What is a function of the amount of a drug to produce an effect?
Potency is GREATER when the dose is ???
Maximum intensity of effect or response that can be produced by a drug regardless of dose?
Administering more drug will NOT increase efficacy of the drug but will often increase the probability of what?
ADVERSE DRUG REACTIONS
B*Efficacy and potency of a drug are...**
____-___ equals half the amount of time for a drug to fall to half of the original blood level; relates to DURATION of effect.
Routes of administration affects what?
Onset and duration
ROA when drug is placed directly into the GI tract by oral or rectal?
ROA when drug bypasses the GI tract; includes INJECTION, inhalation, topical administration?
What ROA is considered the safest, least expensive, and most convenient?
Where is the largest absorbing area in the enteral route?
-stomach or intestinal irritation
-drugs may be inactivated by GI acidity/enzymes like INSULIN
-drug leves are LESS PREDICTABLE
-Necessitates greater pt. cooperation
Oral adminstered drugs must first pass through what?
hepatic portal circulation
Known as first-pass effect
**B* Drugs with high first-pass effect require what?*
*Require a larger dose*
Phase I reactions are carried out in the liver by what?
cytochrome P-450 enzymes
AKA mixed function oxidase
Why would the rectal route be chosen?
Vomiting or unconscious
What route produces the most rapid drug response and the absorption phase is bypassed?
Route of choice for emercency situation?
What are disadvantages of IV route?
phlebitis-caused by local irritation
side effects of high plasma drug concentrations
What does massage do to drug in intramuscular route?
Massage Increases absorption
how does intramuscular route absorption occur?
due to high blood flow has a sustained effect
What ROA is local anesthetics and insulin injections?
This is the route used to adminster protein products and may produce a sterile abscess?
This ROA is injected into epidermis like a TB skin test?
This route provides rapid delivery of a drug across a large surface area of repiratory mucosa?
Inhalation for asthma and nitrous oxide
Topical ROA is contraindicated when?
if surface is ulcerated, burned or abraded
Topical ROA conciderations:
-have increased concentration of the drug
-most effective with less keratinized tissue
-used when Local effect is desired
-may have systemic effect
Study of how a drug is absorbed, distributed, metabolized and excreted? ADME
Rate and efficiency of absorption depend on what?
Route of administration
absorption of a drug may be what?
active or passive
What type of drugs are the only drugs to pass the blood-brain barrier and readily move across MOST biological membranes by diffusion?
Lipid soluble drugs
Absorption is dependent of what several factors?
-Circulation at deposition site
-Total surface area available for absorption
-Temperature at site
After being absorbed, drugs are distrubuted to where?
Sublingual dose--> HEART
Distribution is dependent on what x3?
capillary permeability (Blood-brain-barrier)
Binding of drugs to protiens ALBUMIN
If a drug binds to ALBUMIN, what do you do>?
What is the major site for drug metabolism?
LIVER; liver disease may impair metabolism
Drug elimination _________ drug effects?
Drugs are most often eliminated by biotransformation and/or excretions into what?
Urine or bile
What is the most important means of excretion?
What are other means of excretion?
GINGIVAL CREVICULAR FLUIDS
Are FAT suluble vitamins excreted in urine?
NO, they need to be metabolized into water soluble form in the liver first.
How is fluoride eliminated from the body?
Excretion through urine
What is the most accurate rule to determine childs dose of drug is safe to administer?
Surface area rule
Amount of desired effect is excessive; dose related?
dose related reaction that is not part of the desired therapeutic outcome; ex. drowsiness with antihistamine?
Abnormal drug response that is usually genetically related?
hypersensitivity response to a drug to which the patient has been preciously exposed; NOT DOSE RELATED?
Causal relationship between maternal drug use and congenital abnormalities?
What did Thalidomide induce?
Antinausea drug caused phocomelia (shortened limbs)
Drug interactions may result in what? x2
lack of efficacy
Gingival hyperplasia associated with phenytoin/dilantin generally occurs where?
