being absorbed, where is the drug distributed?
to the organ with the highest blood flow
- orally to the liver
- sublingually to the heart
What is an important protein that may alter the effects of drug distribution
albumin; a plasma protein that binds to a large range of drugs, this interaction may interfere with active drug concentrations in the blood; if it is albumin binding drug, you may have to increase drug dosage
What is Metabolism
the process by which the body breaks down and converts medication into active chemicaal substances
What is a major site for drug metabolism
THE LIVER
If a person has liver disease or past/present substance abuse, what effect may occur when metabolizing medications
May have a compromised ability to metabolize medications
What is elimination
the elimination or excretion of a drug is understood to be any one of a number of processes by which a drug is eliminated from the body
What is the most important route for drug elimination
renal (kidney) excretion
What drugs are NOT excreted in the urine
lipid soluble drugs (need to be metabolized into water soluble form by liver)
What is the only way to terminate a drug’s effect
Drug elimination
What is the major route of fluoride elimination
excretion in the urine
**What are ~the main~ factors that alter drug efficacy (8 points)
- patient compliance
- liver dysfunction
- disease
- past or present abuse
- drug metabolism
- kidney disease
- route of administration
- weight
What doe the ‘surface area’ or ‘clark’s rule’ take into account when determining child’s dosage
more accurate than ‘cowling’s rule’ or ‘young’s rule’ (take into account age) because it calculates in weight
What is a toxic reaction
the amount of desired effect is excessive; dose related
What is a side effect
dose-related reaction that is not part of the desired therapeutic outcome
ex: drowsiness that occurs with antihistamine use
What is an idiosyncratic reaction
abnormal drug response that is usually genetically related
What is a local effect
local tissue irritation
What is a teratogenic effect
relationship between maternal drug use and congenital abnormalities
ex: thalidomide induction of phocomelia (shortened limbs)
What are drug interactions
effect of one drug that is altered by another; may result in toxicity or lack of efficacy
what is an allergic reaction
Immune hypersensitivity reaction to a drug the the patient has previously exposed (NOT dose related)
What is a treatment for a mild allergic reaction
antihistamine with or without steroids
What is treatment for a anaphylactic reaction
epinephrine subcutaneously with or without steroids
**Phenytoin/Dilantin dental effects*
gingival overgrowth, usually occurs in the anterior facial region
**Cyclosporine dental effects
organ rejection preventive medication, generally causes gingival overgrowth
**Calcium channel blockers dental effects
nifedipine, verapamil, amlodipine; causes gingival overgrowth
What medications are most commonly associated with gingival overgrowth (3 points)
- Phenytoin/dilantin
- cyclosporine
- calcium channel blockers (nifedipine, verapamil, amlodipine)
What is potency
how MUCH of a drug is needed to create the desired therapeutic effect
What is efficacy
how WELL the drug creates the desired therapeutic effect
-more important than potency when selecting a particular drug
how are potency and efficacy related
potency and efficacy are NOT related; drugs may have different potencies but the same efficacy
What is latency
the period of time that must elapse between the time at which a dose of drug is applied to a biologic system and the time at which a specified pharmacologic effect is produced; varies with dose
What is onset
the time from drug administration until the drug exerts an observable specific effect or response
What is Half-life
the time it takes for a drug to lose half of its pharmacologic, physiologic, or radiologic activity; relates to duration of effect
ex: one half life = 50%
two half lives= 25% and so on
what is a steady state
When the amount of drug entering the body equals the amount being removed; NOT related to the dosage of the drug or the frequency of drug administration
What is a therapeutic index
a measurement of the safety of the drug; narrow therapeutic index do not have much difference between the effective dose and the toxic or lethal dose-these patients need to be monitored closely for adverse effects
What is a bactericidal
a drug or substance which kills bacteria or is capable of killing bacteria
What is bacteriostatic
a drug or substance that prevents the growth of bacteria by keeping the microbes in the stationary phase of growth
What is resistane
natural or acquired ability of an organism to be immune to or to resist the effects of an antimicrobial agent
What is spectrum
range of activity of a drug
What is synergism
interaction of two (or more) drugs such that the total effect is greater than the sum of the individual effects
What is antagonism
occurs when a combination of two agents produces less effect than either agent alone
What is enteral
placed directly into the GI tract; oral or rectal
What is parenteral
drug bypasses GI tract; injection, inhalation and topical
Which drug administration route is the safest, least expensive and most convenient
the oral route
What is a limitation to the oral route
patient cooperation
What term describes how orally delivered drugs must pass through hepatic portal circulation First which can inactivate some drugs
First-pass effect or Phase 1 reactions
what is an effect of having a high first-pass ratio
They have a greater oral to parenteral dose ratio and require a LARGER oral dose/ the amount of drug available to produce systemic effect is reduced by first pass effect
besides the first pass effect, what can also decrease drug metabolism?
