Pharmacology V Flashcards
Antianxiety Medications are also known by what 2 other names?
Sedative hyponotics
Minor tranquilizers
What class of drugs, among the most widely used in medicine, is diazepam (Valium) a part of?
Benzodoazepines
Valium
diazepam
T/F
All benzodiazepines have the same basic structure of 2 nitrogens (diazo) and a benzene ring that binds GABA receptors
True
Name 4 Benzodiazepines used in Dentistry for pre-op anxiety:
diazepam (Valium)
lorazepam (Ativan)
alprazolam (Xanax)
midazolam (Versed)
Benzodiazepines are Schedule _____ opiates in the US, are highly addictive and also exhibit _______.
IV/V
Tolerance
Name 3 distinct effects of Benzodiazepines:
Effects on behavior
Anticonvulsant effects
Muscle relaxation
Benzodiazepines have ________ effects at low doses and ________ at high doses.
Anxiety reduction
Drowsiness/depression
Anesthetic-induced seizures in dentistry can be prevented by and arrested by what 2 Anticonvulsants?
diazepam (Valium)
midazolam (Versed)
What are the 2 most potent Benzodiazepines?
diazepam (Valium)
chlordiazepoxide (Librium)
Aside from depressing motor nerve and muscle function in healthy pts and ones with skeletal muscle disorders, Benzodiazepines are predatory drugs that cause _______.
Anterograde Amnesia
Describe the mechanism of the Benzodiazepines.
3 things
Enhances inhibitory effect of GABA on neuronal excitability
Causes hyperpolarization (less excitable state)
Neuronal stabilization
What does GABA do to the brain?
Inhibitory
Decreases Excitation
At the level of the synapse, the GABA receptor binds both ______ and ______.
GABA
Benzodiazepines
What can enhance the binding effect of Benzodiazepines at the synapse?
Presence of GABA
*binding is rapid, reversible, stereospecific, and saturable
Most Benzodiazepines have very long _______ and are metabolized in the ______ compounds
half lives
active
Due to the fact the drug is metabolized rapidly to inactive compounds, what Benzodiazepine is a very good choice for Dentistry?
lorazepam (Ativan)
*No significant accumulation of drug do to rapid metabolization
What Benzodiazepine has the shortest half life of the Oral meds and has increased psychomotor impairment and risk of oversedation in the elderly?
triazolam (Halcion)
Name 5 uses of Benzodiazepines in Medicine:
Anxiety relief
Muscle relaxant
Insomnia
Alcohol withdrawal
Pre-op med
What are 3 used of Benzodiazepines in Dentistry:
Pre-op med (for anxiety)
IV sedation (and amnesia)
Emergency intervention for seizures
Name 4 adverse side affects of Benzodiazepines:
CNS depression
Xerostomia
Abuse/addiction
Additive with other CNS depressants (alcohol)
T/F
Parenteral administration of Benzodiazepines causes acute hypotension, muscle weakness, apnea, and can cause cardiac arrest
True
When using Benzodiazepines in conjunction with Opiates, how much should the normal dose of the Opiate be reduced?
1/3
What DDI is most dangerous with Benzodiazepines, resulting in significant Respiratory Depression?
Alcohol
*must be avoided
Why must alcohol be avoided for days after taking a dose of Benzodiazepine?
long half lives
What is the 1/2 life of Valium?
active metabolite of desmethyldiazepam?
20-50 hrs
50-100 hrs
*why EtOH must be avoided
What is the antidote for Benzodiazepine Overdose?
*this antidote will not block CNS effects from other drugs
Flumazenil
Flumazenil (antidote for Benzodiazepine overdose) may not reverse ________.
It may cause _______ as a side effect.
Respiratory depression
seizures
Name a “miscellaneous Anti-anxiety Agent” used to manage generalized anxiety disorder (no known mechanism)
buspirone (BuSpar)
buspirone (BuSpar) causes many DDI’s in dentistry (antibiotics, antifungals) that will increase its concentration and is considered a ________ in dentistry
Red Flag Drug
Antidepressants and Anti-anxiety meds cause ________, which is particular interest in dentistry
Xerostomia
Throwback: SSRI’s cause what to the teeth?
Bruxism
Major Tranquilizers are known as ________ medications and the older term is ________ drugs.
