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Pharmacology (Part 2) DH Board Review

Terms in this set (70)

What is the most commonly used anesthetic in dentistry?
2% lidocaine with epinephrine 1:100,000
Lidocaine (Xylocaine)
Available in a topical and injectable
Safe in pregnancy
Medium duration: 60 minutes of pulpal anesthesia
MRD for Lidocaine
3mg/pound
Max = 500mg
Mepivacaine (Carbocaine)
Shortest duration: 30 minutes of pulpal anesthesia
Comes with vasoconstrictor or as plain
Prilocaine (Citanest)
Avoid prilocaine in patients with anemia and patients taking acetaminophen
In any patients with oxygenation problems
Medium duration: 60 minutes of pulpal anesthesia
Bupivicaine (Marcaine)
Longest duration
90+ minutes of pulpal anesthesia
Articaine (Septocaine)
4% solution
Increased risk of paresthesia, especially with mandibular block
Medium duration: 60 minutes of pulpal anesthesia
Vasoconstrictors in local anesthetic solutions
Prolong and increase the depth of anesthesia
Delay absorption, decreasing toxicity
Decreases hemorrhage
Epinephrine and levonordefrin
MRD for Epinephrine
.2 mg in a healthy pt
.04 mg in a medically compromised pt (approx. 2 cartridges)
Antianxiety drugs: Benzodiazepines
Short term treatment of anxiety and insomnia
CNS depression and sedation
Anxiety reduction and sedation
Anticonvulsant
Muscle relaxant
NOT ANALGESIC
Used in dentistry to reduce pt anxiety
Used in dentistry to treat TMJ disorders
Ex: diazepam (Valium), lorazepam (Ativan), and alprazolam (Xanax)
Nitrous Oxide/Oxygen sedation
Colorless, odorless gas used for conscious sedation and anxiety reduction
CNS is the major system affected.
Works by raising the pain threshold.
Excreted through exhalation.
Not metabolized in the body.
Overdose may cause nausea and vomiting
What color are Nitrous tanks?
Blue
What color are O2 tanks?
Green (Green trees produce oxygen)
Nitrous oxide contraindications
COPD
Upper respiratory tract infection or stuffy nose
Pregnancy (especially first trimester)
Emotional or behavioral instability
Communication barriers
Abuse potential
What can prolonged nitrous oxide lead to?
Tremors and other neurological symptoms
Spontaneous abortion/miscarriage
Numbness and tingling in the extremities
Serotonin Reuptake Inhibitors (SRIs)
Antidepressant
Cause CNS stimulation and xerostomia
Ex: Prozac (fluoxetine)
Zoloft (sertraline)
Lithium
Used to treat bipolar disorder
Drug interaction with NSAIDs
What is contraindicated with a patient is taking Lithium?
Motrin (NSAIDs)
Tricyclic antidepressants
Cause sedation and Xerostomia
Ex: Elavil (amitriptyline)
DO NOT use Epinephrine with pts taking this med.
Dilantin (phenytoin)
Anticonvulsant
Works by depressing the CNS to decrease seizures in patients with epilepsy
Gingival hyperplasia occurs in 50% of pts
Phenobarbital
Anticonvulsant
Barbiturate used in the management of epilepsy
Causes sedation
Carbamazepine (Trgretol)
Anticonvulsant
Used to treat partial seizures
May also be used in dentistry to treat trigeminal neuralgia
Diphenhydramine (Benedryl)
Antihistamine
Most commonly used to treat mild allergic reactions.
Side effects: sedation and xerostomia
Works by blocking histamine receptors in the body
What do H1 receptors cause when stimulated?
Vasodilation, bronchoconstriction, pain and itching
What do H2 receptors cause when stimulated?
Gastric acid secretion
Insulin
Used to treat Type I ("insulin-dependent" diabetes)
Administered by subcutaneous injection
Hypoglycemia is the most common side effect.
Metformin (Glucophage)
Increases the body's sensitivity to insulin
Glyburide (Micronase, Diabeta)
Stimulate the release of insulin from the b-cells of the pancreas
What diseases are treated with respiratory drugs?
Asthma
COPD
Upper respiratory tract infection
Ventolin (albuterol)
Tx Asthma
Adrenergic drug (beta-receptor agonist)
Bronchodilator (opens air passages)
Inhaler- can be used for immediate relief of bronchospasm
May cause insomnia
Corticosteroids
Reduce inflammation in the airways.
Used to treat long term to prevent asthma attacks.
Not for immediate use.
Fluticasone (Flovent)
Triamcinolone acetonide (Azmacort)
Budesonide (Pulmicort) and many others.
Advair disk
Combines a corticosteroid and a cronchodilator
Salmeterol (Serevant)
Long-acting bronchodilators
Relieve asthma symptoms for longer periods of time
Theophylline
Oral medication used to treat asthma, emphysema, and chronic bronchitis
Drug interaction: Erythromycin can cause toxicity
GI drugs are used to treat what?
Gastric Ulcers
GERD (Gastroesophageal Reflux Disease)
Sodium bicarbonate
Systemic antacid
May be contraindicated in cardiovascular patients due to sodium content
Proton-pump inhibitors
Inhibit gastric acid secretion
Used to treat gastric ulcers and GERD
Ex: Prilosec (omeprazole) and Prevacid (lansoprazole)
Histamine blocking agents
Block H2 histamine receptors, which reduces acid secretions.
Ex: Tagamet (cimetidine) and Pepcid (famotidine)
Biphosphonate Drugs
Used to treat cancer
Often administered via IV
Used to also treat osteoporosis (Fosamax)
Assoc. with osteonecrosis of the jaws
May result in impaired wound healing after surgery or other invasive tx.
