184 terms

dhy pharmacology final

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pharmacology
the study of drugs and their effects on living organisms
drug
a chemical substance that affects biologic systems
chemical name
is determined by the chemical structure of a drug and tells the chemist how to make it
generic name
the official name of the drug, starts with a lower case letter, only 1 per drug, and the name is selected by the US adopted name council
Trade or Brand Name
starts with a capital letter, it is made to be easily remembered and promoted commercially, can be more than 1 of these names per drug
chemically equivalent
two formulations of a drug meet established chemical and physical standards
biologically equivalent
two formulations of a drug produce similar concentrations in blood and tissues
therapeutically equivalent
two formulations of a drug have equal therapeutic effects during a clinical trial
biologically, therapeutically
Generic drugs must be ___ and ___ equivalent
chemically
a drug can be ____ equivalent but neither of the others
therapeutically
if a drug is biologically equivalent then most of the time it is also _____ equivalent
therapeutic effect
result of which are judged to be desirable and beneficial
prescription
order of a specific medication for a specific patient at a particular time, with appropriate instructions for how the patient is to use the medication
prescription heading
includes: name, address, phone #, of the prescriber, and name, age, address, and phone # of the patient, also date of the prescription
prescription body
includes: Rx symbol, inscription: name and dose of drug, size and concentration, subscription: amount to be dispensed, transcription: directions to the patient
prescription closing
includes: prescriber's signature, DEA # if required, refill instructions, and generic substitution instructions
schedule I drugs
high potential for abuse, no accepted medical use in the US
schedule II drugs
high abuse potential, psychological or physical dependence possible, requires written prescription with the providers signature, written in ink or typed only, no refills permitted
schedule III drugs
potential fo abuse is less than I or II, abuse may lead to moderate to low psychological dependence, may be telephoned to the pharmacy, may be refilled as many as 5 times in 6 months
schedule IV drugs
low potential for abuse, abuse may lead to psychological or physical dependence, may be telephoned in to pharmacy, may be refilled as many as 5 times in 6 months
schedule V drugs
low potential for abuse, limited physical and psychological dependence
administration
how do drugs enter our bodies?
enteral routes
when a drug is placed directly into the GI tract either by oral or rectal routes
parenteral routes
when a drug bypasses the GI tract, by being placed by one of these routes: intravenously, intramuscular, subcutaneous, intradermal, intrathecal, intraperitoneal, inhalation, or topical
intravenous route advantages
most rapid response, more predictable drug response, route of choice in emergencies
intravenous route disadvantages
inflammation at site, drug irretrievability, allergies, side effects related to high plasma concentration
subcutaneous route
injection of solutions or suspensions of drugs into subcutaneous tissue, EX: insulin
intradermal route
injection into the epidermis or dermis EX: TB skin test
Inhalation route
gaseous, microcrystalline, liquid, or powder, rapid delivery
topical route
application to body surfaces EX: transdermal patch
pharmacokinetics
what happens to drugs once they have been administered
absorption
the study of how a drug becomes available for use in the body
distribution
the circulation of a drug within the body
metabolism
how a drug is changed by the body
excretion
how a drug leaves the body
active absorption
carrier molecule (protein/enzyme) actively moves the drug across the membrane
passive absorption
occurs by diffusion (movement from a higher concentration gradient to a lower concentration gradient)
pinocytosis
cells engulf the drug particle
liver
the #1 primary site in the body where metabolism occurs (where a drug is converted or changed)
excretion
most drugs eliminate the inactive compounds from the body in the urine
5-10%
_____ of patients are admitted to the hospital because of adverse reactions to a dug
type I allergic reaction
immediate hypersensitivity, occurs quickly after a drug is administered, mediated by immunoglobulin E (IgE) antibodies, anaphylactic shock is possible-acute life threatening
Type II allergic reaction