Antipsychotic
Neuroleptic
Name 2 indications for the use of a Major Tranquilizer:
Psychotic disorders (pchizophrenia, paranoia)
Demetia
What is a side effect to Major Tranquilizers?
Severe nausea and vomiting
Major Tranquilizers act as _______ to a swath of neurotransmission
(dopaminergic, alpha 1 and 2 adrenergic, srotonergic, muscarinic, H1 histamine, sigma opioid)
Antagonists
T/F
The primary mechanistic action of Major Tranquilizers is the blockage of dopaminergic transmission
True
*one hypothesis is that Schizophrenia is caused by an overactivity of the dopaminergic system
The blockage of Dopamine by Major Tranquilizers has what 3 important effects?
Antipsychotic
Extrapyramidal side effects
Antiemetic (anti-vomit)
Antipsychotic medications reduce Dopaminergic activity by blocking _____ receptors
D2
T/F
All Major Tranquilizers are strong D2 dopamine receptor agonists with one exception - clozapine (Clozaril)
False
Antagonists
If the receptors are blocked within 2-4 hours after Major Tranquilizers are administered, what is then the problem with the Dopaminergic Hypothesis?
Aside from this, schizophrenia is also associated with alterations in neural structure in the limbic system and the ______.
Therapeutic activity takes weeks for full effect
Prefrontal cortex
The new thought is that Major Tranquilizers, instead of acting to alleviate schizophrenia by turning down dopamine, helps to recover normal cell ________.
Morphology
T/F
All Major Tranquilizers have similar pharmokinetics and Efficacy
True
1/2 life = 18-40 hrs, once daily dosing
Name 5 Extrapyramidal side effect of Antipsychotic Drugs:
Parkinsonism (akinesia - difficult initiating movement)
Akathisia (restless leg)
Dystonia (sustained muscle contraction)
Tardive Dyskinesia (abnormal face/tongue movements)
Sedation
_________ drugs can treat most Extrapyramidal side effects of Antipsychotic Drugs
Anticholinergic
The Sedation side effect of Antipsychotic Drugs manifests itself how (as a result of histamine, cholinergic, and adrenergic blockage)
Autonomic Side Effects
Antipsychotics potentiate (exacerbate) the ________ caused by opioids.
***potentiate CNS effects of all analgesics
Respiratory Depression
Name 3 Dental considerations with Antipsychotics?
Hematologic (WBC count may be low)
Heart (arrhythmias - caution with epi)
Extrapyramidal (movement)
An episode of neurologic dysfunction, often accompanied by motor activity such as convulsions, and emotional/sensory change
*may contain visual, auditory, and olfactory hallucinations
Seizure
The majority of patients suffering from seizures have _______ epilepsy.
Idiopathic
*no known cause
Drugs improve epilepsy in __-__% of cases
70-80%
What are 2 broad groups of epilepsy?
Partial
Generalized
What are the 2 subtypes of Partial Epilepsy
Briefly describe them:
Simple Partial - Single group hyperactive neurons. Few seconds, no loss of consciousness, often single limb/muscle group abnormal
Complex Partial - Hallucinations, Mental distortion, AURA (lasting 3-5 minutes). Full consciousness slow to return
In a Complex Partial Seizure, the Aura lasts for _____ minutes.
They are also known as ________ seizures
_____% of people with complex partial epilepsy experience their initial seizure prior to 20
3-5
temporal lobe
80
What are the 2 types of Generalized Epilepsies?
Tonic-clonic (grand mal)
Absence (petit mal)
In both Tonic-clonic (grand mal) and Absence (petit mal) Generalized Epilepsies, _______ is lost.
Consciousness
______ is producing/restoring normal tone of continuous tension, _______ is contraction/relaxation of muscles.
Tonic
Clonic
In a Tonic-Clonic (grand mal) seizure, Major Motor Activity is involved and during the seizure ________, and consciousness returns with exhaustion, headache, drowsiness, and _______.
Comatose
Confusion
A brief period of heightened sensory activity prior to the onset of a seizure characterized by numbness, nausea, or sensitivity to light, odor, or sound.
Aura
Absence (petit mal) seizures are usually found in what demographic?
Describe a petit mal seizure:
Childred 3-5 yrs
No aura, rapid eye blinking 3-5 seconds, quickly return to normal
What life-threatening condition is characterized by seizures that are continuous or rapidly recurrent?
