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DENT 319 - Pharmacology > Pharmacology of the Medically Compromised Patient > Flashcards

Pharmacology of the Medically Compromised Patient Flashcards

1
Q

Function of digoxin

A
  • Inhibits Na-K ATPase pump
  • Strengthens myocardial tone (increased myocardial contractility)
  • Enhances vagal tone, slows conduction through SA & AV nodes
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2
Q

3 indications for digoxin

A
  • Chronic atrial fibrillation
  • Certain other arrhythmias
  • Heart failure
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3
Q

3 drugs for which interactions with digoxin must be considered

A
  • Sympathomimetic amines
  • Itraconazole
  • Some antibiotics (macrolides and tetracycline in particular)
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4
Q

Interaction of digoxin with sympathomimetic amines

A

Increased risk of arrhythmias (additive)

NOTE: Use vasoconstrictor with caution –> may lead to cardiac excitation

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5
Q

Interaction of digoxin with itraconazole

A

Digitalis toxicity –> decreased clearance of digoxin

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6
Q

Interaction with digoxin with antibiotics (esp. macrolides and tetracycline)

A

Increased risk of digitalis toxicity –> altered intestinal flora (increases drug absorption in pts who inactivate digoxin by bacterial metabolism in lower intestine)

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7
Q

Dental consideration regarding increased vagal tone by digoxin

A

Exaggerated gag reflex

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8
Q

3 common calcium-channel blockers

A
  • Amlodipine besylate (Norvasc)
  • Diltiazem hydrochloride (Apo-diltiazem, Tiazec, Cardizem)
  • Nifedipine (Adalat XL)
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9
Q

Function of calcium-channel blockers

A
  • Inhibit calcium ion influx across cardiac and smooth muscle cells –> decreased myocardial contractility & O2 demand
  • Dilates coronary arteries and arterioles (relaxes vascular smooth muscle)
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10
Q

4 indications for calcium channel blockers

A
  • Exertional angina
  • Unstable angina
  • Coronary spasm
  • Hypertension
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11
Q

4 dental considerations for pts taking calcium-channel blockers

A
  • May cause gingival hyperplasia and dry mouth
  • May experience probs with postural hypotension
  • Use with azole antifungals or macrolide antibiotics may augment pharmacodynamic effects of Ca channel blockers due to inhibition of cytochrome P450 system –> increased plasma levels
  • Diltiazem = inhibits metabolism of benzodiazepines –> increased sedation
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12
Q

Function of Nitroglycerin

A
  • Reduces cardiac O2 demand by decreasing left ventricular end-diastolic pressure and systemic vascular resistance
  • Increases blood flow through collateral coronary vessels
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13
Q

2 indications for nitroglycerine

A
  • Prophylaxis against chronic anginal attacks
  • Treatment of acute anginal attacks
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14
Q

2 dental considerations regarding nitroglycerine

A
  • Patients may experience orthostatic hypotension (change positions slowly!)
  • Patients may complain of burning mouth with the use of sublingual tabs or spray
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15
Q

3 common selective Beta1-Adrenergic antagonists

A
  • Atenolol (Tenomin, Apo-Tenolol)
  • Metoprolol (Lopressor)
  • Bisoprolol (Apo-bisprolol)
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16
Q

Function of selective beta1-adrenergic antagonists

A
  • Decrease cardiac output, peripheral resistance & cardiac oxygen consumption
  • Depresses renin secretion
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17
Q

4 indications for selective beta1-adrenergic antagonist

A
  • Hypertension
  • Angina
  • Reduce mortality in patients with MI (metoprolol)
  • Some cardiac arrhythmias
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18
Q

4 dental considerations for selective beta1-adrenergic antagonists

A
  • Use with NSAID’s (generally if mroe than 5 days) decreases the anti-hypertensive effect of the drug
  • Orthostatic hypotension
  • Patients may complain of dry mouth and alterations in taste
  • Possible lichenois stomatitis
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19
Q

4 common ACE inhibitors

A
  • Ramipril (Altace)
  • Enalapril maleate (Vasotec)
  • Perindopril (Coversyl)
  • Lisinopril (Zestril, Apo-lisinopril)
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20
Q