cytotoxic/cytolytic, complement dependent reactions, IgG or IgM antibodies, causes cytolytic reactions- cells bursting
Type III allergic reaction
immune complex / arthus/ serum sickness, mediated by IgG antibodies, manifests as serum sickness
type IV allergic reaction
delayed type hypersensitivity, mediated by T-lymphocytes and macrophages, manifests as dermatitis, EX: poison ivy
Group A Drug
least teratogenic drugs, or best to take during pregnancy if needed
Group B Drug
there is no demonstrated risk to the fetus in laboratory animals, or that animal studies show a risk that cannot be substantiated by studies in pregnant women
Group C Drugs
an agent for which there is insufficient data in animals or women to ensure safety during pregnancy
Group D Drugs
there is positive evidence of human fetal risk, but the benefits from use in pregnant women may be acceptable despite the risk
Group X Drugs
means never use if you are pregnant or may become pregnant
pharmocodynamics
how drugs exert their effects
drugs that alter in cellular environment
physical alterations, osmotic pressure, lubrication, absorption, or conditions on the surface of the cell membrane
drugs that alter in cellular function
how most drugs wok, drug binds to a receptor like a puzzle piece, and then alters the function of the cell, intensity of a drug response is related to how well the fit of the drug molecule is to the receptor and the # of receptor sites occupied by the drug
agonist
drugs that bind with the receptor to produce a therapeutic response
partial agonist
drugs that have some receptor fit and produce a slight therapeutic response, but inhibit other responses
antagonist
drugs that prevent the action of an agonist, produce no pharmacological effect
receptor competitive
competes with the agonist for the receptor, produces no effect when combined with the receptor
receptor noncompetitive
binds to a different receptor site than the agonist, cannot elicit a response with more agonist
non receptor chemical
may bind a molecule in the activation pathway of the drug,may also directly inhibit the agonist, Ex: antivenom for a snakebite
non receptor physical agonist
activates pathway that oppose the action of the agonist, Ex: epinephrine
mixed agonist-antagonists
has both agonist and antagonist properties, when used alone behaves as a agonist, when administered with other drugs that compete for the same receptor sites, it will act as an antagonists
dose effect curve
how we measure how well a drug works, the intensity of a drug changes as the dose changes, adverse and therapeutic effects are dose related
potency
the amount of a drug required to produce the desired therapeutic effect,
dose
potency and ____ have an inverse relationship
efficacy
minimal intensity of effect or response that can be produced by a drug regardless of dose, assessment of effectiveness
median effective dose
amount of dug that produces a therapeutic effect in 50% of the subjects ED50
lethal dose
death is the endpoint, dose that produces death in 50% of subjects
therapeutic index
lethal dose divided by median effective dose
half life
the amount of time for a drug's concentration in the blood to decrease by one half
syncope
the most common emergency in the dental office
hypoglycemia
insulin shock, the most common cause is excessive doses of insulin in diabetic patients
angina pectoris
pain in the chest that radiates up the left am or in the mandible, rapid pulse and rapid breathing
myocardial infarction
sever pain, pressure, or heaviness in the chest that radiates to other parts of the body, sweating, nausea, vomiting, irregular rapid pulse,
cardiac arrest
use AED, & immediate CPR to treat this
pain
sensory (afferent) neurons can transmit the sensation of ____.
peripheral nerve cell membrane
local anesthetic site of action
amides
parenteral, allergic reactions uncommon, Ex: lidocaine, prilocaine, mepivicaine, articaine
esters
topical, higher rate of allergic reactions, Ex: cocaine, bezocaine, teracaine, procaine( novacaine), propoxycaine
esters
metabolized in blood plasma by plasma pseudocholinsterase primarily
amides
metabolized in the liver by cytochrome P450 mixed function oxidase, except for articaine, use caution for patients with Liver disease
benefits of vasoconstrictors
prolong anesthetic action, suppress systemic absorption of anesthetic, increase duration and intensify block, reduces toxicity, delays absorption, hemostasis, decreases bleeding
.2mg
the maximum dose of epinephrine in a healthy patient is?
.04mg
the maximum dose of epinephrine in a heart / cardiac patient is?
