pharmacology Flashcards
involves the study of the bodily absorption, distrubution, metabolism, and excretion of drugs ADME
pharmokinetics
What is bypassed when a drug is administered intravenously?
absorption phase
only drugs to pass blood brain barrier
lipid soluble drugs
the most important site for drug absorption of orally administered drugs is the
small intestines
oral doses go to the liver
sublingual goes to the heart
true
is an abundant plasma protein that binds to remarkably wide range of drugs this interaction may interfere with active drug concentrations in the blood
albumin
major site for drug metabolism
liver
someone with liver disease or past/present substance abuse may have a compromised ability to metabolize medications. Decrease metabolism leads to increased circulating levels of the drug, more therapeutic effect
true
drugs are most often eliminated by
biotransformation
the most important route for drug elimination is
renal kidney excretion
lipid soluble drugs are not
excreted by urine. but need to be metabolized into water soluble form by liver
the major route of fluoride elimation is
excretion from urine
potency and efficecacy are unrelated
true
drugs may have difference potencies but the same efficacy t/f
true
when the continuing dose of a drug is in balance with the elimination rate of the drug
steady state
larger than normal doses used when therapy is initiated with drugs that have very long half lives the purpose of loading dose is to quickly achieve a blood level of the drug that is in therapeutic range even though the drug has not reached steady state
loading dose
a drug or substance which kills bacteria or is capable of killing bacteria
bactericidial
a drug or substance that prevents growth of bacteria by keeping the microbes in the stationary phase of growth
bacteriostatic
the lowest concentration of an antimicrobial substance or drug that will inhibit the visible growth of a microorganism after overnight incubation
minimum inhibitory concentration MIC
range of activity of a drug
spectrum
interaction of two or more drugs such as the total effect is greater than the sum of the individual effects
synergism
occurs when a combo of two agents produces less effect than either agent alone
antagonism
parenteral route includes
injection
involving the oral route, drugs derived from protein sources may be inactivated by GI acidity or enzymes for example
insulin
orally delivered drugs must pass through hepatic portal stimulation termed
first pass effect or phase 1 reactions
example of p 450 induction
such as smoking, inducement increases enzymes activity and metabolizes drug more rapidly necessitating a larger drug dose for effect
the amount of drug available to produce systemic effect is reduced by
first pass effect
drugs with a high first pass effect have a greater oral to parenteral dose ratio
example morphine
they require a larger dose
what can decrease drug metabolism
impaired liver functioning
which phase is the absorption phase bypassed
intravascular
what is the most common sites for the intra muscular route
deltoid or gluteal
what is the route used to administer protein products
for example insulin and local anesthetics
subcutaneous
what route is a tuberculin skin test
sub route
topical route is contraindicted if surface is ulcerated burned or abraded
topical route
topical route is most effective when
less keritinized tissue
what may have a systemic uptake
topical
any prescription for a controlled substance requires a
dea number
both the — and the —- determine which substances are added or removed from each schedule
dea and fda
highest abuse potential
no accepted medical use
ex heroin, lsd
1
written prescription with providers sig only, no refills
examples codeine, oxycontin, fentanyl
2
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
3
same as 3 but less, examples include xanax soma valium ativan
4
least potential for abuse
can be purchased over the counter
5
ac
before meals
hs
bedtime
pc
after meals
prn
as needed
qd
everyday
qid
4 times a day
tid
3 times a day
ud