This risk is much lower with oral use vs. IV
The risk remains for many years after administration
Estrogen
Estrogen is a steroid hormone
Used as a medication for contraception, menopause therapy and menstrual disturbances
What are the concerns with estrogen medications?
May increase (exacerbate) gingival inflammation.
Nausea and vomiting possible side effects
May promote endometrial cancer and breast cancer.
Examples of estrogen medications:
Premarin (conjugated estrogens)
Estraderm (estradiol transdermal)
Prednisone
Intermediate acting steroid (glucosteroid)
Tx of autoimmune and inflammatory disorders, Addison's disease and allergy
Reduces the body's inflammatory response and suppresses immunity.
Increases risk of infection and delays healing.
Patients taking prednisone may be at the risk of what?
Adrenal crisis during times of stress.
May need to take additional steroids for the appt. if they have taken 5-10mg of steroids for longer than two weeks.
Consult MD
Medications that cause gingival hyperplasia/overgrowth:
1) Dilantin (phytoin): Anticonvulsant to treat epilepsy
2) Procardia (nifedipine) and other CCBs: to tx hypertension
3) Cyclosporine: used to prevent rejection in organ transplants
Medications that cause gingival bleeding:
1) Coumadin (warfarin): anticoagulant
2) Plavix (clopidogrel): anticoagulant
3) Aspirin: analgesic and blood thinner
(Aspirin is contraindicated in patients taking Coumadin)
Medications that cause xerostomia:
1) Diuretics (water pills) to treat BP
2) CCBs to treat BP
3) Antihistamines
4) MANY others....
Nitroglycerin
Used to treat angina pectoris/chest pain
Works as a vasodilator, opening up vessels to increase blood supply to the heart
"Smooth muscle relaxant"
Administered sublingually during acute angina episdoes.
Cardiac glycosides
Used to treat Congestive heart failure
Increases the force and strength of heart contraction (positive inotropic effect)
Ex: digitalis and Lanoxin (digoxin)
Use vasoconstrictor (epi) with caution
Anticoagulant therapy
Blood thinners are used to prevent stroke and heart attack, especially after initial stroke or MI.
Reduce "intravascular clotting"
Pts taking these drugs are at an increased risk of gingival hemorrhage
Ex: Coumadin (warfarin): prevents the formation of the active form of Vit K
Aspirin increases the bleeding of patients taking Coumadin
Antibiotics may increase the effect of Coumadin
Plavix (clopidogrel)
Aspirin
Heparin- administered to hospitalized patients, administered through injection.
High Cholesterol Treatment
"antihyperlipidemics"
-statin drugs
Limit the synthesis of cholesterol in the body
Decrease triglyceride levels
Examples of medications used to treat high cholesterol:
Lipitor (atorvastatin)
Mevacor (lovastatin)
Zocor (simvastatin)
Crestor (rosuvastatin)
Hypertension treatment
Ex: Diuretics
Beta adrenergic blocking agents (-olol)
Calcium channel blockers (-dipine)
ACE inhibitors (-pril)
Diuretics
Water pills
Promote the excretion of sodium and water from the body.
Decreases fluid/blood volume and pressure
Thiazide diuretics include hydrochlorothiazide
Loop diuretics include Lasix (furosemide)
Side effects of diuretics include xerostomia and orthostatic hypotension
Beta-adrenergic blockers
-olol
Reduce BP by decreasing cardiac output
Inderal (propranolol) non-selective beta blocker
Tenormin (atenolol) selective beta blocker
Lopressor (metroprolol) selective beta blocker
Avoid epi with non-selective beta blockers
Calcium channel blockers
Reduce BP by causing systemic vasodilation
Side effects include gingival enlargement and xerostomia
Nifedipine (Procardia, Adalat)
Verapamil (Calan, Isoptin)
Amlodipine (Norvasc)
Diltiazem (Cardizem)
ACE Inhibitors
-pril
Block production of angiotensin II, resulting in vasodilation
Adverse reactions include altered taste (dysgeusia), orthostatic hypotension and dry cough
Enalapril (Vasotec) and Lisinopril (Zestril, Prinivil)
Cocaine
Cocaine is a CNS stimulant
Causes vasoconstriction and dilation of pupils
Crack-cocaine abusers often present to the office with active dental decay
Heroin
Heroin is an opioid drug causing CNS and respiratory depression
Causes sedation and "pinpoint" pupils
Methamphetamine
"meth" is a CNS stimulant
Associated with brain damage and severe oral effects.
Males aged 19-40 most commonly affected group
Abusers present with rampant caries, xerostomia, and soda consumption
Smoking/Nicotine
Nicotine replacement therapy helps to stop smoking. It supplies a low dose of nicotine without toxins found in smoke, and reduces craving for nicotine. NRT may come in the following forms: gum, inhalers, lozenges, nasal spray or skin patch.
Examples of nicotine replacement therapy:
Zyban (bupropion)
Chantix (varenicline)
When written on a prescription, "PO" is an abbreviation for?
By mouth
Narcan (Naloxone) does what?
Combines with endorphin receptors in the CNS, reversing the effects of opioid drugs.
What is Penicillin's mechanism of action?
Destroys the bacterial cell wall
What is a drug's duration?
The length of time that a drug has an effect
During an emergency, which route of drug administration will result in the fastest onset of a drug's action?
Intravenous dose (IV)
The maximum amount of epi that may be administered to a patient with cardiovascular disease is what?
.04 mg
Which organ plays the greatest role in absorption of orally-administered medications?
Small intestine
Which adverse reaction is commonly associated with opioid analgesics?
Sedation
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