Impaired liver functioning
Which drug administration route produces the most rapid response
Intravascular route (absorption phase bypassed**)
Which drug administration route produces a sustained effect (3 points)
Intramuscular route massaging area increases absorption
- GI interactions avoided
- absorption is generally uniform with a rapid onset
Which drug administration route is used to administer protein products
subcutaneous route (insulin and local anesthetics)
What is a disadvantage to topical drug administration route
they may have a systemic uptake** do not overdo
Who determines which substances are added or removed from each drug classification schedule
The DEA and FDA
What is a schedule I drug
Highest abuse potential
-No accepted medical use
Ex: heroin, ecstasy, LSD, Marijuana
What is a schedule II drug
High abuse potential
-Written prescription with provider’s signature only
-NO REFILLS
Ex: codeine, oxycontin, fentnyl
What is a schedule III drug
Moderate abuse potential -Prescriptions may be phoned in -no more than 5 refills in 6 months -may lead to moderate or low physical dependence or high psychological dependence Ex: anabolic steroids
What is a schedule IV drug
Less abuse potential
-same as schedule III, may be phoned in..no more than 5 refills a month.. moderate-low dependence
Ex: Xanax, Soma, Valium, Ativan
What is a schedule V drug
Least potential for abuse
-can be purchased over the counter
ac
before meals
bid
twice a day
gt
drop
hs
at bedtime
po
by mouth
pc
after meals
prn
as needed
q3h
every 3 hours
qd
every day
qid
4 times a day
tid
3 times a day
sig
label; instructions for use
stat
immediately
tab
tablet
ud
as directed
what is an NSAID
nonsteroidal anti-inflammatory drug
What are side effects of Asprin (5 points)
- Interferes with clotting
- GI irritation
- Hypersensitivity
- Reye’s syndrome
- Toxicity termed salicylism
Is aspirin an NSAID
yes
Is Ibuprofen (Advil, Motrin, Nuprin) an NSAID
yes
What are side effects of ibuprofin (2 points)
- GI irritation
- Interferes with clotting
- —less than aspirin
What is analgesic
reduces pain
What is antipyretic
reduces fever
Ibuprofen can decrease the pharmacological effects of MANY drugs including (7 points)
ACE inhibitors Aspirin Beta blockers Corticosteroids Cyclosporine Lithium Loop diaretics **will have a case study
Is aleve/Naproxen an NSAID
yes
side effects of Aleve/Naproxen (2 points)
- increased risk of serious cardiovascular thrombotic events
- prolongs bleeding time
**What occurs when taking an NSAID and phenytoin (Dilantin) (2 points)
increased phenytoin levels
-people taking phenytoin should have a blood test to monitor the phenytoin level when starting/increasing the dose of an NSAID
Is Acetaminophen/Tylenol an NSAID
no (no anti-inflammatory effect or effect on clotting)
what is the drug of choice for patients on anticoagulants (coumadin) or with peptic ulcer disease
Acetaminophen/ Tylenol
Overdose in what is the number one cause of liver failure
Tylenol/ can cause death
What are the common NSAIDS (3 points)
Aspirin
Ibuprofen (Advil, Motrin, nuprin)
Naproxen/Aleve
What is the mechanism of action for narcotic/opioid analgesics
blocks pain receptors in the brain without loss of consciousness
What are the drug actions for narcotics/opioid analgesics (4 points)
analgesia
anti-tussive (cough suppressant)
sedation
euphoria
What are adverse effects of narcotics/opioid analgesics (4 points)
respiratory depression (pt can forget to breathe)**
nausea/vomiting**
constipation**
addiction**
What is the main opioid used in dentistry