as directed
a NSAID
aspirin
what interferes with clotting contraindicted with coumadin (warfarin) due to drug interaction
aspirin and ibuprofen
reyes syndrome is linked to
aspirin
salicylism
aspirin toxicity
what medicine has a side effect of tinnitus (ringing in the ears)
asprin
mechanism of action, prostaglandin synthesis
ibuprofen
ibuprofen is available in suspension form for — uses an an antipyretic
pediatric
ibupforen can decrease the pharmacological effects of many drugs including
ace inhibitors, aspirin, beta blockers, corticosteroids cyclosporine lithium loop
when in doubt dont choose this an option due to the many contraindictions
NSAID
reversibly inhibits cyclooxygenase 1 and 2 cox 1 and cox 2 enzymes which results in decreased formation of prostaglandin precursors
naproxen (aleve)
side effects are possible increased risk of serious cardiovascular thrombotic events, myocardial infarction and stroke, prolongs bleeding time
naproxen (aleve)
taking an nsaid and phentyoin can increase phenytoin levels as a result people who take phenytoin should have a blood test to monitor the phenytoin level when starting or increasing the dose of an nsaid
true
—– has no anti-inflammatory action therefore is not considered an nsaid or effect on clotting
acetaminphen tyenol
drug of choice for patients on anticoagulants (coumadin) or with peptic ulcer disease
acetaminophen tyenol
side effects of —- include
hepatoxicity
liver necrosis
death
tyenol, RARE
blocks pain receptors in the brain without loss of consciousness
narcotic/opiod
Morphine, demerol, dilaudid, vicodin, and codeine are
narcotics / opiods
what is the most commonly used opiod in dentistry usually in conjuction with tyenol
codeine
sign of overdose with narcotics is
pinpoint pupils
codeine may lead to constipation
true
what is used to treat opiod overdose
naloxone
what medicine is only effective in cases of addiction to heroin, morphine, and other opiod drugs
methadone
rest and digest
stimulates salivary gland secretions
constricts bronchiolar diameter
parasympathetic autonomic nervous system
neuro transmitter is acetylcholine
parasym.
cholinergic agents are used to treat
xerostomia
urinary retention
glaucoma
examples of cholinergic drugs are
pilocarpine
nictonie
contraindictions include
asthmas, peptic ulcer, cardiac disease, gi urinary obstruction
cholingergic drugs
inhibits parasympathetic effects by blocking acetylcholine receptors
anticholinergic agents
prototype of anticholinergic drugs, used pre operatively to decrease salivary flow in the dental setting
atropine
helpful hint of the effects of anticholinergic agents
A= antichol. agents
b. blurred vision and bladder retention
c. constipation
d. dry mouth
fight or flight
acetylcholine and no repinephrine
dialation of bronchial tubes in the lungs and pupils in the eyes
decrease in saliva
sympathetic
adrenergic drug
bronchodilators
thrush can occur when a patient used
asthma inhaler
epinephrine**
dopamine
ephedrine
pseydoephedrine
vasopressers
what helps keep anesthetic in the area of administration
vasoconstriction
what is commonly used as a cardiac stimulator
epinephrine
used in tx of attention deficit hyperactivity disorders
ritalin/adderal
what is the only local anesthetic agent with vasoconstrictive properties
cocaine
what is contraindicted in a cocaine or methamphetamine abuser if the abuser has used in the last 24 hours
epinephrine
often suffered from rampant caries and burned mucosal surfaces
methamphetamine
the oral mucosal irritation from meth abuse is likely the results of
the method of drug administation not the drug itself
currently no meds are available to treat meth addiction or overdose the only avenue for addicts is cognitive behavioral interventions that help modify harmful actions and teach coping skills
true
adverse effects of ——- agents
CNS disturbances anxiety fear tension headache and tremor
cardiac arrythmias**
cereral hermorrhage
adrenergic agents
— should not be used in patients with angina, uncontrolled hypertension and uncontrolled hyperthyroidism
adrenergic drugs
