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3rd Year BDS > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

What is the definition of pharmacology?

A

The study of the way living systems are affected by chemical agents

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2
Q

What is the definition of a drug?

A

Any chemical agent that affects a biological system

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3
Q

What is the definition of a receptor?

A

A protein that has a specific binding site to a ligand

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4
Q

Explain how the dose response curve work?

A

More dose = greater response
But once all receptors are occupied, the response plateaus
Log graph has sigmoid curve

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5
Q

What is the definition of EC50?

A

The dose needed to create a 50% response from the system

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6
Q

If a drug has a higher affinity to the receptor, how does the EC50 change?

A

It shifts to the left

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7
Q

What is the definition of affinity?

A

Determined the strength of chemical attraction between the drug and receptor
A lower EC50 indicates a higher affinity

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8
Q

What is the definition of efficacy?

A

Determined by how good the drug is at activating the receptor?

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9
Q

What responses can occur from ligand binding?

A

Full response
Partial response
No response

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10
Q

What is the affinity and efficacy for a full agonist?

A

High affinity and high efficacy

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11
Q

What is the affinity and efficacy for a partial agonist?q

A

High affinity and lower efficacy

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12
Q

What is the affinity and efficacy for an antagonist?

A

High affinity and no efficacy

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13
Q

What is the definition of an agonist?

A

Mimic normal effect of receptor

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14
Q

What is the definition of an antagonist?

A

Block normal effect of receptor

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15
Q

Explain why the dose response curve shifts to the right with added antagonist?

A

The antagonist completes for the binding site, and so more agonist is needed to activate the desired response

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16
Q

What are the enteral routes for a drug?

A

Oral

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17
Q

What are the parenteral routes for a drug?

A 
IV
IM
Subcutaneous
Transdermal
Inhalation
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18
Q

What are the advantages and disadvantages for oral administration?

A 
Adv
- socially acceptable
Dis:
- slow onset
- variable absorption
- gastric acid may destroy drug
- first-pass metabolism
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19
Q

Explain First Pass metabolism?

A

All blood from the GI drains to the hepatic portal vein
Hepatic portal vein drains to the liver
Drugs only reach systemic circulation after passing through the liver

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20
Q

What are the advantages and disadvantages for non-oral drug administration?

A 
Adv:
- predictable plasma levels
- no first pass metabolism
Dis:
- allergic reactions more severe
- access difficulties
- higher cost
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21
Q

What is a solution to first pass metabolism?

A

Higher dose

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22
Q

Name the 5 factors which affect oral absorption?

A 
Lipid solubility and ionisation
Drug formulation
GI mobility
Interactions with other substances in the gut
GU tract disease
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23
Q

What is the definition of bioavaliability?

A

Proportion of an ingested drug that is available for clinical effect

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24
Q

What can alter a drug’s bioavailability?

A

Dosage form
Destruction in the gut
Poor absorption
First pass metabolism

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25
Q

What is the definition of volume of distribution?

A

How much of the body the drug is diluted in

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26
Q

Name the 2 forms of drug transport binding?

A

Lipid

Plasma proteins

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27
Q

What are the phase I reactions for drug metabolism?

A

Oxidation, reduction and hydrolysis

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28
Q

What are the phase II reactions for drug metabolism?

A

Glucuronidation, sulphation, methylation, acetylation and glutathione

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29
Q

Name the 5 forms of drug excretion?

A 
Urine
Bile
Exhalation
Sweat 
Saliva
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30
Q

How can disease affect drug metabolism?

A

Reduced ability to metabolism, higher concentration, need lower dose

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31
Q

Name the 2 pathways for drug metabolism?

A

Zero-order kinetics

First-order kinetics

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32
Q

What is the definition of zero-order kinetics?

A

Removal of a fixed amount over a specific amount of time

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33
Q

What is the definition of first-order kinetics?

A

Drug eliminated in proportion to its concentration in the body

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34
Q

What can dosing too frequently cause?

A

Toxicity, depending on drug’s therapeutic index

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35
Q

What can dosing too infrequently cause?

A

Sub-therapeutic plasma levels, giving no clinical effect

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36
Q

Name 4 examples of possible side effects for all medications?

A

Allergy
Anaphylaxis
Drug-drug interactions
Acute toxic reactions

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37
Q

What is the definition of drug-drug interactions?