contraindications for the use of vasoconstrictors
heart attack in the last 6 months, uncontrolled hypertension, daily angina, uncontrolled hyperthyroidism, uncontrolled arrhythmias, and drugs
lidocaine
is the most common local anesthetic agent, has a rapid onset, diffuses well through the tissues, medium duration, topical anesthetic also, vasoconstrictor: epinephrine
mepivicane
rate of onset, duration, potency, and toxicity similar to lidocaine, plain form without vasoconstrictor-3%, used for short procedures if vasos are contraindicated, systemic toxicity is more likely, not effective topically, vasoconstrictor: levonordefrin
prilocaine
less potent, less toxic, longer duration of action than lidocaine, methemoglobinemia with high doses, should not be administered to pts. with oxygenation problems, vasoconstrictor: epinephrine
bupivicaine
more potent and less toxic than other amides, the most lipid soluble, longest lasting, vasoconstrictor: epinephrine
articaine
the newest local anesthetic approved in the US, great lipid solubility, diffuses through bone, methemoglobinemia with high doses, rarely causes paresthesia (prolonged feeling of numbness) following a mandibular block, vasoconstrictor: epinephrine
antimicrobial
suppress or destroy microorganisms
anti-infective
suppress or destroy infections
antibacterial
suppress or destroy bacteria
suprainfection
opportunistic infection, only an infection when the body is immunocomprimised
Penicillin's
bacteriacidal antibiotics, beta-lactam, effective against 90% of bacteria involved in dental infections, most effective against rapidly growing organisms, most commonly prescribed in the dental offices
gastric acid
Penicillin G is inactivated by___ ____?
Augmentin
clouvaunic acid +amoxicillin, prevents penicillinase from breaking it down
cephalosporins
_____ are contraindicated in patients allergic to peniillins
tetracylines
bacteria static, inhibit bacterial protein synthesis, broad spectrum
minocycline
arestin- often used topically to treat aggressive periodontal disease
cephalosporins
bacteriacidal, inhibit cell wall formation, used if there is a penicillin allergy
antifungal agents
prevent synthesis of ergosterol, which disrupts fungal cell membranes
nystatin
used topically, poorly absorbed from the GI tract when taken orally, DOC: oral candidiasis, both fungistatic and fungicidal properties
imidazoles
clotrimazole, fluconazole (diflucan), ketoconazole
clotrimazole
topical, used to treat oropharyngeal candidiasis
fluconazole
systemic used to treat both vaginal and oral candidiasis, but not very effective, can take up to 5 days to relieve symptoms
ketoconazole
topical and systemic, used to inhibit CYP P450
antiviral medications
prevent or interfere with viral replication
purine, pyrimidine
most antiviral agents used to treat herpes are either ____ or _____ analogues that inhibits DNA synthesis, Acyclovir, docosanol, penciclovir, and famciclovir
acyclovir
decreases pain and speed the healing of sores or blisters in people who have varicella (chicken pox), herpes zoster (shingles), first time or repeat outbreaks of genital herpes, and herpes labialis
penciclovir
used to treat oral herpes simplex, used topically, shown to reduce the duration and pain of the lesion on the lips and face associated with both primary and recurrent herpes simplex
docosanol (10% Abreva)
treatment of oral herpes simplex virus, OTC< topical, apply within 12 hours of prodromal symptoms to decrease the healing time
valacyclovir , famciclovir
DOC for treatment of herpes zoster (shingles), and herpes labialis
nucleoside analogs
didanosine, lamivudine, stavudine, zalcitabine, zidovudine= antiretroviral agents
nonnucleoside analogs
delaviradine, nevirapine = antiretroviral agents
protease inhibitors
indinavir, nelfinavir, ritonavir, saquinavir = antiretroviral agents
amantadine
flu medication- inhibits the penetration of the absorbed virus into the host's cells or inhibits the uncoating of the influenza A virus
Interferons
Hepatitis C and MS drugs= alfa-2a, peginterferon alfa -2a, beta-1b
DEA (drug enforcement agency)
what agency regulates scheduled drugs
controlled substance act of 1970
what is the law that controls scheduled drugs
the major classes of anti-anxiety drugs
barbiturates, benzodiazepines, general anesthetics, nitrous oxide-oxygen,
barbiturates
Ex: phenobarbitol, butabarbitol, secobarbitol, methohexitol, thiopental, CNS depression is the main effect, original sedative, hypnotic agents, used as anticonvulsants
benzodiazepines
Ex: diazepam (valium), lorazepam (ativan),alprazalom (xanax)-used for anti-anxiety control, insomnia, epilepsy, local anesthetic overdose, muscle spasms, these drugs are used before surgery, and are more commonly prescribed
General Anesthetics
Ex: halothane, methoxyflurane, influrane, isoflurane, used in surgerys
nitrous oxide-oxygen
used for dental procedures, and surgery
indications for nitrous oxide
a patient exhibits fear and anxiety, if a patient refuses or is allergic to general anesthetics, patients that have a prominent gag reflex, and patients who are impatient during long appointments
contraindications of nitrous oxide
patients with respiratory obstruction, COPD,emotional instability, debilitating cardiac or cerebrovascular disease, pregnancy, psychiatric disorders or compulsive personalities, claustrophobic, children with severe behavioral problems, cystic fibrosis, and abuse of vitamin B12
the cardiovascular drug classes
diuretics, B-adrenergic blocking agents, calcium channel blockers, antiotension converting enzymes (ace) inhibitors, angiotension receptor blockes
diuretics
the 1st line of therapy for hypertension, also used for CHF,
thiazide diuretics
hydrochlorothiazide (HCTZ)
Loop diuretics
fluosemide (lasix)
potassium-sparing diuretics
amiloride,spironolactone (aldactone)
B-Adrenergic Blocking Agents
these drugs treat Hypertension, Congestive Heart Failure, Angina
nonselective B-adrenergic blocking drugs
block both B1 & B2 receptors, Ex: propranolol (Inderol), contraindicated in asthmatics, USE CAUTION WITH EPINEPHRINE!