If this occurs in a dental office, what should be given?
Status Epilepticus
diazepam (Valium) injection
*lorazepam (Ativan) and midazolam (Versed) also can be used
T/F
Drugs have variable efficacy in the treatment of seizures
True
Drugs for Epilepsy are generally ___________, and prevent the spread of abnormal electric discharges in the brain without causing excessive drowsiness
CNS depressants
Most anticonvulsants have a Narrow/Large therapeutic index.
They tend to stimulate ________ enzymes, thus these drugs are known as _______.
Narrow
Liver microsomal
Inducers
***the addition of an anticonvulsant will change the metabolism of all anticonvulsants
T/F
Metabolism of anticonvulsants can saturate liver microsomal enzymes
- low dose - 1st order
- saturation - zero order
- thus at saturation, even a small change in dose can leade to large increase in blood level of dose
True
Name 2 major side effects of Anticonvulsants:
Name 2 ways these side effects affect Dental Decisions:
CNS depression, GI effects
Opioids and Benzodiazepines Additive (CNS), NSAIDS may exacerbate GI irritation
What drug that blocks Sodium channels is highly effective for simple and complex partial seizures?
carbamazepine (Tegretol)
carbamazepine (Tegretol) blocks _____ channels and is highly effective for ______ and _______ seizures.
sodium
simple
complex partial
Other than treating seizures, carbamazepine (Tegretol) has what 3 clinical uses?
(One of very special interest in Dentistry)
Bipolar depression
Chronic pain
Trigeminal neuralgia (tic douloureux)
What are 4 side effect of carbamazepine (Tegretol)?
Hematologic
Liver Toxicity
Congestive heart (altered BP)
Xerostomia
carbamazepine (Tegretol) is a classic Inducer, which means…
Decreases effectiveness of a variety of drugs
warfarin, doxycycline, oral contraceptives, asthma bronchodilators
T/F
carbamazepine (Tegretol) DDI’s include macrolides, which increase the former’s blood levels and the hepatotoxicity of acetaminophen
True
What drug reduces the frequency of seizures by decreasing neuronal membrane passage of sodium ions thereby having a stabilizing effect?
phenytoin (Dilantin)
***remember, carbamazepine (Tegretol) blocks Na channels completely
What are 3 anticonvulsant applications of phenytoin (Dilantin)?
***What is 1 Dental Application?
Partial seizures
Tonic-Clonic seizures
Status Epilepticus
***Trigeminal neuralgia
Other than Gingival Hyperplasia, what are 2 dental side effects of phenytoin (Dilantin)?
(1 has to do with Vitamin D/folate deficiencies, which leads to osteoporosis)
Loss of taste
oral mucosal ulceration or glossitis from Folate deficiency
What % of pts taking phenytoin (Dilantin) experience Gingival Overgrowth?
What reduces the severity?
50-60%
Good Oral Hygiene
phenytoin (Dilantin) is Teratogenic category D, and causes what?
How does this manifest?
Fetal Syndrome
cleft lip, palate, congenital heart disease
phenytoin (Dilantin) has many DDI’s, ______ the metabolism of many drugs, and is a ________ of cytochrome P450
Increases
Inducer
What type of agents Inhibit the release of Acetylcholine from the presynaptic neuron?
What do they release?
GABAmimetic Agents
GABA from presynaptic interneurons
How do GABAmimetic agents prevent seizures?
Prevent acetylcholine release
*many seizures caused by tremendous release of acetylcholine
GABA is Inhibitory/Excitatory?
Inhibitory
Anticonvulsant that reduces the Na and K transport along axonal membranes and Potentiates the Inhibitory effects of GABA-mediated neurons?
phenobarbital (Luminal)
What is the most common barbiturate used as an anticonvulsant?
phenobarbital (Luminal sodium)
What types of seizures dos phenobarbital (Luminal sodium) prevent?
Tonic-clonic
Partial seizures
The most common side effect of phenobarbital (Luminal sodium) is sedation, but what rarely happens?
In this rare instance, what should be done?
Skin rxns - stomatitis
Discontinue
***some cutaneous rxns from this drug have been fatal
phenobarbital (Luminal sodium) has many DDI’s, meaning it’s a strong ______. It also enhances hepatotoxicity of acetaminophen, and additive CNS effects
Inducer
What drug, related to phenobarbital, is metabolized to phenobarbital in the Liver?