Mouthbreathing would exhibit inflamed gingiva where?
What are the 2 systems of the autonomic nervous system?
Parasympathetic nervous system
Sympathetic nervous system
Neurotransmitter for the Parasympathetic nervous system?
functions of the PANS?
REST and DIGEST;
dilates blood vessels-->increasing blood flow
constricts bronchiolar diameter
Stimulates salivary gland secretion
digestion/absorbtion of food
What x3 type of drugs are used to mimic the effects of the parasympathetic nervous system?
What are the previous drugs used to treat?
What are examples of cholinergic agents derived from plant alkaloids?
*B*Contraindications for cholinergic/parasympathomimetic drugs?
Peptic Ulcer-->increase GI secretions
Cardiac disease-->decrease heart rate
GI/Urinary obstruction-->increase GI motility**
What are examples of anticholinergic drugs?
*Atropine*-->to decrease salivary flow in the dental setting
Effects of anticholinergic drugs?
A anticholinergic agents
B blurred vission & bladder retention
What is the neurotransmitter for the Sympathetic Autonomic nervous system?
*B* what else is a neurotransmitter for the SANS?
Functions of the SANS?
Fight or Flight
Dilates bronchioles of the lung
-Increase heart rate
Examples of Sympathomimetics or Adrenergic agents?
Adverse effects of adrenergic agents?
CNS disturbances (ANXIETY,fear, tension...)
Contraindications for Sympathomimetics or Adrenergic agents?
Cocaine, Meth abuse
Oral signs of methamphetamine abuse?
rampant caries and burned mucosal surfaces from the route of administration of meth, not the meth
TX for meth?
NO meds; councling only
What is albuterol?
drug of choice for acute asthma
Where are beta-1 receptors located?
where are beta-2 receptors located?
all over the body, but mainly in the lungs
What is the action of B-adrenergic blocking agents on the heart?
lower heart rate and blood pressure and are useful when the heart itself is deprived of oxygen
When are beta blockers prescribed?
Often after heart attacks
**when should non-selective beta blockers not be used?
with patients with asthma or any reactive airway disease-->can block the effects of beta=2 agonists, such as ALBUTEROL
What is the prototype for Beta-adrenergic blockers?
What does Propranolol have an effect on?
Heart...lowers cardiac output
What is a cardioselective B-blocker used for tx. hypertension when pt. is asthmatic because it has no effect on lungs?
*B* If a pt. is taking a cholinergic drug (Albuterol); what must the pt. take to treat hypertension?
A cardioselective b-blocker (heart only/no lung)
What is the Prototype of non-narcotic analgesics and is considered an NSAID?
What are the uses for Aspirin?
What is the mechanism of action for Aspirin?
Inhibition of prostaglandin synthesis
through an action on what does aspirin reduce fever?
An action on the HYPOthalmus-thermostat for body
What are the side effects of aspirin?
interferes with blood blotting (CX w/ coumadin)
GI irritation (CX w/peptic ulcers)
Hypersensitivity (~15% pts. allegic)
REYE's Syndrome in kids/adolecents, give tylenol instead
What is a term for asprin toxicity?
What are symptoms of Salicylism?
TINNITUS-ringing in the ears
Respiratory and metabolic acidosis
Death from respiratory failure
Prostoglandins cause what?
What is the prototype for NSAIDS?
What is the mechanism of action for ibuprofen?
Inhibition of prostoglandin synthesis
What is the actions of ibuprofen?
What are side effects of Ibuprofen?
Interferes with blood clotting-CX w/coumadin
GI irritation, less than aspirin, CX with peptic ulcers
IBUPROFEN is available in suspended form for pediatric use as an antipyretic-fever reducer
B What drugs can ibuprofen reduce the pharmacological effects of?
What are the actions of Acetaminophen?
Is Aspirin an NSAID?