Function of ACE inhibitor

A
  • Prevents conversion of angiotensin I to angiotensin II reducing peripheral arterial resistance
  • Inhibits degradation of bradykinins –> increased vasodilation
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21
Q

4 indications for ACE inhibitors

A
  • Hypertension
  • Sometimes used in the management of essential hypertension (alone or in combo with thiazide diuretic)
  • Treatment of symptomatic CHF
  • Diabetic nephropathy
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22
Q

Interaction of ACE inhibitors with concurrent NSAID and/or sympathomimetic use

A

Possible reduction of antihypertensive effect of the drug (i.e. reduced bioavailability)

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23
Q

6 possible symptoms/conditions to consider with ACE inhibitor use

A
  • Dry mouth
  • Loss of taste
  • Dry, persistent, tickling, non-productive cough
  • Possible oral angioedema (lips, tongue, mucous membrane)
  • Bone marrow depression may result in:
    • Neutropenia
    • Agranulocytosis
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24
Q

4 Angiotensin II-Receptor antagonists

A
  • Irbesartan (Avapro)
  • Telmisartan (Micardis)
  • Losartan (Cozaar)
  • Valsartan (Diovan)
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25
3 indications for angiotensin II-receptor antagonists
* Hypertension (alone or in combination) * CHF * Diabetic nephropathy
26
4 dental considerations for angiotensin II-receptor antagonists
* Concurrent use with NSAIDs (\>5 days) may diminish anti-hypertensive effects * Hypotension can occur in pts who may be volume depleted (i.e. very long dental surgical procedures) * Orthostatic hypotension * Dry mouth
27
4 statins
* Atorvastatin (Lipitor) * Rosuvastatin (Crestor) * Simvastatin (Zocor) * Pravastatin (Pravachol)
28
Function of statins
Inhibit HMG-Co reductase enzyme, and early step in cholesterol biosynthesis
29
2 indications for statins
* An adjunct to diet, in order to decrease LDL, total cholesterol and triglycerides * Adjunct to diet to increase HDL in pts with 1o hypercholesterolemia
30
2 dental considerations for pts taking statins
* With macrolides (esp erythromycin) or azole antifungals --\> increase statin serum levels with increase risk of myopathy OR * Rhabdomyolysis (inhibition of CYP450-3A4 enzyme system) * NOTE: Mild myopathy common
31
Function of ezetimibe (Apo-ezetemibe)
Cholesterol Absorption Inhibitor --\> selectively inhibits the intestinal absorption of cholesterol
32
2 indictions for ezetimibe use
* Used alone or in combo with a statin as an adjunct to diet in order to decrease LDL, total cholesterol and triglycerides * Adjunct to diet to increase HDL in pts with primary hypercholesterolemia
33
Dental considerations for ezetimibe
Myalgia and back pain
34
Function of furosemide (Lasix, Apo-Furosemide)
Loop diuretic --\> inhibits sodium & chloride resorption at the proximal and distal tubules & ascending loop of Henle
35
3 indications for furosemide
* Acute pulmonary edema * Peripheral edema in heart failure * Hypertension
36
6 dental considerations for pts taking furosemide
* Use of NSAIDs inibits diuretic response * Use with aminoglycosides may potentate the risk of ototoxicity * W/ corticosteroids may increase risk of hypokalemia * Orthostatic hypotension * dry mouth * Oral lichenoid reaction
37
Function of hydrochorothiazide (Apo-Hydro, Novo-Hydrazide)
Thiazide diuretic --\> increases Na and water excretion by inhibiting Na & Cl resorption in distal segment of nephron
38
2 indications for hydrochorothiazide
* Edema (CHF, renal failure) * Hypertension
39
4 dental considerations for pts taking hydrochorothiazide
* Use w/ NSAIDs may increase risk of renal failure (use w/ caution) * Use of corticosteroids may increase risk of hypokalemia * Orthostatic hypotension possible * Possible dry mouth
40
Function of warfarin
Anticoagulant; interferes with the synthesis of kitamni K-dependent clotting factors