how many types of beta receptors are they
3
which beta receptors are located in the heart primarily, eye and kidneys
b1
receptors are found in the lungs primarily, gastrointestinal tract, liver, uterus blood vessels and skeletal muscle
b2
receptors are located in fat cells
b3
—- primarily block —- by blocking the effects of norepinephrine and epinephrine, reduce heart rate. they may constrict air passages by stimulating the muscles that surround the air passages to contract, considered an adverse side effect
beta blockers, adrenergic blocking agents, or b blockers
what can manage a post heart attack (myocardial infarction, or generalized anxiety disorders
beta blockers
propranolol (hemangeol)
metoprolol (lopressor, toprol xl)
atenolol (tenormin)
beta
discovered the first natural anitbiotic, penicillin in 1928
alexandar fleming
what cannot fight viral infections
can either kill bacteria or slow its growth
side effects include diarrehea oral candidiasis and gi upset
anitbiotics
most commonly prescribed antibiotic in dentistry
penicillins
penicillin is safe for
pregnant women
pencillins are classfied as beta lactam antibiotics based upon the presence of beta lactam ring
true
what is preferred more Penicillin vk or penicillin g
VK because G is inactivated by gastric acids
as a beta lactam antibiotic, penicillins are not effective againsst penciliilinase which is an enzyme produced by penicillin resistant organsisms
true
combats primarily respiratory diseases examples erythromycin clarithromycin azithromycin
macrolides
what can be used for premed if a patient is allergic to penicillin
clarithromycin and azithromycin
is tetra bactericidal or static
static
tetra should be taken with
a full glass of water on an empty stomach, atleast 1-2 hours after meals, tetra cannot be taken with milk or other dairy products
tetra especially doxycycline concentrate in the
gingival crevicular fluid and have anti collagenase effect
effective against obligate anerobes only example metrondazole (flagyl) due to anabuse like reaction alcohol should be avoided
nitromidazoles
class of b lactam antibiotics 10 percent of patients allergic to penicillin are also allergic
cephalosporins
if a patient indicates they are taking isoniazid or rifampin only, they are likely taking the antibiotic as
preventive agent
in general for patients with prostehtic joint implants
prophy. antibitoics are not recommended prior to dental procedures
the current infective edocarditis heart disease the use of preventive antibiotics with
prosthetic cardiac valves history of infective endocarditis cardiac transplant unrepaired cynotic congenital heart disease residual shunts
suggested antibiotic regiment for dental prophylaxis
amoxicillin 2000 mg, 30 minutes to one hour prior to invasive proceudre
if a patient is allergic to penicillin and needs dental prophy..
cephalexin (keflex)(2000 mg one hour before)
clindamycin (600 mg one houro before)
azithromycin (500 mg one hour before)
clarithromycin (500 mg one hour before)
most frequently used in dentristy to tx fungal infections
nystatin
5 ml qid for 2 weeks
what is fuconazole (diflucan)
antifungal meds
systemic
mycelex (clotrimazole)
nizoral (ketoconazole)
patients with — allergies/ should not recieve an anesthetich with a vasoconstrictor
sulfite
asthmatic patients who are given local anesthetic agents with a vasoconstrictor and sulfite need to be watched for
signs of wheezing and chest tightness
inhibit the influx of sodium ions by competing with calcium for binding sites
local anesthetic agents
most commonly employed drugs in the dental office
local anesthetic decrease the rate of depolarization
and effects small —- first, and the large heavily — fibers last
myelinated
function is lost following administration of local anesthesia in this order
autonomic temp pain touch pressure vibration motor regain function in reverse order
used primarily topically benzocaine
ester
other examples pricaine novicain
propoxycaine ravocaine
tetracaine pontocaine
—- metabolized in the liver and — metabolized in the blood
ester