What is it used to treat?
primidone (Mysoline)
*it is phenobarbital’s precursor
Partial seizures, Tonic-clonic seizures
Describe the mechanism of action of Valproates (valproic acid, Depakene, etc.)
Increases GABA
T/F valproic acid (Depakene) is used for Tonic-clonic seizures and Generalized seizures (absence, myoclonic)
True
What are 2 adverse rxns of Valproates?
Hepatotoxicity
Platelet aggregation inhibition - bleeding
What 2 DDI’s do Valproates have?
macrolide antibiotics (mycins)
Aspirin (other salicylates)
What is the 1st choice in absence seiures (petit mal)?
*remember - the children
ethosuximide (Zarontin)
phenytoin (Dilantin) works on absence seizures
False
*does not work - prescribe ethosixumide (Zarontin)
ethosuximide (Zarontin) is prescribed for Absence Seizures in children and has what side effects (2) of interest to Dentistry?
Gingival hyperplasia
Tongue swelling
Of the Benzodiazepines, ________ has an unknown mechanism and is used for all seizure types.
_______ is used for seizures caused by Local Anesthetic and is the drug of choice for status epilepticus
clonazepam (Clonipin)
diazepam (Valium)
gabapentin (Neurontin) has an unknown mechanism and is used for _____ and ______ seizures and also ______, related to shingles.
Partial
Tonic-clonic
Chronic Pain
What anticonvulsant’s major advantage is that the drug is NOT metabolized?
*therefore lacks DDI’s, doesn’t affect liver enzymes
gabapentin (Neurontin)
What anticonvulsant used for partial and grand mal seizures inhibits the release of glutamate?
*remember, glutamate is excitatory
lamotrigine (Lamictal)
lamotrigine (Lamictal) ____ inhibits _____ receptors and is used to treat ______ disorder.
*secondarily - primarily this drug inhibits glutamate
weakly
serotonin
bipolar
6 drugs that treat Tonic-clonic (grand mal) seizures:
valproic acid
phenytoin
phenobarbital
primodone
gabapentin
lamotrigine
2 drugs that treat Absence seizures:
ethosuximide
valproic acid
6 drugs that treat Partial seizures:
carbamazepine
phenytoin
phenobarbital
primidone
gabapentin
lamotrigine
What is used instead of phenytoin to avoid gingival hyperplasia?
carbamazepine
T/F
Always ask pts when they had their seizure meds last and about known triggers
True
T/F
phenytoin (Dilantin) and phenobarbital are classic…
P450 inducers
Liver toxicity is a concern with what 2 drugs?
carbamazepine (Tegretol)
valproic acid (Depakene)
*all valproates
Local anesthetic OD will trigger a ______
seizure
What Convulsant is used as a provocative to diagnose epilepsy?
pentylenetetrazole (Metrazole)
What chemical causes generalized convulsion and causes OD’s when added to heroin?
Strychnine
rat poison
T/F
picrotoxin blocks GABA and causes convulsions
True
Stimulants are used as a restorative “analeptic,” can be used to alleviate depression, but are Primarily used to reverse _____, ______, and ______.
Respiratory
Cardiac
CNS
What stimulants are primarily used for asthma?
What stimulants are Centrally Acting Sympathomimetics?
What are used for diagnostics?
Xanthenes
Amphetamine
Convulsants
caffeine is a ______.
Xanthene
Name 2 Xanthenes used for asthma, chronic bronchitis, COPD:
aminophylline
theophylline
How many mg of caffeine or theophylline is needed to increase cortical activity?
OTC stimulants have how many mg?
50-200
100-200
The cerebral cortex is stimulated at ______ mg of Xanthenes
Brainstem:
Spinal cord (this can lead to convulsions, shakiness):
50-200 mg
greater than 250 mg
1000 mg
Coronary and peripheral blood vessel dilation and Constriction of cerebral blood vessels are hallmarks of what class of drug?
Xanthenes
_____ is more potent than caffeine
theophylline
Xanthenes have a Beta 1 effect, which does what?
stimulates heart (increases output)
Caffeine will cause arrhythmias in a normal heart
False
*cause them if at risk
How does caffeine cause hypotension?
peripheral smooth muscle relaxation
w/ normal heart rate
Aside from relaxing smooth muscle, the Beta 2 effect of caffeine and theophylline dos what?