codeine (generally used in conjunction with Tylenol 3)***
**What is the #1 sign of an overdose/addiction to ANY opioid
pinpoint pupils
What is used to treat Opioid overdose**
Narcan!!** (naloxone) should always be in dental emergency kit***
What is the ANS
autonomic nervous system involuntary responses
What does the ANS require
neurotransmitters
What are the two divisions of the nervous system
Parasympathetic nervous system and Sympathetic Nervous sytem
Which is the ‘Rest and Digest System’
Parasympathetic Nervous System
What is the neurotransmitter for the Parasympathetic Nervous System
actycholine
What dentally significant function is of the PNS
stimulates salivary gland secretion
What are parasympathomimetics (2 points)
drugs used to mimic the effects of the PNS; aka cholinergic agents or muscarinic drugs
What are cholinergic agents used to treat (3 points)
- Xerostomia*
- urinary retention
- glaucoma
What are some examples of cholinergic agents (2 points)
pilocarpine
nicotine
What are contraindications of cholinergic agents (4 points)
- asthma
- peptic ulcer
- cardiac disease
- GI/urinary obstruction
What are anticholinergic agents
inhibit parasympathetic effects by blocking acetylcholine receptors
What is an example of an anticholinergic agent in the dental setting
Atropine-decreases salivary flow
What are the effects of anticholinergic drugs (4 points)
A-anticholinergic agents
B-blurred vision and bladder retention
C-constipation
D-dry mouth
What is the fight or flight system
SNS- Sympathetic Nervous System
What are the neurotransmitters for SNS
acetylcholine and norepinepherine
What are functions of the SNS (6 points)
- increase in the rate and constriction of the heart
- *dilation of bronchial tubes in the lungs (allows for greater oxygen exchange) and pupils in the eyes
- contraction of muscles
- release adrenaline from adrenal gland
- decrease in saliva production**
- vasocnstriction**
What are sympathomimetics (2 points)
medications that mimic the effects of the sympathetic response
-AKA adrenergic drugs.. each adrenergic drug treats different conditions depending on which receptors are targeted
Where are beta-1 (B1) receptors (3 points)
*heart (primarily) (remember..have ‘1’ heart ‘2’ lungs)
eye
kidneys
Where are beta-2 (B2) receptors (6 points)
*lungs (primarily) (remember..have '1' heart '2' lungs) GI tract liver uterus blood vessels skeletal muscle
Where are beta-3 (B3) receptors
fat cells
What are bronchodilators for (4 points)
- open bronchial tubes
- bind to beta-2 receptors
- used for treatment of asthma, COPD, emphysema, bronchitis
- most common is albuterol
What can be an adverse effect of an asthma inhaler
candidiasis
Where do vasopressors act on
-alpha1, beta-1 and beta-2 adrenergic receptors as well as dopamine receptors
what do vasopressors do (3 points)
- stimulate smooth muscle contraction in the blood vessels leading to vasoconstriction which increases blood pressure
- good for treating shock and to stop bleeding
- keep anesthetics in area of administration
What are common vasopressors (4 points)
- Epinephrine
- dopamine (Parkinson’s disease, shock, hypotension)
- ephedrine (for colds)
- pseudoephedrine (for colds)
What are cardiac stimulators used for
to stimulate and restore the heartbeat in emergency situations *generally epinephrine
What are other common adrenergic agents (besides vasopressors, cardiac stimulators and bronchodilators) (3 points)
- ritalin/adderall
- cocaine
- methamphetamine
What is contraindicated for cocaine or methamphetamine abusers
Epinephrine
What is cocaine considered?