NO; it has no antiinflammatory effect
what is acetaminphen a drug of choice for?
for patient in anticoagulants (coumadin) or with Peptic ulcer disease
What can an overdose of Acetaminophen result in?
What is the post-opperative pain med recemmendation following root planning?
When nonopiods fail at reducing pain, what is the drug of choice?>
What is the mechanism of action of an opiod drug?
Blocks pain receptors in the brain without loss of consiousness
What is the prototype for opiods?
what are other examples of opiod drugs?
What is the most commonly used opiod in dentistry?
What schedule drug is codeine alone?
What schedule drug is codeine with acetaminophen?
Codeine is what?
Codeine is a stopper; what does it stop?
breathing-Side effect...respiratory depression
What is a sign of codeine/opiod addiction/use?
Pinpoint PupilsB Boards love their pupil ?'s
What is an opiod ANTAGONIST? used to treat opiod overdose and should be in dental emergency kit?
what can stop codiene, NarCAN can stop Codiene OD
What drug is used for TX of narcotic withdrawal and dependence of heroin, morphine, and other opiods?
B Pupils for heroin? Pupils for cocaine?
Heroin...pupils are pinpoint;
Cocaine...pupils are dilated
B What is the best pain medication for heroin users?
What appointment consideration should be done for IV drug users?
Antibiotic Pre-medication; becuase they dirty people
What is the most commonly prescribed antibacterial in the dental proffesion?
What % of bacteria is penn VK effective against?
Why is Penn VK preferred over Penn G?
Because Penn VK has less erratic absorbion;
Penn G is inactivated by Gastric acids
Why is Amoxicillin preferred over Penn VK?
pt. compliance; Amoxicicillin is TID instead of QID dosing
What is the mechanism of action for Pennicillins?
Destroys bacterial cell wall integrity leading to LYSIS of bacteria
When is the bacteria more susceptible to penn?
while rapidly growing organism; during sex they are too distracted and are killed easier
B What antibiotics is most likely to produce an Anaphylactic reaction?
Penicillin; if pt. allergic to penn, will be allergic to all derivatives
What is the most common manifestation of Penn allergy?
Can Penicillin be given to pregnant women?
Penicillinase is an enzyme released from some gram - bacteria that breaks down penicillin, AKA?
If culture is positive for beta lactamase, what is used in conjuction with Amoxicillin and its called what?
Clavulanic acid; Augmentin
When taking tetracyclines, what should be avoided?
-because they cause chelation of tetras. which reduces the GI absorbtion
Tetracyclines are used in perio, why?
because they have the ability to **concentrate in gingival crevicular fluid**
Tetracyclines are often used TOPICALLY to treat WHAT?
Tetracyclines are used SYSTEMICALLY to treat what?
What type of bacteria is metronidazole effective against?
obligate anaerobes ONLY
What should be avoided with metronidazole? WHy?
ALCOHOL, mouthrinse; because of anabuse-like reaction
What are side effects of antibiotics?
Secondary fungal infection; candidiasis, yeast
What are the 4 ANTItuberculosis agents the pt. must take all of? RIPE
If a pt. is taking ISOIAZID only; what is it most like being used for?
IS TB caused by a virus or Bacteria?
What test is used to test for TB?
Mantoux skin test
What does a positive Mantoux skin test mean?
that the pt. has been previously exposed to TB
What is the antigen used in the Mantoux skin test?
PPD; purified protein derivative
B Know meds for TB vs. HIV
What is the TOPICAL drug of choice for Candida?
What is the SYSTEMIC drug of choice for Candida?
When does someone with joint replacement need premed?
Less than 2 years following replacement
Previous prosthetic joint infection
ALWAYS consult orthopedic surgeon when in doubt
RX abbrviation: ac
at bedtime, husshh! go to sleep
twice a day
every 3 hours
4 times a day
3 times a day
label; instructions for use
*How are class II drugs handled?*
*Written RX with providers signature only, NO REFILLS*
how are class III drugs handled?