Dilates bronchioles
*increases lung capacity - used as asthma med
T/F
Xanthenes can cause muscle contraction and pain, stiffness, and psychic tension in the neck, and Diuresis, which increases GFR and inhibits ADH
True
Where is the potency of caffeine equal to theophylline?
Where is caffeine stronger?
Everywhere else?
CNS
Sk muscle
theophylline
How many mg of caffeine is required to produce toxicity?
300 mg
T/F
600 mg caffeine a day produces physical dependence, Withdrawal begins within 24 hours, and Tolerance develops to caffeine
True
Xanthenes can be used to treat ______ poisoning by blocking adenosine receptors, which increases respiration.
Opioid
What do Xanthenes treat in infants (2 things)?
Acute pulmonary edema
Apnea
CNS Sympathomimetics ______ fatigue.
Best example of a drug class:
Decrease
Amphetamines
T/F
CNS Sympathomimetics like Amphetamines reduce REM, appetite, and may produce depression and paranoia
True
Amphetamines (CNS Sympathomimetics are indicated for what 2 conditions?
Narcolepsy
Hyperkinetic syndromes
What drug blocks Na/K ATP-ase reuptake and causes Dopamine and Norepinephrine to remain in the synapse?
Cocaine
Name an Adrenergic agonist drug for ADHD:
methylphenidate (Ritalin)
Name a Stimulant for ADHD that blocks the reuptake of dopamine and NE:
dextroamphetamine (Dexadrine)
What drug for ADHD is a Selective norepinephrine reuptake inhibitor?
atomoxetine (Straterra)
Available Amphetamines include amphetamine (Benzadrine), dextroamphetamine (Dexadrine) - the latter for narcolepsy, and what drug (used for cough/cold decongestant)?
ephedrine
Name 2 Amphetamines pulled from the market:
phenylpropanolamine (PPA)
ephedra
*both “diet” pills
Why must we use caution when administering local anesthetics + vasoconstrictors to pts using Amphetamines?
Cardiac effects
What stimulant is sold as a parenteral drug to reverse general anesthesia or drug-induced respiratory depression?
doxapram (Dopram)
Even at low doses, nicotine stimulates nicotinic receptors in the ____ and ______.
Higher concentrations can cause ______
brain stem, cortex
convulsions
In both Sympathetic and Parasympathetic neurons, Preganglionic fibers terminated at ______ receptors and both use _____ as a neurotransmitter
Nicotinic
Ach
Sympathetic Postganglionic fibers terminate using _______ (neurotransmitter) that stimulates either ______ or ______, ______ receptors.
NE
Alpha, Beta, Adrenergic
Parasympathetic Postganglionic fibers terminate at ______ receptors using ______ as neurotransmitter.
Muscarinic
Ach
T/F
Somatic fibers have no ganglia and terminate at a Nicotinic Receptor on striated muscle
***there are different subtypes of Nicotinic receptors (N1 is for NMJ)
True
What are the 4 groups of drugs that alter the ANS?
PANS stimulatory
PANS inhibitory
SANS stimulatory
SANS inhibitory
A drug that acts where Ach is released is…
A drug that acts where NE is released is…
cholinergic
adrenergic
A drug that acts where PANS action occurs…
A drug that acts where SANS action occurs…
parasympatho
sympatho
If a drug has the same effect as a neurotransmitter at an ANS site (sympathetic or parasympathetic), its suffix is…
aka…
mimetic
agonist
If a drug blocks the action of a neurotransmitter in the ANS its suffix is either _____ or ______
aka…
lytic, blocker
antagonists
*don’t produce effect - plugs site
Cholinergics and parasympathomimetics are ________.
Anticholinergics, parasympatholytics, and cholinergic blockers are ________.
Stimulatory
Inhibitory
Adrenergics and Sympathomimetics are _______.
Adrenergic blockers, sympathetic blockers, and sympatholytics are ________
Stimulatory
Inhibitory
What are the 2 types of Cholinergic Agonists and which is more predictable?