a vasoconstrictor–only local anesthetic agent with vasoconstrictive properties
What are oral signs of methamphetamine abuse? (3 points)
- rampant caries
- burned mucosal surfaces
- mucosal irritation is a result of the METHOD of drug administration, not the drug itself*
What are treatment options for those suffering from meth addiction or overdose
There are none only cognitive behavioral interventions for coping skills
What are adverse effects of adrenergic agents (3 points)
- CNS disturbances (anxiety, fear, headache; imortant consideration for anesthesia selecton–case study–)
- Cardiac arrhythmias***
- cerebral hemorrhage
Contraindications for adrenergic drugs (3 points)
- patients with angina
- uncontrolled hypertension
- uncontrolled hyperthyroidism
What are adrenergic-blocking agents
beta-blockers/B-blockers
-drugs that block norepinephrine and epinephrine from binding to beta receptors on nerves
Where are norepinephrine and epinephrine produced
by nerves throughout the body as well as by the adrenal gland
What happens when beta-blockers block norepinephrine and epinephrine?
beta blockers reduce heart rate, reduce blood pressure by dilating blood vessels
-may constrict air passages by stimulating the muscles that surround the air passages to contract (an adverse side effect)
What are beta blockers used to manage (5 points)
- cardiac arrhythmias
- heart failure
- diabetes
- post heart attack (myocardial infarction)
- hypertension
off-label uses of beta blockers (4 points)
- migraines
- glaucoma
- hyperthyroidism
- anxiety
Adverse effects of Beta Blockers (2 points)
- may cause shortness of breath in asthmatics
- can cause low or high blood glucose
Who found the first antibiotic and when
Alexander Fleming discovered penicillin in 1928
Do antibiotics fight viral infections?
No, they kill (bacteriocidal) or slow bacterial (bacteriostatic)
What are side effects of antibiotics (3 points)
- diarrhea
- oral candidiasis
- GI upset
What is synergism
occurs when a combination of two antibiotics taken together produces a greater effect than would be expected if their individual actions were added together
what is antagonism
occurs when a combination of two antibiotics produce a lesser drug effect than either medication on its own
What are the most commonly prescribed antibiotics in dentistry
Penicillins (safe for pregnant women)
What antibiotic is most likely to produce an anaphylactic reaction
penicillins (generally a rash**)
What are examples of penicillin antibiotics (4 points)
- Penicillin VK (preferred over Pen. G because Pen. G is inactivated by gastric acids)
- Penicillin G
- Amoxiillin
- Amoxicillin in combination with clavulonic acid (augmentin)
What antibiotics are generally used to combat respiratory diseases
Macrolides due to their broad spectrum of activity and their relative safety (bacteriostatic)
If a patient is allergic to penicillin, what is an alternative
clarithromycin and azithromycin
What are tetracyclines
a broad spectrum antibiotic (bacteriostatic
When are tetracyclines contraindicated
during pregnancy
How are tetracyclines to be taken
- with a full glass of water on an empty stomach
- 1-2 hours after meals
- cannot be taken with milk or other dairy products
What are ideal antibiotic periodontal therapy options in cases of NUP/NUG and aggressive periodontal diseases
tetracycline (especially doxycycline) because they concentrate in the gingival crevicular fluid and have an anti-collagenase effect
What specific antibiotic should alcohol be avoided with
Nitromidazones (no mouth rinse)
What four antibiotics are used to treat tuberculosis and MUST be taken together
(RIPE) Rifampin Isoniazid Pyrazinamide Ethambutol
If a patient is taking isoniazid or rifampin ONLY what is most likely the reason**
taking it as a preventive agent
What is the suggested antibiotic regiment for dental prophylaxis***
amoxicillin 2000 mg (2g) if allergic to amoxicillin: -cephalexin 2000 mg (2g) -clindamycin 600 mg -azithromycin 500 mg -clarithromycin 500 mg
What are drugs used to cure Herpes Simplex Virus (HSV)
- Acyclovir (look for -vir- (virus))
- Penciclovir
- Valacyclovir
What is treatment with HIV medicines called
antiretroviral therapy (ART)
What is the most common antifungal agents used in dentistry
- Nystatin (for thrush)(topical)
- Fluconazole (systemic)
What are the most commonly employed drugs in the dental office?