A

One drug interferes with the absorption, action or metabolism of another

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38
Q

What can occur from an acute toxic reaction?

A

Bone marrow suppression
Hepatotoxicity
Biliary stasis
Acute nephrotoxicity

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39
Q

What must a full prescription contain? MUST BE CLEAR

A 
Name, address and age
DoB or CHI number
Number of treatment days
The drug
Drug formulation and dose
Instructions on quantity to be dispensed
Instructions for the patient
Signed
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40
Q

How long are prescriptions available?

A

6 months

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41
Q

How many dispensing occasions can be present?

A

Many

Time saver

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42
Q

What to avoid when writing a prescription?

A

Abbreviations

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43
Q

What is some specific advice to give to patient after prescribing a drug?

A

Take drugs at correct time and finish the course
Not feeling well - STOP
Side effects should be discussed/interactions
Keep medicines away from children

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44
Q

What to consider about the patient’s medical history before prescribing a drug?

A

Current medical issues
Chronic medical issues
Current medication list
Previous adverse reactions

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45
Q

What is the definition of polypharmacy?

A

Where 4 or more drugs are prescribed for the patient

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46
Q

What drug interactions does Warfarin have?

A

ALL drugs possible Systemic antifungals and miconazole
Erythromycin, metronidazole and amoxycillin
ALL NSAIDs

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47
Q

What drug interactions do statins have?

A

Systemic antifungals

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48
Q

What are the 5 main drug categories a dentist can prescribe?

A 
Antibiotics
Antifungal
Antiviral
Analgesics
Hypnotics
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49
Q

Name 2 topical antifungals?

A

Nystatin

Miconazole

50
Q

Name 2 systemic antifungals?

A

Fluconazole

Itraconazole

51
Q

What is the formulation for nystatin?

A

Suspension

Ointment

52
Q

What is the formulation for miconazole?

A

Gel
Buccal adhesive tablet
Cream and ointment (+hydrocortisone)

53
Q

what is the formulation for fluconazole and itraconazole?

A

Capsule

Suspension

54
Q

Name 2 antivirals?

A

Aciclovir

Peniciclovir

55
Q

WHat is the formulation for aciclovir?

A

Topical cream

Systemic

56
Q

What are the indications for aciclovir?

A

HSV or Zoster (herpes)

Prophylactically (herpes)

57
Q

What is the formulation for penciclovir?

A

Cream

58
Q

Name 5 analgesics a dentist can prescribe?

A 
Paracetamol
Aspirin
Co Codamol (can't prescribe)
Ibuprofen
Diclofenac
59
Q

What is the function of paracetamol?

A

Antipyretic and analgesic
Little anti-inflamm properties
Few sides
Combined with codeine

60
Q

Name 3 COX I inhibitors? ad their deriv?

A

Aspirin - salicylates
Ibuprofen - propionic acid deriv
Diclofenac - phenylacetic acid deriv

61
Q

When to avoid aspirin?

A

In children

62
Q

Dosage for ibuprofen?

A

200-600 three times daily, depending on situation

63
Q

What is the function of diclofenac? and its dose?

A

More effective anti-inflammatory

50mg 3 times a day

64
Q

Name 4 types of anxiolytics?

A

Diazepam*
Temazepam
Nitrazepam
Promethazine

65
Q

Name 2 topical antiseptics?

A

Chlorhexidine

H202

66
Q

Name 2 topical analgesics?

A

Benzamine spray or m/w

Lidocaine spray/ointment

67
Q

Name 4 topical immunomodulators?

A

Beclomethasone inhaler
betamethasone risne
Hydrocortisone pellets
Doxycycline dispersible tablets

68
Q

Indications for oral soft tissue infection?

A

Topical antiseptic

Topical analgesic

69
Q

Indications for oral mucosal ulceration?

A

Topical immunomodulator

Topical analgesic

70
Q

Treatment for dry mouth?

A

Saliva orthana (spray or lozenge)
Salivix pastilles
Saliva stimulating tablets

71
Q

Secondary treatments for dry mouth

A

Higher Fl toothpaste

High caries watch

72
Q

What alternative to antibiotics can a dentist do for an abscess

A

Drainage

73
Q

Name the 5 most common antibiotics prescribed?

A 
Penicillin
Amoxycillin
Erythromycin
Doxycycline
Metronidazole
74
Q

What is the definition of an adverse drug reaction?