RX may be phoned in; No more than 5 refills in 6 months...
ex. Tylenol III with codeine
how are class IV drugs handled?
Same as schedule III drugs;
RX may be phoned in; No more than 5 refills in 6 months
Any RX for a controlled substance requires what?
Any RX for a schedule II drug must what?
Be written in pen or typed
Some states require what for Class II drug Rx?
Triplicate prescription blanks
What are the 2 major classes of Antianxiety agents?
What is the principle effect of barbiturates?
What is a long-acting barbiturate used in the TX of EPILEPSY?
(pheno...like pheny-toin for seizures
Does Barbiturates provide an anelgesic effect?
NO pain relief
What are Benzodiazepines useful in treating?
SHORT-term anxiety, insomnia, alcohol withdrawel
All benzodiazepines have what properties?
All Benzodiazepines have NO what activity?
NO antipsychotic activity
NO analgesic activity
DO NOT affect the ANS
Benzodiazepines + other CNS depressents (alcohol) =
additive effect (death)
what reduces the effectiveness of Benzodiazepines?
How is Benzodiazepines used in the dental setting?
relax fearful patient
BReverse status epilecticus and siezures associated with local anesthetic OD
Examples of Benzodiazepines?
What do general anestheics produce?
Reversible loss of consciousness and insensitivity to painful stimuli
What is nitrous oxide considered?
Nitrous oxide used in the dental setting, maintains the patient in what stage of anesthesia?
The end of stage I is marked by what?
Loss of consciousness
Stage II is associated with what?
involuntary movement, delirium, excitement
What stage is most major surgeries performed in?
What happens in stage IV?
Respiratory cessation, DEATH
NOT the ideal stage!
What may be given prior to general sedation?
What is the most common inhaled anesthetic?
How does Nitrous work for pain control?
Raises pain threshold
What color are Nitrous tanks?
What is used for the removal of nitrous from air?
What is route of excretion for Nitrous?
What is the side effect sweating caused by while using nitrous?
vasodilation of extremities
*What are CX to the use of Nitrous Oxide?*
Upper respiratory infection, stuffy nose
Lack of communication
*B* What can long-term recreational abuse of N20 lead to?
Neurological symptoms similar to Parkinsons
Vitamin B12 deficiency...numbness/tingling in extremities
What is the leading cause of death in the US?
Heart disease (Cardiovascular disease)
What does cardiovascular disease include?
Congestive heart failure
What are cardiovascular CX to dental tx?
Myocardial infarction (3-6 months)
Uncontrolled congestive heart failure
What are Digitalis Glycosides used to treat?
Congestive heart failure; increase contractive strength (make heart stronger)
BWhat is the most common Digitalis Glycoside?*
What needs to be avoided with Digoxin/Lanoxin?
sympathomimetics (VASOCONSTRICTORS in LA) can lead to Cardiac Arythmias
What effect does Tetracycline and Erythromycin have on Digoxin/Lanoxin?
increases Digoxin levels in blood
What oral side effects does Digoxin/Lanoxin have?
increased gag reflex
What is the drug of choice for ACUTE Angina?
How does nitroglycerin work?
vasodilates, smooth muscle relaxant
Where is nitroglycerin given, and following absorption, where does it go?
Sub-lingually, goes to heart
What is the most common of all cardiovascular diseases?
What is the first line of therapy for hypertension?
how do diuretics work to lower blood pressure?
promote excretion of sodium and water, which decreases blood volume and pressure
What are the two major types of diuretics?
Thiazide and Loop diuretics
What is the most commonly used thiazide diuretic?
Side effects of Hydrocholorthiazide?
What is the most common loop diuretic?
what patients use Furosemide (Lasix)?
Hypertensive patients with Congestive heart failure
how do Calcium channels work?
By producing systemic vasodilation by BLOCKING vasoconstriction in smooth muscle blood vessels
Calcium channel blockers are one of the few antihypertensive agents whose effect is?