Local anesthetics
How do local anesthetics work
inhibit the influx of sodium ions by competing with calcium for binding sites
local anesthetics -de-crease the rate of
-de-polarization
What are the two groups of anesthetic agents
Esters and Amides
**What ester is used primarily topically?
benzocaine
also Novocain, but it is not available anymore
What anesthetic group is allergic reactions most common
Esters
What is the most used Anesthetic agent in dentistry
Lidocaine (it is an amide)
Is lidocaine safe for a pregnant patient
yes and during lactation as well
what is the recommended dose of lidocaine
300 mg
Which anesthetic agent has a longer duration and lower epinephrine content than lidocaine and what is it’s maximum dose
Prilocaine (max dose 400mg)
What anesthetic agent has the longest duration and what is it’s maximum dose
Bupivacaine (max dose 90 mg)
What are the most common anesthetic agents from shortest duration to longest (5 points)
Mepivacaine Lidocaine Prilocaine Articaine Bupivicaine
What is the max dosage for Artiaine
500mg (safer than bupivacaine)
What is the max dosage for Mepivacaine
300mg
**Why are vasoconstrictors added to anesthetics (4 points)
Prolong anesthetic action
Reduce anesthetic toxicity
Delays absorption
Decreases bleeding
**What are the anesthetic agents available without a vasoconstrictor (3 points)
Lidocaine
Mepivacaine
Citanest
**What two anesthetics will ALWAYS contain a vasoconstrictor
Articaine
Bupivacaine
how much anesthetic agent in mg is in a 2% anesthetic solution
36mg
in a 1:100000 epinephrine solution, how much epinephrine is present
.018 mg
What is the maximum number of carpules containing 1:100000 epinephrine allowed for a hypertensive patient
2
What is the limit of epinephrine allowed for ASA I, II, III, and IV patients
ASA I or II - .2mg
ASA III or IV- .04 mg
***Why don’t local anesthetics work well in inflamed tissue
They are a weak base and inflamed tissue has an acidic environment; necessitates an increased dose of anesthetic agent
***What is the BEST way to reduce systemic toxicity from local anesthetic administration
use an aspirating syringe
What is the effect of barbiturates
CNS depression (look for ending -barbital)
What long acting barbiturate is used in the treatment of epilepsy
Phenobarbital
What is used for the short-term treatment of anxiety, insomnia, and alcohol withdrawal
benzodiazepines
***What is the most common type of drug used in the dental setting
benzodiazepines (allays apprehension in fearful dental patients)
***What can reverse status epilepticus and seizures associated with local anesthetic overdose
benzodiazepines
What are examples of benzodiazepines (3 points)
- Diazepam (valium)
- Lorazepam (Ativan)
- Xanax (Alprazolam)
**How does nitrous oxide sedation work to calm patients
Increases pain threshold (does NOT decrease peripheral nervous system response)
**What color are nitrous oxide tanks
blue
What is the route of excretion for nitrous oxide
exhalation
**What are contraindications for nitrous oxide/ oxygen sedation (6 points)
- COPD
- Upper respiratory infection (including stuffy nose)
- emotional/anxiety disorder
- Pregnancy
- Cystic fibrosis
- Lack of communication/language barrier
***What stage does nitrous oxide keep the patient in
Stage 1 anesthesia (analgesia)
***What can long-term nitrous oxide abuse lead to
- neurological symptoms similar to parkinson’s disease and dementia
- vitamin B12 deficiency leading to numbness and tingling in the extremities
***How is Nitrous oxide sedation effective with cerebral palsy patients
reduces the orofacial muscle tones
What are the 3 groups of anti-anxiety medications?