Direct acting (agonists) - more predictable
Indirect acting - cause release or accumulation of Ach
What type of Indirect acting Cholinergic Agonist cause an accumulation of Ach thereby stimulating PANS?
Cholinesterase inhibitors
T/F
Direct acting Cholinergic Drugs (agonists) have Longer action, are More Selective, and Stimulate the PANS
True
Subtypes of Ach receptors are located in different synapses, so Ach must fit ______ and ______ at the receptor.
Physically
Chemically
3 areas affected by Cholinergic Drugs;
CV
Eye
GI
CV effects of Cholinergic drugs:
Eye:
GI:
bradycardia
miosis (decrease pressure)
Increase activity (motility and secretion - excites smooth muscle)
What are 2 Primary indications for the use of Direct Acting Cholinergic Drugs:
Glaucoma
Myasthenia gravis (autoimmune)
(also, GI disorders and reversed urinary retention after surgery)
What are 2 examples of Direct Acting Cholinergic Agonists:
*both are used for Sjogren’s, which is used for Glaucoma?
cevimeline (Evoxac)
pilocarpine (Salagen) *glaucoma
pilocarpine is primarily used for ________, and acts by decreasing ________.
pilocarpine is used for what in Dentistry?
Glaucoma
Intraocular pressure (allows drainage)
Xerostomic intervention (stimulates saliva)
Indirect Acting Cholinergic Drugs, aka ________, stop the breakdown of _______, thereby producing _______
cholinesterase inhibitors
Ach
PANS stimulation
Primary Indications for Indirect-Acting Cholinergic Agonists (Cholinesterase inhibitors) includes Glaucoma, post-op urinary retention, Paralytic ileus, and _______
Antidotes
***poisons produce neuromuscular blockade
Indirect-Acting Cholinergics are divided based on what?
Degree of reversibility (of attachment to enzyme)
- Reversible
- Irreversible
Reversible Indirect-Acting Cholinergics are used to treat ________ and _______.
*remember, these increase Ach by binding Cholinesterase
myasthenia gravis
Glaucoma
Name 3 Reversible Indirect-Acting Cholinergics and what they’re used for:
edrophonium (Enlon) - reverses rapidly
physostigmine - reverses anticholinergic OD (atropine, Benadryl)
pyridostigmine (Mestinon) - myasthenia gravis, nerve gas
What would Reversible Ach-esterase inhibitors that act Centrally do?
What are these used for?
Drug?
raise Ach in brain
Dementia/Alzheimer’s
donepezil (Aricept)
Irreversible Ach-esterase Inhibitors include _______ and _______
Insecticides (organophosphates)
Nerve gas (chem. warfare)
What 2 antidotes can be used in case of OD with insecticides/organophosphates?
pralidoxime
atropine (antimuscarinic)
What are the side effects of Cholinergic drugs?
SLUD
Salivation
Lacrimation
Urination
Defecation
*compliance often low
Aside from SLUD, what are some side effects to Direct and Indirect Acting Cholinergic Drugs?
Bradycardia
Bronchoconstriction
Miosis
Paralysis at high doses
What are 3 names for Cholinergic Antagonists?
Anticholinergics
Antimuscarinics
Parasympatholytics
Anticholinergic Drugs (parasympatholytics) _______ the receptor site for ______.
Block
Ach
*Ach is released but cannot act
Anticholinergic Drugs have central effects determined by ________.
Dose
Scopolamine, a CNS acting Anticholinergic, is used for what 2 purposes?
Sedation
Motion Sickness
Atropine, a CNS acting Anticholinergic, causes what?
Stimulation, delirium, hallucinations, convulsions, coma
What are Anticholinergics effects on Exocrine Glands?
How is this used in Dentistry?
What drug?
Decreases Secretion
Decrease Salivation
Atropine
What are Anticholinergics effects on the lungs?
GI tract?
Bronchodilators
Decrease gut motility
*Affects smooth muscle
What are 2 Anticholinergic effects on the Eye?
*How is this used in medicine?
mydriasis (dilated pupils)
cycloplegia (near vision blurred - distance vision awesome)
*opthamologic exam
What do Anticholinergics do to PANS?
Reduce activity
What can Anticholinergics do in Large Therapeutic doses?
Tachycardia
*vagal blockade
How do Anticholinergics affect Parkinson’s disease?
How do they affect Urinary disorders?