amide
lidocaine (xylocaine)
mepivacaine (carbocaine)
prolocaine (citanest
amide
lidocaine
2 percent with 1:100,000 epineprhine for medium duration
which amide is safe in pregnancy and during lactation
lidocaine
mrd for lidocaine is
300 mg
not available topically
available with vaso or plain
shorter duration than lidocaine
mrd is 300 mg
mepivicaine (carbocaine)
longer duration and lower epinephrine content (1:200,000) than lidocaine. Should not be used in patients with oxygenation problems
mrd is 400 mg
prilocaine *citanest, citanest forte
—- administration is contraindicted for patients with methemoglobinemia
prilocaine
longest duration
90 mg rmd
bupivicaine (marcaine)
used in 4 percent solution with epinephrine 1:100,000 concentarion. has longer duration than prilocaine and shorter duration than marcaine
mrd is 500 mg
articane (septocaine)
shortest duration is
mepivicaine
vasoconstrictors are added to anesthetics to
prolong anesthetic action
reduce anesthetic toxicity
delays absorption
decrease bleeding
what anesthetic agents are available without a vasoconstrictor
lidocaine
mepivicaine
citanest
what two will always contain a vaso
articane and bupivicane
max number of carpules containing 1:100,000 epinephrine allowed for a hypertensive patient
2
for asa 1 or 2 patients limit epinephrine to — per appt
.2mg
for asa 3 or 4 — is the max dose
.04
mrd for epi in a healthy patient:
3mg/pound up to max 500 mg
in a 2 percent anesthetic solution there is
36 mg of anesthetic
benzocaine is an
ester
— is a long acting barbiturate used in the tx of epilepsy
phenobarbitol
barbiurates has no analgesic effect
board alert
can be used for allaying apprehensions in fearful dental patients, most commonly used type of drug in the dental setting for this purpose
benzodipines example diazepam (valium) lorazepam ativan xanx alprazoloam tranxene
what reverses status epileptiucus and seiure associated with local anesthetic overdose
benzodiazepines
what works by raising pain threshold, has rapid onset and rapid recovery
nitrous oxide
must be in place for removal of nitrous oxide leaked into the environment
scavenger systems
contraindictions for ------- COPD URI includes stuffy nose emotional behavioral instability pregnancy first trimester cystic fibrosis **
oxygen sedation
nitrous oxide sedation maintains the patient in
stage 1 anesthesia
– can be effective in reducing the orofacial muscle tonus in cerebral palsy patients during dental treatment
nitrous oxide
long term recreational abuse of nitrous oxide can lead to
neurological symptoms similar to parkinsons
vitamin b 12 deficiency
used to treat mood disorders such as bipolar. a total of 1164 drugs are known to interact with this including acetaminophen and ipbuprofren
lithium
do not use epinephrine in patients taking
trycylic anti depressants
considered effective for treating depression that is resistant to other drugs. Although cyclic antidepressants can be effective some people find their side effects difficult to tolerate (including risk of suicide)
tricylic antidepressants
in addition to treating depression they are also used for treating parkinsons examples include rasagline (azilect) and seleginline (eldepryl, zelapar), buproprian (zyban)
MAOI’s
buproprian (zyban) was originally prescribed as an antidepresssant however in 1997, the fda approved zyban as the first medication to help
people stop smoking
although it is not clear exactly how buproprion works researchers do know that it blocks some of the chemicals in the brain that react with nicotine to increase the feel good component when a person smokes
true
controls parital seizures and generalized tonic clonic seuzures. side effect gingival enlargement on the anterior facial region generally, increased hair
phenytoin dilantin
first choice for parital generalized tonic clonic and mixed seizures, often used in the dental setting to treat trigeminal neuraligia
carbamazepine (tegretol)
effective in short term tx of all seizures. used often in the emergency room to stop a seizure parituclarly status epilepticus which can occur following local anestheisa overdoze