Barbiturates
Benzodiazepines
Nitrous Oxide Sedation
What are the 5 groups of Antidepressants
Selective serotonin Reuptake Inhibitors (SSRIs) Lithium Tricyclic antidepressants Monoamine Oxidase Inhibitors (MAOIs) Bupropion (Zyban)
What are the most common antidepressants
Selective serotonin Reuptake Inhibitors
What are a common side effect of SSRI’s
xerostomia
***What is lithium used to treat
mood disorders such as bipolar disorder
***What are two main drugs out of 1164 drugs that are known to interact with lithium
acetaminophen and ibuprofin
What are tricyclic antidepressants used to treat and an example of one
depression that is resistant to other drugs
ex: amitriptyline (elavil)
What is a major side effect of tricyclic antidepressants
risk of suicide
What are other side effects of tricyclic antidepressants (3 points)
- swelling of the tongue and face
- sedation
- xerostomia
***What should we NOT use for patients taking tricyclic antidepressants
DO NOT use epinephrine
What are Monoamine Oxidase Inhibitors
elevate levels of norepinephrine, serotonin and dopamine by inhibiting an enzyme called monoamine oxide… no longer used often because of certain food interactions
-also used for treating parkinson’s
What is Bupropion (Zyban) used to treat
depression but also largely used to help people stop smoking
How does Bupropion (Zyban) help smokers quit smoking
blocks some of the chemicals in the brain that react with nicotine to increase the ‘feel good component’ when a person smokes–so it reduces tobacco cravings and eases other withdrawal symptoms
What are the 4 main anticonvulsant and anti-seizure medications
Phenytoin
Caramazepine
Benzodiazepines
Phenobarbitol
What is Phenytoin (Dilantin) used to treat
controls partial seizures and generalized tonic-clonic seizures
What is a dental significant side effect of Phenytoin (Dilantin)
gingival inlargement-generally on the anterior facial region
What is Phenytoin also known as
Dilantin
What is Bupropion also known as
Zyban
What is Carbamazepine also known as
Tegretol
What is the first choice for partial, generalized tonic-clonic and mixed seizures
Carbamazepine/Tegretol
What is effective for short-term treatment of ALL seizures
Benzodiazepines
What can be used in the emergency room to stop a seizure or status epilepticus following local anesthesia overdose
Benzodiazepines
What is the oldest epilepsy medicine still used and why
Phenobarbitol- it is effective and low cost
What are antihistamine
- agents that block histmine release from histamine-1 receptors
- used to treat symptoms of an allergic reaction
What are antihistmines also used for (besides allergic reaction treatment)
- reduce anxiety
- induce sleep
- motion sickness
What are side effects of anthistamines and an example
- xerostomia
- sedation
ex: benedryl
***What adverse reaction is NOT associated with hypoglycemia
shortness of breath
***What is insulin-shock
hypoglycemia
***What hypoglycemics are used to treat Type 2 diabetes
Metformin and glyburide
How do rescue medications help an asthma attack and an example
open up inflamed airways
ex: albuterol
What is a controller medication for asthmatic patients
a daily medication that is used to prevent or improve asthma symptoms in patients who experience frequent symptoms
***What is an oral medication used to treat chronic asthma and the bronchospasm associated with emphysema and chronic bronchitis
Theophylline–erythromycin can increase serum levels of theophylline and toxicity may result