41
2 indications for warfarin
* Prophylaxis and treatment of DVT & pulmonary embolism * Prevention & treatment of systemic embolism re: MI, atrial fib. prosthetic heart valve
42
Management of pts taking warfarin
Determine prothrombin time prior to invasive dental procedures (INR 2-3 safe)
43
Interaction of warfarin with acetaminophen
Increased anticoagulant effect (unknown mechanism) --\> use w/ caution & monitor status
44
Interaction of warfarin with azole antifungals, macrolides and metronidazole
Increased anticoagulant effect --\> avoid concurrent use
45
Interaction of warfarin with NSAIDs
Increased risk of gastric erosion and ulceration of gastric mucosa --\> avoid concurrent use
46
Function of clopidogrel (Plavix)
Anticoagulant --\> platelet aggregation inhibitor
47
3 indications for clopidogrel
* Secondary prevention of thromboembolic events in pts with recent MI, stroke, or peripheral vascular disease * Acute coronary syndrome * Prevention of stent thrombosis (with ASA)
48
Interaction of clopidogrel with azole antifungals
Inhibit conversion of the pro-drug to the active form of clopidogrel (CYP2C enzyme) --\> avoid concurrent use
49
Interaction of clopidogrel with NSAIDs
Potential risk of increased GI bleed --\> use with caution
50
Function of dabigatran (Pradaxa)
Anticoagulant --\> direct thrombin inhibitor
51
4 indications for dabigatran
* Decreased risk of stroke & systemic embolism in nonvalvular atrial fib * Treatment of DVT & pulmonary embolism, following parenteral anticoagulant therapy * Decreased risk of recurrence of DVT and PE * Prophylaxis of DVT & PE following hip replacement
52
Interaction of dabigatran with NSAIDs
Risk of bleeding may increase --\> avoid concurrent use if possible, otherwise use lower dose and monitor therapy
53
Interactino of dabigatran with azole antifungals
May increase serum concentration of dabigatran --\> avoid concurrent use
54
Interaction of dabigatran with clarithromycin
May increase serum concentration of dabigatran, use lower dose and monitor or avoid concurrent use if possible
55
Function of levothyroxine sodium (Synthroid)
* Thyroid hormone replacement * Stimulates metabolism of all body tissues by accelerating rate of cellular oxidation
56
Interaction of synthroid with sympathomimetics (i.e. epinephrine)
May lead to increased risk of coronary insufficiency (use with caution)
57
Danger of employing narcotic analgesics and sedatives to hypothyroid patient
Possible excessive respiratory depression
58
Function of metformin (Glucophage, Apo-metformin)
Biguanide derivative --\> decreases hepatic glucose production and intestinal absorption of glucose & improves insulin sensitivity by increased peripheral glucose uptake and utilization
59
Indication of metformin
Adjunct to diet to lower blood glucose level in patients with Type II non-insulin dependent diabetes
60
2 dental considerations for metformin users
* May produce unpleasant metallic taste * Certain drugs eliminated by renal tubular system (i.e. vancomycin) may compete with metformin --\> increased hypoglycemia
61
Function of glyburide (Diabeta, Euglucon)
Sulfonylurea --\> prob stimulates insulin release from pancreatic beta cells & reduces glucose output by the liver --\> increases peripheral sensitivity to insulin and causes mild diuretic effect
62
Indication for glyburide
Adjunct to diet to lower blood sugar in patients with Type II non-insulin diabetes
63
Drug interactions with glyburide
Hypoglycemia may be potentiated when given with fluconazole or NSAIDs
64
Function of repaglinide
Meglitinide --\> stimulates pancreas to excrete more insulin NOTE: similar to sulfonylurea, but faster acting and shorter duration
65
Indication for repaglinide
Adjunct to diet to lower blood sugar in patients with Type II non-insulin diabetes
66
Interaction of repaglinide with azole antifungals & clarithromycin
Increased risk of hypoglycemia --\> avoid concurrent use
67
Interaction of repaglinide with sympathomimetics (i.e. epinephrine)