NOT REDUCED by NSAIDS
Common oral side effects of CCB is?
Common calcium channel blocking agents include?
Nifedipine (Procardia, Adalat)
What do ACE inhibitors stand for?
Angiotension Converting Enzyme Inhibitors
Common suffix for ACE inhibitors?
What are ACE inhibitors used for?
To lower Blood Pressure
What are adverse reactions for ACE inhibitors?
DRY COUGH [going to ACE hardware store will give you a cough from the -dril (-pril)]
What ACE inhibitor is used for someone who has Congestive heart failure to lower their high blood pressure?
What is the effects of NSAIDS on ACE inhibitors?
NSAIDS decrease the effectiveness of ACE inhibitors!
What is the most serious drug interaction of warfarin/coumadin?
ASPIRIN (increases bleeding tendecies)
How does Coumadin work?
Vitamin K helps clot blood; coumadin inactivates Vitamin K
What other drug category has an effects on warfarin?
Antibiotics; due to effect on vitamin K
Who decides to reduce warfarin dose prior to TX?
What is the most commonly emplayed anticoagulants given by injection in hospitalized patients only?
Heparin; rat poison
What is the most common barbiturate used to treat epilepsy?
Trigeminal neuralgia AKA?
Tic del la rue; suicide disease
what anticonvulsant is used to treat trigeminal neuralgia and partial seizures and is similar to a tricyclic antidepressants?
What are side effects of Benedryl?
What is the mechanism of action for Benedryl?
blocks histamine receptors
what are the 2 types of histamine receptors?
H1 receptors (bronchospasm/vasodilation)-where antihistamines work
H2 receptors (gastric and secretion)
What is the most common adverse reaction associated with insulin?
most common Type 2 diabetes meds?
What is the most common short-acting bronchodilator inhaled B-agonist?
What is used long term to preven asthma attacks?
Corticosteroids EX. FLOVENT (fluticasone)
What is a combination of a corticosteroid and a long-acting bronchodilator?
What is used to treat chronic asthma and the bronchospasm associated with emphysema and chronic bronchitis?
*What can increase serum levels of THEOPHYLLINE and cause toxicity*
What NSAID should Asthmatics avoid? Why? *Board
ASPIRIN many asthmatics are allergic to aspirin (4-19%)
B What can albuterol cause?
what are the first line of treatment for COPD?
What is the drug of choice for long-term management of COPD?
what are used as "cough suppressants" for the relieft of a non-productive cough?
Antitussives (Opiods are used because they are a stopper)
What drugs can Antacids inhibit?
What is the most prevalent GI disease in the US?
What are the 2 ways to treat GERD?
Histamine 2 blocking agents
Proton Pump Inhibitors (PPI)
What should be avoided with Histamine 2 blocking agents?
ANTACIDS-it disrupts absorption
What are examples of Histamine2 blocking agents?
famotidine (Pepcid AC)
What is a POTENT Proton PUMP Inhibitor (PPI)? (Think P's)
Pt. who lists TAGAMENT on health history is likely being treated for what?
If a pt. is suddenly taken off Synthroid (hypothyroid drug), what would occur?
What does Iodine deficiency cause?
What does Alcohol in combination with Nitroglycerin result in?
Dangerously Low Blood Pressure
What is CX with Flagyl (metronidazole)?
Alcohol-antabuse like reaction
What does Chantix do?
Blocks nicotinic receptors in the brain
Common side effects of Estrogen?
may cause gingival inflamation
-May promote endometrial carcinoma and breast cancer in post-menopausal women
What is lipitor?
high cholesterol drug
What does lipitor do to warfarin?
increases the anticoagulant effect
Prednisone treats what?
Side effects of Prednisone?
Cushings disease like symtoms
Hypothyroidism in children can lead to what?
Symptoms associated with Cretinism?
-Delayed tooth eruption