Reduce tremors/muscle rigidity
Can treat overactive bladder
The Anticholinergic ________ is used for Motion sickness
The Anticholinergic ________ is used in Dentistry to maintain a dry field
Scopolamine
Atropine
________ = anticholinergic = ________ salivation
________ = cholinergic = _________ salivation
atropine, stops salivation
pilocarpine, increases salivation
What is the drug of choice for emphysema (stops bronchial secretion - anticholinergic)?
ipratropium (Atrovent)
Name 4 contraindications to Anticholinergics:
Glaucoma
Prostatic hypertrophy
Intestinal/urinary retention
CV disease
*anticholinergics can cause tachycardia
What is the mnemonic for Atropine Toxicity?
Dry as a Bone
Red as a Beet
Blind as a Bat
Mad as a Hatter
T/F
Neuromuscular Blocking Drugs can either be Antagonists or Agonists
True
*non-depolarizing or depolarizing
What is an example of a Non-depolarizing (competitive) neuromuscular blocking agent?
What does it inhibit at the NMJ?
Is it reversible?
Curare
Nicotinic Receptors
yes
How can the effects of Curare be reversed?
Cholinesterase Inhibitors
*so, blocking the receptors can be overcome by throwing more Ach at it.
What is a Depolarizing NMJ blocking agent?
What does it cause?
succinylcholine
flaccid paralysis
How long does flaccid paralysis caused by succinylcholine last?
What is a clinical use?
few minutes
intubation
Where does the Botulinum Toxin (from C. botulinum) work?
What does it do there?
Presynaptic
Prevents Ca++ dependent Ach release
***new NMJ plates must grow to replace
_____ is a powerful Ganglionic Blocking Agent, and inhibits nicotinic receptors blocking both PANS and SANS.
Another one, outdated, might be on boards:
Nicotine
Trimethaphan
The endogenous Adrenergics are known as ________
catecholamines
Name 3 catecholamines (endogenous adrenergics)
Epinephrine
Norepinephrine
Dopamine
Name an exogenous Adrenergic neurotransmitter:
isoproterenol
What types of receptors do Adrenergics work on?
What do they control?
Alpha - smooth muscle contraction
Beta - heart muscle contraction, smooth muscle relaxation
Adrenergics are classified by their mechanisms, which are (3):
Direct acting
Indirect acting
Mixed action
T/F
Adrenergics can be alpha/beta agonists, or apha/beta antagonists
True
T/F
Alpha receptors are found in the Skin and cause vasoconstriction (via smooth muscle contraction)
True
How are Beta Receptors divided and what do they do?
Beta 1: rate/force heart
Beta 2: vasodilation of Skeletal muscle, bronchodilation
What might be a reason not to use Adrenergic Agonists on Diabetics?
Peripheral vasoconstriction
*exacerbates
9 Adrenergic Agonists:
Albuterol
Amphetamine
Clonidine
Dopamine
Oxymetazoline (Afrin)
Phenylephrine (Sudafed PE)
Phentermine (diet pills)
Pseudoephedrine (Sudafed)
Tetrahydrozoline (Visine)
Albuterol is included in all dental emergency kits for asthma and is a ______ agonist
Beta 2
What can be used as a 2nd line intervention for hypertension?
Alpha Antagonists
*decreases total peripheral resistance
Name 4 uses for Alpha Antogonists:
Hyptertension
Peripheral vascular disease (Raynaud’s)
pheochromocytoma diagnostic
Prostatic Hypertrophy
What are the most widely used Beta Blocking drugs in the US?
Selective
Beta 1 only
(fewer side effects, DDI’s)
*non-selective’s block both
Beta Antagonists (blockers) are used for Cardiac arrhythmias, Angina, Hypertension, Hyperthyroidism, Anxiety, Glaucoma, Parkinson’s, and Migraine
True
Selective Beta blockers are alphabetically ______.
Non-selective Beta blockers are ______
A through M
N-Z
What can pts taking Non-Selective Beta blockers experience when given epinephrine?
(2-4 fold increase of this occurring)
Pressor response
The Pressor Response includes what 2 things?
Hyptertension
Reflex bradycardia
Epinephrine given to those taking Non-selective Beta blockers must be limited to ____ mg, which is ___ cartridges of epi 1:100,000.
0.04 mg
2 cartridges