benzodipines
diazepam (valium) lorazepam (ativan) and clonazepam (klonopin
oldest epilepsy medicine still in use
used to treat most forms of seizures and is known for its effectiveness and low cost
phenobarbitol
treating type 2 diabetes with medications
meformin (glucophage)
Glyburide
long acting bronchodialotirs
salmeterol (serevent) and formoterol (foradill)
is an oral medication used to treat chronic asthma and in the bronchospasm associated with emphysema and chronic bronchitis, ertythromycin can increase serum levels of theophylline and toxicity may result
theophylline
what should be avoided in asthmatics
aspirin
what can cause insomnia
albuterol
rapidly alleviates an acute asthma attack when taken by inhalation but its rarely used as a bronchodialtor
isoproteerenol
produces dilation of the bronchioles and improves airway function, useful as a bronchodialtor in the tx of asthma and for reversal of bronchospasm
metaproterenol (alpunet)
most prevalant GI disease in the US
associated with failure of the lower esophageal sphincter to close properly which results in reflux of acid into the unprotected lining of the esophagus
GERD
an imbalaance between mucosal defenses, low bicarbonate secretion, and elevated acid as well as pepsin lvels in the stomach
peptic ulcer disease
the fining that —- —- infection may be associted with 80 to 90 percent of gastic ulcers was a milestone discovery in medicine. it is not associated with the developed of gerd though
helicobacter pylori
—- is an alkalinizing agent that reduces stomach acid, commonly used antacid to treat heartburn acid ingestion and upset stomach
sodium bicarbonate (baking soda)
people with heart failure on sodium restriction should avoid high sodium containing antacids
true
people with kidney failure tend to have problems with ecetrolyte balance and aluminum toxicity —- should be used with caution
antacids
most powerful meds available for treating gerd
ppis
omeprazole (Prilosec)
Iansoprazole (Prevacid)
rabeprazole (aciphex)
esomeprazole (nexium)
Proton pump inhibitor
the patient who lists tagamet on the health history is likely being treated for
gastric ulcers
what does not cause gingival bleeding
gastric ulcerations
erosion on the enamel on the lingual surfaces of the max anterior teeth are common in patients with
gast. reflux disease
most common medications prescribed for osteoporosis treatment
bisphosphanates
Alendronate (Fosamax)
biphosphonates
— use is associated with heightened risk of osttenecrosis of the jaw and impaired wound healing
bisphosphonate
acute myocardial infarction cannot be treated if it has been with in the last
3-6 months
Diuretics
b- adrenergic blocking agents
CCB
Ace inhibitors
anti hypertension meds
considered first line therapy for hypertension
works by promoting excretion of sodium and water which in turn decreases blood volume and pressure
diuretics
what is the most commonly used thiazide
hydrochlorothiazide
most common loop diruetic
furosemide (lasix)
used in the management of hypertensive patients with congestive heart failure
furosemide (lasix)
Propranolol
metaprolol
b adrenergic blocking agents
avoid using —- in patients taking a nonspecific beta blocker such as propanolol
epi
Gingival enlargement also occurs in
CCBS
Cardizem *dilitizaem
norvasc *amlodipine
verapamil *isoptin
Nifedipine *procardia
CCB common
— is lowered when these drugs block the conversion of angitension 1 to angiotension 2 causes vasodilation
blood pressure
whats a fairly common oral side effect to ACE inhibitors
dysgeusia *altered taste sensation
common ace inhibitors
Lisonorpil *prinivil, zestril
catopril *capoten
enalapril (vasotec)
decrease the effectiveness of ace inhibitors
NSAIDS
avoid —- — with ace inhibitors
postural hypotension
most common type of drug used in treatment of congestive heart failure
Digitalis glycosides
digoxin lanoxin is most commonly used
in combination with sympathomimetics (adrenergic agents) —- can lead to cariac arrythmias
digoxin
cautious with vaso for this reason!