May reduce hypoglycemic effect and lead to hyperglycemia --\> use with caution
68
Function of sitagliptin (Januvia)
Increases insulin synthesis and release
69
Indication for sitagliptin
Type II diabetes as an adjunct to diet and exercise
70
Drug often prescribed in combination with sitagliptin
Metformin
71
Dental considerations for sitagliptin users
Some reports of angioedema of face, lips, tongue, but no drug interactions of importance
72
Indication for saxaglyptin (Onglyza)
Type II diabetes as an adjunct to diet and exercise to improve glycemic control
73
Drug prescribed in conjuction with saxaglyptin
Metformin
74
4 side effects of saxaglyptin
* Hypoglycemia * Nausea & dyspepsia * Myalgia * Back pain
75
2 types of drugs to avoid use with saxaglyptin use
Metabolized by CYP3A4, so * Azole antifungals (esp. ketoconazole & itraconazole) --\> caution * Macrolide AB's
76
5 common antiulcer drugs
* Omeprazole (Losec) * Pantoprazole (Pantoloc) * Esomeprazole (Nexium) * Lansoprazole (Prevacid) * Rabeprazole (Pariet)
77
4 indications for PPIs
* Symptomatic GERD * Erosive esophagitis * Short term treatment of duodenal ulcers & benign gastric ulcers * H. pylori infection (with clarithromycin)
78
Interaction of PPIs with NSAIDs
Use with caution -- may exacerbate GERD or PUD
79
Interaction of PPIs with ketoconazole and itraconazole
Decreased bioavailability of ketoconazole and itraconazole due to need for low gastric pH for optimal absorption (avoid concurrent use)
80
Function of salbutamol sulfate (Ventolin)
Relaxes bronchial smooth muscle by stimulating Beta 2 receptors
81
2 indications for salbutamol sulfate
* Prevention and treatment of bronchospasm (reversible obstructive airway disease) * Prevention of exercise-induced bronchospasm
82
3 oral side effects of salbutamol sulfate
* Dry, irritated throat * Hoarse voice * May cause bad taste
83
2 indications for fluticasone propionate (Flonase, Flovent Diskus)
* Maintenance treatment of asthma (prophylactic) * Management of nasal symptoms of seasonal allergies in adults
84
3 oral side effects of fluticasone propionate
* Pharyngitis * Throat irritation * Oral candidiasis
85
Interaction of fluticasone propionate with azole antifungals
CYP3A4 inhibitors --\> increase plasma levels of fluticasone (caution)
86
Function of montelukast (Singulair)
Leukotriene receptor antagonist
87
2 indications for montelukast
* Maintenance treatment of asthma (prophylactic) * Management of nasal symptoms of seasonal allergies in adults
88
3 adverse effects of montelukast
* Headache * Dry throat * Dental pain
89
Interaction of montelukast with azole antifungals
CYP3A4 inhibitors --\> increase plasma levels of fluticasone (caution)
90
Function of alendronate sodium (Fosamax) and risedronate sodium (Actonel)
* Bisphosphanates --\> specific inhibitors of osteoclast-mediated bone resorption * Increases bone density (alendronate)
91
3 indications for Fosamax and Actonel
Treatment/prevention of: * Post-menopausal osteoporosis in women * Osteoporosis in men to prevent incidence of fractures * Paget's disease of the bone in men and women
92
3 adverse effects of fosamax and actonel
* Perverse alteration of taste (for some) * Very irritating to GIT (caution with NSAIDs) * Risk of osteonecrosis of the jaw reported
93
Function of tamsulosin (Flomax)
Peripherally acting anti-adrenergic, causing relaxation of prostate smooth muscle --\> increased urinary flow rate and a reduction of symptoms of BPH
94
Indication for tamsulosin
Treatment of signs and symptoms of benign prostatic hyperplasia
95
3 dental considerations for tamsulosin
* Possible cough or sinusitis * Headache and dizziness relatively common * Possible back pain --\> alterating dental chair position NOTE: no known drug-drug interactions
96
Function of amitriptyline hydrochloride (Elavil)
Tricyclic antidepressant; non-selective monoamine reuptake inhibitor
97
3 indications for Elavil