A

An unwanted or harmful reaction which occurs after admin of a drug or drugs and is suspected or known to be due to the drugs

75
Q

How do ADR affect the NHS?

A

5% GP consultations
10-20% of hospital in-patients
7% of all hospital admissions

76
Q

Name the 4 most common ADR drugs?

A

Aspirin
Diuretics
Warfarin
NSAIDs

77
Q

How much do ADRs cost to the NHS?

A

£466 million

78
Q

Name the 2 main types of ADRs?

A

Augmented

Bizarre

79
Q

What is the definition of an augmented ADR?

A 
Predictable from the known pharmacology of the drug:
- exagg of intended effect
- unrelated to intended therapeutic effect
E.g.
- hypo with antihyper
- dehydrated with diuretics
- hyponat with thiazides
- breathless with beta-block
80
Q

Name 2 factors which increases the risk for augmented ADRs?

A 
Drug concentration
Patient factors (hepatic enzymes)
81
Q

Name 3 ways in which to deal with augmented ADRs?

A

Reduce dose
Try an alternative agent
Treat ADR

82
Q

Name 3 drugs that cause liver impairment via augmented ADRs

A

NSAIDs
Warfarin
Metformin

83
Q

Name 2 drugs that cause heart failure via augmented ADRs

A

NSAIDs

Glitazone

84
Q

Name 3 drugs that cause frailty via augmented ADRs

A

NSAIDs
Sedatives
Antichol

85
Q

Name 3 drugs that cause dehydration via augmented ADRs

A

NSAIDs
ACE/ARBs
Diuretics

86
Q

Name 6 drugs that cause renal impairment via augmented ADRs

A 
NSAIDs
ACE/ARBs
Metformin
Digoxin
Antibiotics
Opiates
87
Q

What is the definition of a bizarre ADR?

A

Not dose related and are not predictable from the pharmacological action of the drug. They are mostly due to specific immune or genetic factors of the patient and therefore cannot be predicted

88
Q

Give 1 example of a bizarre ADR?

A

Penicillin allergy;

  • some sulphonylureas and acute intermittent porphyria in susceptible people
  • Steven-Johnson syndrome with a number of drugs.
89
Q

Name 2 forms of management for bizarre ADRs?

A

Stop causative agent

Deal with the ADR

90
Q

Name the 3 secondary types of ADRs?

A

Chronic
Delayed
End of use

91
Q

What is the definition of a chronic ADR?

A

Predictable from known pharmacology:

- require prolonged period of exposure to develop

92
Q

Give 2 examples of chronic ADRs?

A

Osteonecrosis from bisphosphonates

Osteoporosis from high dose steroids

93
Q

What are the 2 forms of management for chronic ADRs?

A

Use prophylaxis

Monitoring patients

94
Q

What is the definition of a delayed ADR?

A

Effects do not arise until a prolonged period after exposure possible even after drug has been withdrawn

95
Q

Give 1 example of a delayed ADR?

A

Chemo:

- increased risk of lymphomas

96
Q

What is the definition of an end of use ADR?

A

Effects seen on medicines withdrawal also known as withdrawal reactions

97
Q

Give 3 examples of end of use ADRs?

A

Opiates
SSRI
Beta blockers

98
Q

What is the definition of pharmacovigilance?

A

Process involving detection, assessment, understanding and prevention of ADRs
Provides continual assessment of the risk and benefits for each drug resulting in the best drug therapy for the patient

99
Q

Give 1 example of a pharmacovigilance system in the UK?

A

Yellow card

100
Q

What information does the Yellow Card system works?

A

The Scheme collects information on suspected problems or incidents involving:

  • side effects (also known as adverse drug reactions or ADRs);
  • medical device adverse incidents;
  • defective medicines (those that are not of an acceptable quality);
  • counterfeit or fake medicines or medical devices;
  • safety concerns, e.g. for e-cigarettes or their refill containers (e-liquids).
101
Q

How does the Yellow Card system work in the UK?

A

Voluntary scheme
Both healthcare
professionals and members of the public can file a yellow card report.
Healthcare professionals should report all suspected adverse reactions to:
- new drug and vaccines on market and black triangle drug
- children (Mostly off license)
- Serious ADRs for established drugs and vaccines, e.g. anaphylaxis, events that have led to significant harm, those which are fatal.

102
Q

Name the 3 essential pieces of information included in a Yellow Card report?