***What drug should be avoided in asthmatics
aspirin
***Albuterol can cause….
insomnia (it is an adrenergic drug)
***What can rapidly alleviate an acute attack of asthma when taken by inhalation but is rarely used as a bronchodilator
Isoproterenol
***What is used for the reversal of bronchospasms
metaproterenol
***What is the most prevalent GI disease in the US
GERD (gastroesophageal reflux disease)
What is GERD
failure of the lower esophageal sphincter to close properly which results in reflux of acid into the unprotected lining of the esophagus
What are treatment options for GERD
OTC medications that help neutralize stomach hydrochloric acid
What is an alkalinizing agent that reduces stomach acid; commonly used antacid to treat heartburn, acid ingestion and upset stomach
baking soda (sodium bicarbonate)
What can antacids inhibit absorption of
tetracyclines
What is the most powerful medication available for treating GERD and an example
PPIs (Proton pump inhibitors) (Prilosec)
**What do gastric ulceration’s cause
could have erosion of the enamel on the lingual surfaces of maxillary anterior teeth but will NOT have gingival bleeding
***What are the most common medications prescribed for osteoporosis treatment and an example
Bisphosphonates such as Alendronate (Fosamax)
prevent loss of bone density
What are two possible effects of bisphosphonates
Heightened risk of osteonecrosis of the jaw
impaired wound healing
What do corticosteroid medications do
prevent the release of substances in the body that cause inflammation and suppress the immune system
What are corticosteroids used for (4 points)
rashes
autoimmune disorders
Addison’s disease
asthma
What are the main side effects of corticosteroid use (5 points)
increased risk of infection Delayed wound healing Glaucoma Fluid retention Weight gain
What are medications used in the treatment of Cardiovascular diseases (4 points)
Anti-hypertension medications (diuretics, b-adrenergic blocking agents, calcium channel blockers, ACE inhibitors)
Digitalis glycosides
Nitroglycerin
Anticoagulants
What is the first line of therapy for hypertension
diuretics
How do diuretics work in decreasing blood pressure?
promote excretion of sodium and water which then decreases blood volume and pressure
How do B-Adrenergic work in decreasing blood pressure?
lower blood pressure primarily by decreasing cardiac output (second line-therapy)
How to identify B-Adrenergic blocking agents?
look for suffix -olol (propranolol, metaprolol)
***If a patient is taking a B-Adrenergic blocking agent what should you do
Avoid using ANY epinephrine containing agents
How do Calcium channel blockers work in decreasing blood pressure?
produce systemic vasodilation by BLOCKING vasoconstriction in smooth muscle of blood vessels
What are oral manifestations of Calcium channel blockers
gingival enlargement
What are common channel blocking agents (4 points)
Cardizem
Norvasc
Verapamil
Nifedipine
How to ACE Inhibitors decrease blood pressure?
the drugs block the conversion of angiotension I to angiotension II
What are common side effects of ACE Inhibitors (2 points)
Dysgeusia (altered taste sensation)
Dry cough
What suffix signify ACE inhibitors
-pril medications
***what decreases the effectiveness of ACE inhibitors
NSAIDS (except Calcium Channel blockers)
What is the most common type of drug used in the treatment of congestive heart failure.. and an example
Digitalis glycosides(increases contractile strength) ex: Digoxin
***What is the drug of choice for acute angina
Nitroglycerin
How does Nitroglycerine work
it is a vasodilator, it acts as a smooth muscle relaxant
***How is Nitroglycerine used
sublingually and should be in all emergency kits
What do anticoagulants do and what is the most common one
reduce intravascular clotting
Ex: warfarin (Coumadin)
***What is used to prevent blood clots after a recent heart attack or stroke, and in people with certain disorders of the heart or blood vessels
Plavix
**What are medications that cause gingival overgrowth (4 points)
Dilantin (phenytoin)
Calcium channel blockers
Cyclosporine (prevents tissue/organ rejection from transplant)
***What are medications that cause gingival bleeding (2 points)
Anticoagulants (coumadin, clopidogrel)
Aspirin
Beta Adrenergic blockers end in…
olol
opioid analgesics end in…
codone
morphone
antifungal drugs end in…
azole
antiviral medications end in…
cyclovir
benzodiazepines end in…
azepam
azolam
Lipid-lowering drugs end in…
statin
ACE inhibitors end in…
pril
Corticosteroids end in…
sone
lone
Histamine 2 blockers end in…
tidine
Proton pump inhibitors end in…
prazole