selective B-adrenergic blocking dugs
block B1 receptors more than B2 receptors, Ex: Atenolol (tenormin), metaprolol (lopressor)
Calcium Channel Blockers
Used for hypertension, arrhythmia, and angina, Ex: diltiazem (cadizem), verapamil (Isoptin), amlodipine (norvasc), felodipine (plendil)
digitalis glycosides
Digoxin- the most common type of drugs used in the treatment of congestive heart failure (CHF)
antiotension convertinf enzymes (ACE) inhibitors
Used primarily for the treatment of CHF, is now the first line therapy for CHF, also used for hypertension. Ex: Lisinopril (Prinivil, Zestril), Captopril (Capoten), Enalopril (Vasotec)
Angiotensin Receptor Blockers
used to treat congestive heart failure and hypertension, losartan (cozaar), candesartan (atacand)
Antiarrhythmic agents
Digoxin- sodium channel blockers, quinidine, lidocaine, b-blockers- propranolol, acebutolol, potassium channel blockers-bretylium, calcium channel blockers- verapamil, diltiazem
Hyperlipidemia Medications
statins- atorvastatin (lipitor), rosuvastatin (crestor),simvastatin (zocor), bile acid sequestrates, fibrates, niacin
nitroglycerin
drug of choice for acute angina, also used for prophylaxis
prophylaxis only
beta blockers and calcium channel blockers
anticoagulants
coumarin, warfarin (coumadin)-most common, the #1 drug interaction is ASPIRIN, increases bleeding tendencies, antibiotics can also penetrate the effects, dose reduction ONLY under advise of treating physician and allow several days for a change in effect, most dental procedures require no change in the dose of warfarin.
heparin
anticoagulants injected used in hospital settings or hospice only, use caution with ASPIRIN
phenytoin
the most common treatment for epilepsy, treats trigeminal neualgia and antiarrtythmic, adverse effects are gingival enlargement!!