A

Side effect
Info about person
Name of medicine
Name and full address

103
Q

What is the definition of a drug interaction?

A

Effects of a drug are changed by the co-admin of another drug

104
Q

Name the 3 mechanisms that cause drugs to interact?

A

Pharmaceutical interactions
Pharmacodynamic interactions
Pharmacokinetic interactions

105
Q

What is the definition of a pharmaceutical drug interaction?

A

Chemical reaction between drugs prior to admin of dru
Drugs are mixed inappropriately in syringes if infusion fluids before admin
(Phenytoin and glucose)

106
Q

What is the definition of a pharmacodynamic drug interaction?

A

Drug B increases/decreases the effect of Drug A without affecting the concentration of Drug A at its site of action

107
Q

What are the risk factors which cause pharmacodynamic drug interactions?

A

Acting on same receptor system
Acting at different receptor in same physiological system
Synergistics effects
Antagonists

108
Q

What is the definition of a pharmacokinetic drug interaction?

A

Occurs when one drugs affects the absorption distribution, metabolism and excretion of another
Drug B increases/decreases the effect of Drug A by changing Drug A’s concentration at its site of action

109
Q

Name the 4 stages at which pharmacokinetic interactions can occur?

A

Absorption
Distribution
Metabolism
Excretion

110
Q

Describe how absorption of a drug can be affected?

A

Change in pH
Chelation
Motility
(Occur in SI)

111
Q

Describe how distribution of a drug can be affected by another drug?

A

Carried in plasma attached to proteins (albumin)
Active from of drug not protein bound
If drug A displaces drug B from the carrier protein then there is an increase in the active form drug B

Amiodarone displaces digoxin and can lead to toxicity

112
Q

Describe how metabolism of a drug can be affected by another drug?

A

Drug A induces/inhibits the enzyme that metabolises Drug B

Warfarin meta inhibited by amiodarone, leading to an increased effect from Warfarin

113
Q

What is the definition of P450?

A

Microsomal enzyme found in Liver and Gut
3A4 accounts for 50% of drug metabolism
Also 2D6 important

114
Q

Name 9 inhibitors of P450?

A 
Omeprazole
Disulfiram
Erythromycin
Valproate
Isoniazid
Ciprofloxacin and Cimetidine
Ethanol (acutely)
Sulphonamides
Grapefruit juice
115
Q

Name 6 inducers of P450?

A 
Alcohol (chronic use)
Barbiturates
Carbamazepine
Phenytoin
Rifampicin
Sulphonylureas
116
Q

Name 4 drugs that are excreted in their active form via the kidneys?

A

Methotrexate – NSAIDs increase the risk of methotrexate toxicity because of competition for renal tubular excretion.
Lithium
Digoxin
Gentamicin – can reduce GFR (especially if through levels are elevated), leading to its accumulation as well as a number of other drugs that depend on renal excretion.

117
Q

How to avoid drug interactions?

A

Most serious DDIs related to common prescribed drugs are predictable – combination of awareness and use of good reference resources helps when prescribing.
Polypharmacy – major cause of increased risk for DDIs. Prescribers must take responsibility for assessing the risks for individual patients.
Medicines reconciliation, review and de-prescribing can further reduce the risks.
Comprehensive drug histories are vital
Reporting of all ADRs suspected of being related to a DDI

118
Q

Should you omit Vit K antagonist before extraction?

A

Check INR, ideally no more than 24 hrs before procedure (up to 72 hrs if patient well anticoagulated). If INR is below 4:
Treat without interrupting medication

119
Q

Should you omit antiplatelet drugs before extraction?

A

Aspirin alone:
- treat without interrupting medication (use haemostatic measures)
Clopidogrel/dipyridamole or ticagrelor + aspirin:
- treat without interrupting medication (suturing and packing)

120
Q

Should you omit NOACs before extraction

A

Low bleeding risk:
- treat without interrupting medication
Higher bleeding risk:
- advise to miss/delay morning dose (suture and pack)

121
Q

What is the schedule change for apixaban/dabigatran before high bleeding risk procedure?

A

Miss morning dose

Then continue as normal

122
Q

What is the schedule change for rivaroxaban before high bleeding risk procedure?

A

Delay morning dose:

- take post-treatment dose after 4 hours after haemostasis achieved

3rd Year BDS (21 decks)

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