* Management of depression * Depressive state of bipolar disorder * Management of chronic, non-malignant pain
98
5 dental considerations for Elavil
* Significant sedative properties (additive CNS depression w/ other CNS depressants) * May potentiate cardiovascular effects of sympathomimetics --\> possible cardiac arrhythmias * Orthostatic hypotension * Xerostomia * Rarely: black tongue, bitter taste, sublingual adenitis, stomatitis
99
Function of MAOI's (monoamine oxidase inhibitors)
Promotion of accumulation of neurotransmitters through inhibition of MAO enzyme system
100
Indication for MAOI's
Severe depressions with close follow-up
101
2 important drug interactions of MAOI's
* Potentiation of sympathomimetics --\> hypertensive crisis (avoid) * Opioids = increased CNS depression --\> possible coma & convulsions
102
2 side effects of MAOI's
* Orthostatic hypotension * Xerostomia
103
4 SSRI's
* Fluoxetine HCl (Prozac) * Paroxetine HCl (Paxil) * Sertraline (Zoloft) * Citalopram HCl (Celexa)/escitalopram
104
4 indications for Prozac
* Various forms of depression * OCD * Bulemia & anorexia * Occasionally panic disorders
105
Important drug interactions with Prozac
Additive CNS depression w/ concurrent use of opioids and sedative-hypnotics
106
2 side effects of Prozac
* Abnormal taste * Xerostomia
107
3 indications for Paxil
* Various forms of depression * Panic disorders * Social anxiety
108
3 side effects of Paxil
* Aphthous stomatitis * Glossitis * Orthostatic hypotension
109
2 indications for Zoloft
* Various forms of depression * OCD
110
Interaction of Zoloft with NSAID's
Increased risk of abnormal platelet aggregation (caution)
111
Interaction of Zoloft with Tramadol
Possible increased risk of serotonergic syndrome (avoid)
112
Interaction of Zoloft with opioids, macrolides and azole antifungals
May increase risk of QTc prolongation and torsade de points
113
3 side effects of Zoloft
* Xerostomia * Taste perversions * Myalgia
114
2 indications for celexa
* Depression occurring post-CVA * Alleviation of disturbances in elderly with dementia disorders
115
Interaction of Celex with azole antifungals or erythromycin
May increase blood levels of citaprolam
116
3 SSNRIs
* Venlafaxine (Effexor) * Duloxetine (Cymbalta) * Bupripion HCl (Wellbutrin)
117
3 indications for Effexor
* Major depressive illness * Refractory depression * Generalized anxiety disorder
118
Interaction of Effexor with other CNS depressants
Increased sedation (not recommended)
119
3 possible side effects of Effexor
* Taste disturbances * Stomatitis * Candidiasis
120
4 indications for Cymbalta
* Major depression * GAD * Diabetic peripheral neuropathic pain * Fibromyalgia
121
2 adverse effects of Cymbalta
* Xerostomia * Nausea * NOTE: No important drug-drug interactions of interest to dentistry
122
Function of bupropion HCl (Wellbutrin) and decreases neuronal uptake of serotonin and norepinephrine
Dopamine reuptake blocking compound
123
3 indications for Wellbutrin
* SAD * ADHD * Aid to smoking cessation (Zyban)
124
3 dental considerations for Wellbutrin
* Xerostomia * Taste disturbances * Withdrawal of benzodiazepines may increase risk of seizures (caution)
125
3 antipsychotics
* Quetiapine fumarate (Seroquel) * Risperidone (Risperdal) * Olanzapine (Zyprexa)
126
Side effect of olanzapine
Xerostomia
127
Drug interactions with lithium carbonate (Carbolith)
* NSAID's = Increased plasma lithium --\> possible toxicity (avoid) * Erythromycin and metronidazole = risk lithium toxicity
128
2 side effects of lithium carbonate
* Taste disturbances * Lichenoid eruptions orally
129
FUnction of pregabalin (Lyrica)
Antiepileptic
130
4 indications for pregabalin
Management of: * Neuropathic pain * Postherpetic neuralgia * Fibromyalgia * Partial onset seizures
131
3 adverse effects of lyrica
* Dizziness * Somnolence * Dry mouth
132
2 drug interactions with Lyrica
Additive effects with oxycodone, lorazepam

DENT 319 - Pharmacology (7 decks)

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