adrenal crisis
a medical emergency that happens to people who are taking steroids 5-10mg of prednisone for longer than 2 weeks time , avoid stress, steroid supplementation may be necessary, but most dental patients will not, supplementation is based on patient anxiety and type of procedure being performed
inscription
name dose size and concentration on a prescription
subscription
the amount of drug to be dispensed (Disp:)
transcription
directions to the patient (Sig:)
the 5 major routes of drug administration
Oral Route, Rectal Route, IV route, IM Route, & Topical Route
route of administration
this affects both the onset and duration of response, onset: the time required for the drug to begin to have its effects, duration: the length of a drugs response
5 contraindications to taking aspirin
Gout, ulcers, pregnancy, children with chicken pox or flu, asthmatics, patients on other anticoagulants
salicylism
aspirin toxicity
mechanism of action of aspirin
inhibits prostaglandin synthesis by inhibiting the enzyme cyclooxygenase (COX) in the hypothalamus
pharmacologic effects of aspirin
antipyretic (fever reducer), analgesic (pain reliever), anti-inflammatory (decreases inflammation), antithrombotic (reduces blood clotting)
adverse reactions of aspirin
gastrointestinal (most common), bleeding, reye syndrome, hepatotoxicity, renal toxicity, hypersensitivity
Nonselective NSAIDS
Ibuprofen, Naproxen/ Naproxen Sodium (Aleve), pharmacologic effects the same as aspirin- antipyretic, analgesic, anti-inflammatory, anti-thrombotic
adverse reactions of NSAIDS
gastrointestinal (less than aspirin), bleeding, renal effects, and hypersensitivity reactions
contraindications for NSAIDS
Gout, Ulcers, Pregnancy, Pts. on other anticoagulants, and Pts. with hypersensitivity reactions to aspirin
cyclooxygenase II (COX) specific agents
EX: celebrex (celecoxib), Rofecoxib (Vioxx), and valdecoxib (Bextra)-Taken off the market because they caused severe side effects and death
Acetaminophen
Not related to Salicylates or NSAIDS, have antipyretic and analgesic effects ONLY!! DOC for patients on anticoagulants, with peptic ulcer disease, an ASPIRIN hypersensitivity, childen because it does not cause reye syndrome, OVERDOSE effects: hepatotoxicity or even death
colchicine, & NSAIDS
Drugs used for the acute treatment of gout
Allopurinol, & Probenecid
Drugs used for the prevention of a gout attack
the pharmacologic effects of opioid analgesics
analgesia, euphoria, sedation, antitussive effect, (dextromethorphan), antidiarrheal (lomotol, imodium)
opioid analgesics
morphine, Demerol, dilaudad, codeine- used to treat dental patientswho cannot tolerate NSAIDS or when NSAIDS are contraindicated,
mechanism of action
bind to opioid receptors in the CNS, and spinal cord, No loss of consciousness.
adverse reactions of opioid analgesics
respiratory depression- usually the cause of death with overdose, nausea and emesis- result from stimulation in the medulla, constipation and urinary retention, myosis, histamine release- stimulate release resulting in itching and urticaria, CNS effects, Cardiovascular effects, biliary tract constriction, pregnancy and nursing considerations
allergic reactions with opioid analgesics
most common allergic reaction- skin rash and uticaria, due to histamine releasing properties,
combination drugs
combining an opioid with a non-opioid analgesic produces and additive analgesic effect with fewer adverse reactions
addiction of opioids
the rate of development of addiction and tolerance is related to the strength of the opioid and the frequency of use, tolerance can develop to all of the effects of the opioids except miosis and constipation
opioid antagonists
naloxone (narcan)- DOC for treating agonist or mixed opioid overdoses, reverses opioid-induced respiratory depression, parenteral administration, Nalmefene- Parenteral administration also, Naltrexone -prevent opioid and alcohol use in addicts, orally administered , and long acting
mixed opioids
pentazocine (talwin)- the only antagonist-agonist opioid available in oral form, Dezocine, Nalbuphine, Butorphanol, Partial agonists-Buprenorphine
cidal antibiotics
Penicillin, Cephalosporins, Vancomycin, Aminoglycosides
static antibiotics
tetracyclines, aminoglycosides, erythromycin,azithromycin, clarithromycin, and clindamycin
general side effects of antibiotics
gastrointestinal- most common (nausea, vomiting, and diarrhea), suprainfections- candidiasis, drug interactions- oral contraceptives- make oral contraceptives less effective, anticoagulants- potentiate the effects of oral anticoagulants, and allergic reactions
cephalosporins
____ are contraindicated in patients allergic to penicillin's
amoxicillin
_____ is not effective against penicillinase
penecillin V
the drug of choice for dental infections
amoxicillin
DOC for antibiotic prophylaxis
fungal infections
___ ___ are common after antibiotic or steroid use, or in immunocomprimised patients
composition of local anesthetics
vasoconstrictor, antioxidant (Bisulfite), retards oxidation of epinephine, sulfur allergies- watch in asthmatics- can send into an attack, alkalinizing agent- sodium hydroxide, adjusts the pH, methylparaben and propylparaben- preservatives not in dental cartridges
common order of nerve function loss
1) Autonomic
2)Cold
3) Warmth
4) Pain
5)Touch
6)Pressure
7)Vibration
8)Proprioceptive
9)Motor
8)
1:200,000
recommended dose of epinephrine to combine with a local anesthetic is?
Acetylcholine
Mediator in the PANS