what increases digoxin levels in ten percent of patients
tetra and ertyhromycin
drug of choice for acute angina
nitroglycerin
what acts as a smooth muscle relaxant
nitroglycerin
how is nitroglycerin generally given
sublingual to prevent angina attacts
most common anticoagulant
warfarin (coumadin)
the most serious drug interaction of warfarin is with
asprin (increases bleeding tendencies)
what prevents the conversion the inactive vitamin k to active form
anticoagulant
one of the most commonly employed anticoagulant agents in hopsitalized patients, given by injection only
heparin
often used to prevent blood clots after a recent heart attack or stroke in people with certian disorders of the heart or blood vessels
PLAVIS (clopidogrel) BOARD
class of drugs that lowers the level of cholesterol in the blood by reducing the production of cholesterol by the liver. Known as statin therapy
antihyperlipidemics
atorvastitin *lipitor
lovastatin *mevacor, altoprev
rosuvastatin *crestor
simvastatin *zocor
antihyperlipidemics
standard tx for hypothyroidism *hashimitos disease, involves daily use of the synthetic thyroid hormone —-
levothyroxine
thyroid meds restores adquate hormone levels — ,—
T3 T4
Hyperthyrodism
graves disease
dilantin phenytoin
ccb
cyclosporine
gingival overgrowth
anticougulatians, coumadin
aspirin
gingival bleeding
anaphylaxis
epi
adrenal crisis
hydrocortisone
chest pain
nitroglycerin
insulin shock hypoglycemia
oral carb/glucose
management of seizure status
diazepam valium
syncope
ammonia inhalent
opiod overdose
naloxone
most emergencies not hyperventilation or COPD
oxygen
-cyclovir
antiviral
- azepam
- azolam
benzodi.
- statin
lipid lowering drugs regylgates blood cholesterol
pril
ace
- sone
- lone
corticosteroids
-prazole
PPI
dilates pupils and bronchioles
sympathetic
constricts pupils and bronchioles
para
Which of the following local anesthetic agents may be useful in patients with hepatic dysfunction?
a. carbocaine
b. marcaine
c. xylocaine
d. articaine
d
Diruetics are used in the treatment of hypertension. Which of the following is an example of a loop diuretic?
a. furosemide
b. indapamide
c. chlorthalidone
d. hydrochlorothiazide
a
All of the following are drugs used to treat tb except one. What medicatin is the exception?
a. rifampin
b. isonizid
c. prednisone
d. ethambutol
c
nitroglycerin works by
a. decreasing blood pressure
b. relieving neural pain
c. increasing vasoconstriction
d. relaxing arterial smooth muscle
d
corticosteroid drugs are useful in treating many conditions such as autoimmune disorders, rashes, allergy, addisons disease and asthma. use of these steroidal meds can result in side effects such as
a. weight loss
b. hypertension
c. delayed wound healing
d. increased risk of infection
weight loss
All of the following medications affects bleeding times except one. Which drug is the exception?
a. aspirin
b. xarelto
c. coumadin
d. acetaminophen
d
Fosamex is often used as a medication to treat osteoporosis. What adverse oral side effect has been linked to fosamex use
jaw necrosis
nitrous oxide is eliminated via
exhalation
A patient presents for periodontal debridement in the upper left quad. Generalized erythema, edema, and bleeding on probing is noted in the area to be treated. What anesethetic considerataions should be anticipated?
a. increase dose of anesthethic agent
b. decreased need for vasoconstriction
c. avoidance of injectable anesthetic agents
d. use of nitrous oxide/oxygen is recommended
a
the primary site for drug metabolism is a. liver b. sweat c kidneys d. gingival crevicular fluid
liver
Your patient presents with peptic ulcer disease and is taking coumadin for stroke prevention. Which of the following analgelsic agents should you recommend following invasive procedures?
a. aspirin
b. ibuprofen
c. naproxen
d. acetaminophen
d
omeprazole is a medication primarily used in the tx of A. gerd b. hypertension c. muscle spasm d. high cholesterol
gerd
which of the following meds can cause gingival hyperplasia
nifidipine
how are latency and drug dose related
a. they are unrelated
b. drug dose increases with increased latency
c. latency is dependant on high dose infusion
d. the latent period varies inversely with dose
d
an abnormal drug responce that is usually genetically related is termed
a. ididosyncratic reaction
b. teratogenic responce
c. potency efficiacy reaction
d. type 2 hypersensitivity reaction
a
which route of drug administration is used to administer insulin
a. oral route
b. intravenous route
c. intramuscular route
d. sub route
d
antibiotic steroids are classified as
a. schedule 1 drug
b. schedule 2
c. 4
d. 3
d
